Press Conference - Australian Parliament House, ACT

Transcript
08 Apr 2021
Prime Minister
E&OE

PRIME MINISTER: Good evening. I’m joined by the Health Minister. Of course, I'm joined by the Chief Medical Officer  and the Secretary of the Department of Health. Australia's journey through COVID has been certainly one of the world's best and there's no place you'd rather be. We've had our successes over the course of the last year, but we've also had our setbacks, and we've indeed had our heartbreaks as well, as so many Australians can attest. Throughout this journey, though, we have always sought to keep Australians as informed as we possibly can. I can recall standing in this room a year ago taking you all through many different issues as a result of the matters being worked through by our medical advice experts who have informed us all the way through this past year and more.

Tonight, we have received advice from ATAGI in the last 15 minutes and we thought it was important that we came and briefed you on that this evening so it was available immediately to Australians. The key principle of our management of the COVID-19 pandemic has been always to base our decisions on the expert medical advice. It has not been our practice to jump at shadows. It has not been our practice to take unnecessary precautions. We've been taking the necessary precautions, based on the best possible medical advice. We've always taken the time to ensure we get that advice, consider it carefully and make decisions in the best interests of Australians. And those best interests principally have to address the health of Australians. This is why we are in the position we are in today, and so many other countries would want to be exactly where Australia is today. And it means that when setbacks occur, then we can still go about our lives here in Australia, perhaps not as much as we may have before when COVID wasn't in this country. But even now to say it's in this country would be an overstatement. We have no community transmission currently being reported around Australia and where outbreaks do occur as a result of arrivals into Australia, we've demonstrated a great capacity to be able to deal with that in a very effective way.

The Australian Technical Advisory Group on Immunisation, known as ATAGI, has met to consider the medical evidence regarding unforeseen but yet rare and serious side effects, mostly associated with younger people from the AstraZeneca vaccine. ATAGI has reviewed that matter, drawing on the international advice and data and provided recommendations to government, which the Health Minister and I have this evening accepted. That recommends that an advisory be provided for administration of the AstraZeneca vaccine for persons under the age of 50 and I'll ask the Chief Medical Officer to speak to that in just a moment's time.

We expect that this will require some changes to the arrangements we have as part of the vaccination rollout. We discussed that this morning at my media conference earlier today, that that could be possible and this includes when we might expect our first doses ultimately to be able to be offered to all Australians. As always, we will encourage Australians to seek out the advice of their own doctor in relation to these issues. Australians make choices about their own health and the best people to advise them on those decisions is their own GP and we would encourage them to do just that. So with that, I might ask the Chief Medical Officer to speak to the recommendations we've received from ATAGI this evening. I’ll then ask Professor Murphy to speak on the issues that then relate to the vaccination rollout. And then I'll ask the Health Minister to make some closing comments and then we'll take questions on these issues tonight. I'm not proposing that we have a broader press conference on other matters tonight, I'm sure you will understand. We had one of those this morning and I'll be standing up after the National Cabinet tomorrow. So there'll be ample opportunity at that time. Paul?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: Thanks, PM. So as the Prime Minister has mentioned, we've received advice from the ATAGI group this evening. So this is a group of experts on vaccines, on epidemiology related to vaccines, on vaccination programmes. And really are- they’re an appointed committee to do exactly what they've provided tonight, to provide advice to government, specifically to Minister Hunt, and so that those decisions of government can be advised by the best medical advice. I was at their meeting today, which went for several hours. That was the second one in two days where they were considering specifically the issues that have been raised and people are aware of through last night and over the last week, particularly in Europe and the UK. Several members of that ATAGI group, as well as the Therapeutic Goods Administration, have dialled into those meetings. And so they had very up to date information on this issue of these particularly rare but serious blood clots that have been associated now with the AstraZeneca vaccine. So they took into account and really balanced the risk and benefit of taking the decisions they took today, which is related to their advice, given to government this evening. And so they took definitely note what was decided in other countries, which has been variable in relation to these matters, and put that into an Australian context, not only as we are now in terms of the epidemiology of the disease in Australia up to this point, but also looking into the future about what might happen if there are outbreaks of COVID-19 in Australia.

