Morrison has finally embraced ‘informed consent’ for AstraZeneca, what took him so long to take Atagi’s advice?

For weeks, Scott Morrison has been huffing and puffing that he couldn’t defy medical advice about the safety of AstraZeneca’s Covid-19 vaccine.

Despite that black and white view, the prime minister has finally found there’s more nuance to the question – and it was there in the medical advice all along.

On 8 April, the Australian government radically overhauled the Covid-19 vaccination program after advice from its immunisation experts warning people under 50 that AstraZeneca could cause rare blood clots.

The Australian Technical Advisory Group on Immunisation’s advice was most commonly summarised as a simple warning: that people under 50 should not take AstraZeneca.

The advice never said that. It said that Pfizer “is preferred over … AstraZeneca in adults aged under 50 years”.

So much of the debate about Australia’s vaccination “strollout” has proceeded from an incorrect premise, omitting the fact Atagi gave AstraZeneca an amber – not red – light for those under 50.

Scott Morrison has blamed Atagi’s advice for setting Australia’s vaccination program back – but what if I told you Atagi had always left plenty of wriggle room for people to take whatever vaccine they wanted (after it had been approved by the Therapeutic Goods Administration)?

“Covid-19 vaccine AstraZeneca can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits,” it said.

Belatedly, Morrison has begun to sell the benefits of “informed consent” – which he summarises as meaning that nobody can force you to take a vaccine, but nor can they tell you not to take it.

Well, that was always there in the advice. Atagi said it “respects a person’s choice to make an informed decision on whether to accept the risk of Covid-19 vaccination with the AstraZeneca vaccine”.

When Morrison was still in blame-shifting mode, he suggested Atagi’s advice was based on an “assumption that the cases in Australia would remain low”. That too was incorrect.

Although Atagi’s balance of the risk and benefit of AstraZeneca was made at a time of low cases – the original advice explicitly warned low cases might not continue for ever.

“While Australia currently has very low or no community transmission of Covid-19, this could change, particularly in the context of high global transmission rates, including of new variants of the virus,” it said.

“The risk of serious disease and death in Australia remains, even as border controls and other measures continue.

“Although Australia has had few deaths from Covid-19 in young adults until now, large outbreaks in other countries have caused many thousands of deaths in young adults, indicating that the risk for serious outcomes exists across the age spectrum.”

Covid is a deadly disease – for all ages. Australia’s borders can’t protect you. It was all there.

In April, the government suggested that people under 50 would need to speak to their GPs before taking AstraZeneca. On Thursday, the Morrison government expanded access to AstraZeneca at pharmacies – prompting one journalist to question whether this was in contradiction of Atagi advice.

Answer: no, it never said that. Atagi suggested the health department “develop and refine resources for informed consent that clearly convey the benefits and risks of AstraZeneca vaccine for both immunisation providers and consumers of all ages”. But it never said informed consent could only be achieved at a GP’s office.

The fact is that Atagi left room for individuals to opt to take the first vaccine available, to choose protection now before possible future outbreaks.

The nuances of the advice were lost – perhaps because Morrison and the health minister, Greg Hunt, fronted a press conference just 15 minutes after they received it on the evening of 8 April.

It has taken the Morrison government months to grope towards solutions that allow access to a vaccine the TGA has approved for use in adults.

In late June, Morrison used a national cabinet agreement on indemnity for doctors as a pretext to revisit the AstraZeneca policy settings.

In response to a question about whether under-40s were now eligible for vaccines, Morrison replied: “If they are willing to go and speak to their doctor and have access to the AstraZeneca vaccine, they can do so. So the answer is yes, they can go and do that.”

On Thursday, we saw a further liberalising of those settings – with the move to make AstraZeneca available at pharmacies and Morrison and New South Wales health minister, Brad Hazzard, encouraging people to take it.

The TGA on Thursday reported two more deaths from blood clots after a first dose of the AstraZeneca vaccine. One was a 44-year-old man from Tasmania and the other was a 48-year-old woman from Victoria.

Since the beginning of the vaccine rollout in Australia, a total of five deaths from very rare blood clotting have been reported from 6.1m doses of AstraZeneca.

So AstraZeneca is not without risk. It may still be a difficult choice for some people to make.

Many may be more than happy to wait until greater Pfizer supplies arrive – they are due in October – particularly if they are in the at-risk group for blood clots or live away from the current hotspots.

But it is good that the settings that barred people from participation in the vaccination program based on a flawed reading of medical advice have now been overturned.

It took the Delta variant and the current greater Sydney outbreak to create the space where the medical advice could be listened to much more closely.