So just to reiterate, this is a very rare event at the moment. It seems to be around four to six per million doses of vaccine. It's only been found in the first dose of the AstraZeneca vaccine, usually within four to 10 days after that vaccine. But it is serious and it can cause up to 25 per cent death rate when it occurs. So that was the background and so the ATAGI recommendations are the following. At the current time, the use of the Pfizer vaccine is preferred over the AstraZeneca vaccine in adults aged less than 50 years who have not already received the first dose of AstraZeneca vaccine. This is based both on the increased risk of complications from COVID-19 with increasing age and thus increased benefit of the vaccination and the potentially lower but not zero risk of this rare event with increasing age. The second recommendation is that immunisation providers should only give a first dose of AstraZeneca COVID-19 vaccine to adults under 50 years of age where benefit clearly outweighs the risk for that individual’s circumstances. The third recommendation is people that have had their first dose of the COVID-19 AstraZeneca without any serious adverse events can safely be given their second dose. This includes adults under the age of 50 and people who have had blood clots associated with low platelet levels after their first dose of COVID-19, AstraZeneca should not be given a second dose. So that's the all but one person that we've had so far in Australia are in that category. People who have had their first dose should safely have their second dose. The final recommendation is that the Department of Health further develop and find resources for informed consent that clearly convey the benefits and the risks of the AstraZeneca vaccine for both immunisation providers and consumers of all ages. And that is underway, that work, and that will be provided overnight and into the morning.

PRIME MINISTER: Thank you. Professor Murphy?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: Thank you. So I want to start by just reiterating what Professor Kelly said, that this is a very, very rare event and it is a highly precautionary position that Australia can take because we're in a fortunate position with COVID. All vaccines have adverse effects. Some serious flu vaccines do, the Pfizer vaccine has a risk of anaphylaxis, which we've seen. But this syndrome, after all of the work we've done with the UK and Europe, does seem to be a real syndrome and we now feel that at an abundance of caution, given that this syndrome seems to occur mainly in younger people for whom the risk of severe COVID is not so great, that there is a basis to have a preferred recommendation for those under 50. I want to reiterate that we are strongly encouraging those 50 and over to take up the AstraZeneca vaccine. It is a highly effective vaccine at preventing severe COVID. The risk is extraordinarily low. I've had my first dose, I'll have my second dose. It is a vaccine that is very, very effective. And so this is a position that we're in that we feel out of an abundance of precaution on the evidence we have at the moment.

So what does this mean for the programme. For phase 1, which is for the vulnerable people, will pretty much continue as we are. Those over 70 and 80 will continue to get AstraZeneca at their GPs and be confident in its efficacy and its safety. For those health care workers under 50, they will now be prioritised to Pfizer and that might delay that particular phase of 1B, but that's the only phase that might be delayed. The important thing is that all, all of the vulnerable people, those vulnerable to severe COVID, will be covered as we planned by the middle of the year. Clearly, when we move into the broader younger population later on, we will have to recalibrate by reprioritising some Pfizer for younger people. And we are now reviewing all of the vaccine purchases we've made. You know, we have 51 million Novavax coming later in the year. We're looking at when we can bring other vaccines forward and continuing under the advice of the committee I chair to look at all of our vaccine portfolio. We always had a diverse and redundant portfolio and we will look forward, but we will have to replan the prioritisation of the programme, replan with the states and territories who are our partners in this endeavour, how we will deliver vaccines and we'll have to come back at a later stage with better estimates on when things in each phase will be completed. So thank you.

PRIME MINISTER: Thanks, Brendan. Greg?

THE HON. GREG HUNT MP, MINISTER FOR HEALTH AND AGED CARE: Thanks very much, Prime Minister. Right from the outset, our approach has been to focus on safety. The decisions, based on medical advice, whether it was with regards to what we've done in relation to closing the borders with China. The very difficult decision, but nevertheless the very clear decision not to proceed with the University of Queensland molecular clamp, a safe and effective vaccine under all the preliminary advice but which, of course, carried with it a side effect in terms of a false positive HIV marker, which was not deemed to be medically acceptable within Australia. Similarly, today, again, we're following the medical advice. We’re placing safety first. But what we've heard from Professor Murphy, what we've heard from Professor Kelly, two of the people at the heart of the medical advice to Australia, is that this remains a highly effective vaccine, safe for over 50s on the advice that we've received. And again, like Brendan, one of those that's had the vaccine, and I'll be lining up for my second dose when my turn comes around.

What is the context here? Of course, as the Prime Minister said at this moment, no community transmission in Australia with zero cases again today for the 58th day this year against a world of over 668,000 cases and 15,000 lives lost in the last 24 hours. Against that background, the advice that we received was to procure a broad-based vaccine programme, which we've done, and that was initially four vaccines across three different classes, mRNA, which had never been produced before, Pfizer, the AstraZeneca as a viral vector vaccine, the Novavax as a protein vaccine, and the molecular clamp. We already have 20 million Pfizer which are due this year, reconfirmed with the head of Pfizer Australia today. We have the AstraZeneca, which of course is available for all of those over 50 years of age. We have Novavax, 51 million units. The latest advice is that that is expected to commence, confirmed today, that this remains their intention and their projection subject to clinical trials and approvals within the third quarter for Australia and we also have access to the COVAX facility. And of course, where the committee that Professor Murphy chairs recommends additional acquisitions, we will seek those, but we won't preempt them publicly. I think that's what we need from me. We have a strong, clear vaccine programme that will have passed a million people during the course of today and will continue particularly in that over 50, which will be unaffected. The over 50 components right through the heart of phase 1B and right through the heart of phase 2A.

JOURNALIST: There are going to be lots of people in phase 1B, people under the age of 50, healthcare workers, people with disabilities, people with health conditions. How are we going to get them vaccinated if we’re only getting about 140,000 doses of Pfizer a week?

PRIME MINISTER: I’ll ask Brendan to come forward, and as he does that I’ll make this point that we have tasked now have overnight and through the course of tomorrow and over the weekend, there will be a recalibration of how the programme will need to be adjusted to take into account the decision the Government has taken tonight to accept those recommendations from ATAGI. As the Minister has just said, there are, of course, Pfizer vaccines that are in Australia and we are getting a regular supply of those and they can be prioritised against the individuals for whom that will be the more appropriate vaccine for them. But we just have to work through the logistics of that and the calibration of how that is done and that will be our task now. So we'll do that in an orderly way. Tomorrow, I'll meet with National Cabinet. I alerted them earlier today, as I had last week, about these issues, and so we'll update them on those issues tomorrow and I'm sure they will raise questions and that we can take that on as we recalibrate the programme in the days ahead. But Brendan?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: So obviously, Pfizer have committed to 20 million doses this year and we are working with them almost on a daily basis to see when they can increase their supply and we are confident that at some stage in the near future we will get improved supply of Pfizer. The other important parameter is we will finish aged care in a number of weeks’ time and that will free up the Pfizer that has been going into aged care and all of that Pfizer will go to those under 50s, particularly in the 1B priority groups. Important to remember, though, that we don't have community transmission. These health care workers are not at significant risk if it means they wait a few more weeks to get their vaccine.

JOURNALIST: Can I ask about, you say it’s an abundance of caution. But it seems to be extraordinarily cautious because the numbers that Paul Kelly gave before were 4-6 per million, which is pretty much what you said today, Prime Minister. But we have allowed for decades millions of Australian women to take contraceptive pills, which has, in effect, a thousand times more risk than this. And yet you're abandoning for all intents and purposes some generations getting this vaccine, which by any reckoning of recent medicine is deemed safe.

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: So I would just point to the expert advice that we've got from ATAGI and chaired by Professor Allen Cheng. They've really weighed up all of those things. They've looked at the fact that we do have an alternative in terms of Pfizer right now. And as Brendan has said, other vaccines will be made available later this year. It is a very cautious approach...

JOURNALIST: Very, very cautious, isn’t it? I mean, it’s more than abundance of caution. This is more caution than you would see in any pharmaceutical, I'd say, in recent decades.

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: Yes, but this is what has happened in other countries as well. And this is the advice that we've received and as the PM has said, that's the advice that has been
taken on.

JOURNALIST: Prime Minister, are you disappointed at this? This challenges the logic that you presented in recent hours?

PRIME MINISTER: Well no, I don't know if I'd share that view. What I said is that we would seek the medical expert advice, and that is ATAGI. That's what they're there for. They are considering the situation here in Australia. Those in other jurisdictions are in different situations to Australia. In other countries right now, the death rate is appalling and the risk of not proceeding is very great. As I said this morning, some 6,000 lives saved in the UK because their situation is far more desperate.

But I want to draw you, to answer your question, to recommendation 2, which says that the immunisation providers should only give a first dose of AstraZeneca vaccine to adults aged under 50, where the benefit clearly outweighs the risk for that individual’s circumstances. And so ultimately here, the choice is with individual Australians and their doctor and that would be the case for the other treatments and vaccines that are out there currently. This advice is provided into the medical community, and then it's important to have that discussion with your local doctor. And so Greg, well, he's not quite under 50 anymore, but not too far past it. But the point is, we chose to predominantly deliver the vaccine on the advice of Professor Murphy's committee. And to do it through the GPs because that's where primary health care can be provided and you can have that discussion with your doctor and make an informed decision about your own health.

So the advice here today is not to not have the AstraZeneca vaccine. There is not a prohibition on the use of the AstraZeneca vaccine for persons under 50. There is an expression of a preference. And you're very right, Andrew, Australians will look at that risk. They will ask their doctor about that risk. Their doctor will know their own personal health circumstances and can answer any questions that they might have and for the benefit of they may feel quite, quite strongly that they would be better off having that vaccine, given the risks are clearly understood. So this is not a directive. This is not an instruction. This is advice that has been provided to Australians and the broader medical community who are responsible for administering these vaccines. But you're right, it is an abundance of caution and it's a caution that has been exercised consistent with many other countries around the world and we would expect to see that also continue in other countries now making similar decisions. And why we're here tonight is just to be very upfront with Australians, so Australians can know that they're getting all the information that we have and they can feel informed about the decisions they make about their own health and we want to empower them in those decisions.

JOURNALIST: Prime Minister, despite the advice…

PRIME MINISTER: I'm going to go around the room tonight and just take one at a time.

JOURNALIST: Despite the advice that it's just a precaution, why would anyone now risk giving their elderly relatives the AstraZeneca vaccine, given we don’t have the virus here, we don’t have community transmission. Would it be preferred to perhaps wait for the Pfizer vaccine and is there now a need to speed up the delivery to give people over the age of 50 Pfizer rather than AstraZeneca?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: So the advice as I said from the beginning is based on the evidence that we have so far. And we must say that this is very preliminary evidence. There are very few cases of this extremely rare event that have happened anywhere in the world. But the ones we've seen, there's definitely a tendency for it to be in younger people and we're still working out what the mechanism might be for why this is occurring. But it's most likely to be, seems to be related to an immune reaction, probably to the adenovirus of the AstraZeneca vaccine. So younger people have, we know, have a more robust immune system and are likely to have this sort of reaction. So the 50 cut off is based on what we've seen from these events so far, more common in younger people, less common in older people. We know older people are at higher risk of COVID and COVID could come. You know, we could get outbreaks. We've had incursions from hotel quarantine in recent weeks. So it's very important that those people in those priority groups are vaccinated as quickly as possible and AstraZeneca is perfectly safe in people in those older age groups.

PRIME MINISTER: And that goes to the point that the health advice is that the AstraZeneca vaccine for persons aged over 50 is well advised because their risk, should there be an outbreak of COVID-19, they would be very exposed to that risk. They are the most vulnerable group in the country. And so it's important for them to be vaccinated because the vaccine protects against very serious illness. And we have seen in the more than 900 deaths that we've had in Australia, they have predominantly been with older Australians. And so that would mean that the health advice would encourage them taking that vaccine to protect them from what is a global pandemic. We've done very well during the pandemic, but when we're not immune from these uncertainties and then taking the precautions that are necessary when we need to.

JOURNALIST: Prime Minister, what impact is this expected to have on the uptake of AstraZeneca? And was that a consideration tonight, the chance that you can scare too many people from taking AstraZeneca by taking this very cautious approach?

PRIME MINISTER: Well, let me answer the first one. I'll let Paul deal with what was considered within ATAGI. Our purpose here is to reassure Australians, to reassure them that we've been very clear about what the very low level of risk is here. But it is rare, but a serious risk for those who can find themselves in that situation. I'd also note that it was unforeseen. I mean, these are not things that are presented in the trials or other phases, as I understand it, when the AstraZeneca vaccine was going through that process, either here or overseas. You'll recall that the Health Minister and I were very adamant that the process for approving the AstraZeneca vaccine, indeed, all of the vaccines that are being used here in Australia would go through every single process required of our TGA, and it did. No corners cut out, no process not followed. And so in standing here tonight, I'm saying to Australians that we've been very upfront with you. There is this issue. It is an issue of, I'd say, low, low risk in terms of its incidence. So four to six out of a million, that is a very low incidence. But it would not be appropriate, it would not be the right thing to do to not share that information with Australians. So we are doing that. And I would hope that that would provide a reassurance about the way that the Government is seeking to inform people about the programme. Paul, on the issues that we considered and impacts on vaccine resistance?

PROFESSOR PAUL KELLY: So vaccine confidence is absolutely crucial. We understand that. But I would echo the PM's comments there that one of the most important things, we know this from many years of working in vaccines and vaccine confidence, is about sharing information and being upfront with that information is a key component of that. People should have trust in this programme because this new signal, which has come from the many millions of doses that have happened, particularly in Europe and the UK, and those rare events have started to come out that were not found in the clinical trials. We've taken very rapid decisions to look at that data carefully and to make the decision that has been made today and the advice has come from medical experts on that basis. We are sharing that with the Australian public so that they can be aware and know that if we ever get that information, we will immediately and fully be transparent about it.

PRIME MINISTER: I'm moving all around. So I'll get to you, I promise.

JOURNALIST: Can I ask you about CSL and Novavax? How will or how will this affect I guess the production of AstraZeneca from CSL? Will they still  be asked to make the 50 million doses? I know there was some talk a while ago about CSL potentially making Novavax as well, I think you said a few weeks ago, professor, that you said we're expecting that in October or September. Will we see CSL produce Novavax?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: All options are on the table. Clearly, CSL, we still have a big need for AstraZeneca. It is going to be a really important vaccine to vaccinate a significant proportion of the population. So they will continue to make AstraZeneca. We will be reviewing with them over coming months just what the output will be. They can't make another vaccine while they're making AstraZeneca. They made that very clear. We will explore with Novavax if there are any options to manufacture onshore. But most importantly, we are working with Novavax to get their promised deliveries as early as possible. As Minister Hunt said, they are talking about getting some deliveries to us in quarter three and we will continue to explore with every vaccine company, according to the advice of the SITAG Committee. So all options are on the table.

PRIME MINISTER: So in short, yes. Greg?

THE HON. GREG HUNT MP, MINISTER FOR HEALTH AND AGED CARE: And I might just add, I spoke earlier today with the global vice president of Novavax. They remain on track on their advice to us for a likely delivery in the third quarter, commencing then and proceeding from then on. The advice that they have on their published results, albeit early stage, are 100 per cent effectiveness with regards to prevention of serious illness, hospitalisation or loss of life.

JOURNALIST: Just a follow up on the vaccine, I think the last time I remember hearing about Novavax, I think they were still quite early in the process of applying with the TGA and that sort of thing, are they where are they at now in terms of the application?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: Well advanced. It's a progressive process. They're providing data as they come. Obviously, final approval will probably await the publication of the main phase three trial in the US, but they are progressively providing information to the TGA and that's progressing.

JOURNALIST: Professor Murphy, can I just clarify,  the equal aged 50 to 70, when were their vaccinations due to start and are they still starting on those dates and on the point the Prime Minister made about the reliance on one’s individual doctor, obviously, the doctor knows patient’s health state, but he or she doesn't necessarily know much about the vaccines and as we see in you experts getting changing information. So I just wonder how much people can really rely on that information?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: So we are providing information to the doctors. That's really important. We're providing preliminary information tonight and we'll be providing information as we have done right through the GP vaccination programme. Comprehensive information, informed consent, patient information sheets.

JOURNALIST: All doctors, instantly?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: Preliminary information tonight will go out to all of our vaccination providers and we'll provide new information over coming days. In terms of the general population aged 50 to 70, they’re planned to come in phase two.

JOURNALIST: Which starts…

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: Which starts when we've finished most of phase one, around the middle of the year. And for those with AstraZeneca, we'll have plenty of AstraZeneca.

JOURNALIST: Still on track though, that timetable?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: We intend to start them at that time.

PRIME MINISTER: I'd also stress, Michelle, that with vaccines, normally this is what happens. This is not a new process. From time to time., if there are issues with vaccines that occur and ATAGI consider matters on other medicines or vaccines, then this is the same process and GPs and doctors are familiar with that. So they would get their alerts, they would get their information or that is what would normally happen. And so that is a process they're familiar with. And that's the process we will be following on this occasion as well.

THE HON. GREG HUNT MP, MINISTER FOR HEALTH AND AGED CARE: I think it is worth understanding with our flu vaccines. We have some flu vaccines for under 65s and some flu vaccines over 65s. So the notion of an age cut-off is actually something which is already part of our current operating vaccine programme. So that's not a new concept, but it's an evolution with this particular vaccine based on the advice.

JOURNALIST: Can you just clarify what this means for the timeline for the wider rollout. And just on targets like these, is a setback like this give you reason to reconsider even setting targets in terms of how many doses are being devices or just the uncertainty around this entire process just makes it impossible to know how to say that we will do this by this point?

PRIME MINISTER: Well, in terms of what the overall implications are at this stage, it's too early to give you that answer. And that's what I said in my opening comments. I mean, this now has to be considered, the impacts assessed and the programme evaluated and recalibrated. And once we've done that we’ll be in a better position to understand those implications. The early stage implications of this, though, are far less significant because of the nature of who we're vaccinating right now. I can tell you that at Parkville in Melbourne, they'll be cranking out AstraZeneca just as quickly as they were over the last few weeks. And that will continue. The distribution will continue. And we'll be discussing that also at National Cabinet tomorrow. So the early stage impacts with the groups that we're vaccinating at the moment, we would expect to see less change, obviously, for those who are under 50, who are frontline health workers or quarantine workers. But majority of those will be vaccinated already, then those who are working in aged care or disability care, there will be implications there. And so we will have to look at how you read reapportioned where Pfizer goes and makes it available to those groups.

On the broader question that you've raised about seeking to provide some guidance as to how we think things are going to play out. These are questions that I'm asked as all the others who are joining me on this platform this evening by the media and not just the media, but states and territories and others on a daily basis. I think Australians reasonably want to know how they think things are going to proceed in the weeks and months ahead. But you're right to highlight that, as I did this morning, that the environment in which COVID is existent is not a certain one. There are many uncertainties. There are many, many variables. And when we have indicated these types of marks, we have always qualified them by saying that is subject to the events that may occur. And so I think it's important that when we provide that sort of guidance that the appropriate reporting of the qualifications is noted because things do change. This is not a certain world and we're not on our own. The whole world is dealing with the same uncertainty. The whole world has gone through a process of relying on expert medical advice to define those vaccines that they would seek to contract and have available to their populations. And Australia has made some very sound decisions on that front. And we have access to vaccines that many countries don't. But we also have additional options now to pursue and we will be pursuing those. But the overall impact of this on the timetable of the rollout, it is far too early. As I said, we received this advice formally at seven o'clock this evening. Brendan, anything you want to add to that?

PROFESSOR BRENDAN MURPHY, SECRETARY OF THE DEPARTMENT OF HEALTH: No, I think that's absolutely right Prime Minister. We will be working with our partners in the states and territories as we have been. It's been a very strong partnership the whole way through working on the recalibration of the programme and working with vaccines suppliers as we've already said, and we will be able to provide further updates in coming weeks.

JOURNALIST: I appreciate- just on that question. I appreciate that uncertainty but does that also include your October deadline to have at least one job for every Australian by that point is that part of- you do have to rethink around things like lockdowns and international border closures because of this and probably risk of sending people to the doctor Google, Professor Kelly. Is there any research being done around giving people blood thinners like aspirin to address the issue of clotting with AstraZeneca?

PRIME MINISTER: Why don't you start with that? 

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: I'll just do the easy question. So, look, this is a very new syndrome, as Professor Murphy mentioned. This is a brand new thing. It's only been demonstrated in the world over the last few weeks. There's lots of research going on about what the mechanism is to why it's why it's occurred. It's something similar to a particular type of blood thinner, actually, heparin, which can cause a similar syndrome, but it's different to that. So we have some ideas of the mechanisms, but we need to really understand that before we know what to do. There are treatments, in fact, to follow on from what the question about the advice to general practitioners and others. The Haematology Society of Australia has been very helpful and rapid in their advice about what to do on the basis if someone is diagnosed with this type of disease. But in terms of actual prevention, there's nothing it seems that it comes virtually spontaneously. It can't be predicted because of what people have had in the past, particular diseases. The only only one thing is if it's if you had this with the first AstraZeneca vaccine, you don't have the second.

PRIME MINISTER: And in relation to the other matter, that is exactly what I was referring to about the uncertainty and that's why we will have to look at the impact of this on that broader rollout. I think that's fairly obvious and fairly understandable. That was what I was referring to in my opening comments. So we will look at that. And in terms of the impact on other issues, well, of course, the vaccine rollout provides more opportunity, I think, to be surer to reduce further the risk that can encourage states and territories in terms of how they're managing restrictions. Now, right now, when it comes to community transmission, we're in a good place. But as we know from experience, that can change quite quickly. But what we've also seen is a rather quick responses. Restrictions have come on quickly, but they've gone off quickly, too. And I'm seeing a growing confidence from the states and territories, which I welcome and have long encouraged to move quickly on these things, as Northern Territory has done actually for a very long time, moved quickly on, moved quickly off on a hot spot basis. And same applies with how we are managing things across the ditch now with New Zealand and we're working on it on a very similar basis. So I don't expect to see that. I mean, the fundamental protections we have in place in Australia at the moment with how we've been suppressing COVID have been very important. And Australians are living life here very different to how people are in other countries. And that means, you know, a setback like this, an event like this does not have the impact that it is having it in those other countries, both to risk to life and risk of serious disease, but also risk that it means for the economy. And so we need to stay on our game when it comes to suppressing the virus. And we need to stay on our game and continuing to roll the safe and effective vaccines out to the population.

JOURNALIST: Will all Australians get at least one jab by the end of this year? And if we were to see another Melbourne-style, Victorian-style outbreak, would you change your advice to encourage young people to get vaccinated?

PRIME MINISTER: Well, I've already answered the first question on several occasions, so I don't propose to do that again.

JOURNALIST: Do you have a rough time?

PRIME MINISTER: No, we don't. No, we don't. Because as I said, we've learnt this at seven o'clock this evening and I think we have to take the time to assess the implications for the programme. And when we've done that, well, we may be able to form a view, but I don't think anyone should expect that any time soon. This will take some time to work through the implications. But it won't stop the work that we're doing in rolling out the vaccination programme right now with the doses that we have, particularly from Pfizer, but also rolling out from AstraZeneca, which are predominantly for older Australians above 50 in phases 1A and 1B. But the other question was?

JOURNALIST: If we were to see another big outbreak, say like Victoria, would you change your advice to younger people about AstraZeneca?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: So the ATAGI advice that I read directly from earlier also addresses exactly that point, and it makes the point that the advice is based on the situation at the moment, but that risk and benefit equation can, with increased risk, change. And so the benefit of having vaccination rapidly and that sort of situation could change that advice. So, yes, this is the advice as of today, things may change in the future if the epidemiology of the disease changes in Australia as well as other matters. But that one in particular was looked at.

JOURNALIST: Just to clarify, Professor Kelly, just in terms of this blood clotting, have we only got one instance, the 44 year old chap in Melbourne, and we are sharing everything that ATAGI shared with you? Or is there some other concern, broader concern, that’s come from state departments scouring their records of people who been vaccinated?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: Andrew, I've been completely transparent tonight, as we all have. So the advice...

JOURNALIST: It’s one in a million, isn’t it?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: Well, I don't think that we've got quite to a million in terms of AstraZeneca. It's a million doses including the Pfizer vaccine. But, yes, so far, we've only seen that one case. That's the only one that we've had and that was subject to a specific response by the TGA, and they think that it fits into this general syndrome.

PRIME MINISTER: I'm going to take two more. One here, one there. I'm sorry, then we'll have to go.

JOURNALIST: How many people actually had the AstraZeneca shot here in Australia? And is there any general health advice that they should be considering right now, people out there who have already got one of these shots? Is there anything they should be worried about, should they take any precautions or anything like that?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: I don't have the number of the exact AstraZeneca, sorry, I can provide that. We do know that that is rolling out now, and it's been rolling out to many people. I think the advice that we should say is that people who have had it over two weeks ago, they shouldn't be worried at all. Others should be watching out for the specific symptoms and that'll be part of our advice we'll be giving to GPs, they should talk to their general practitioner about those matters.

JOURNALIST: Prime Minister, where are our Pfizer doses coming from? It’s not Europe is it? Could they face more export blocks?

PRIME MINISTER: Greg?

THE HON. GREG HUNT MP, MINISTER FOR HEALTH AND AGED CARE: So we don't identify, for security reasons, the specific source. Shall we say that we've been very heartened by the continuity, the reliability, of Pfizer so far. I would add, on a general point, Europe has often said that they do not have a dispute with exporting vaccines, they have a specific dispute with AstraZeneca. I think that is very important to understand. So we're very confident in the continuity of our supply from Pfizer, and that's been reaffirmed to me today by the Australian CEO of Pfizer, Anne Harris, and they remain on track not just with their week to week deliveries, but the delivery of the full 20 million doses during the course of 2021.

PRIME MINISTER: Let me finish with just some, we will have passed the millionth dose being administered today. At the end of 24 hours ago, at the end of Wednesday, we had 996,214 doses having been administered, and 75,880 on that day. 361,083 had been administered through that primary care network. And of that 75,880, more than half of those were being done through the GPs. So you can see that that GP network is now becoming the dominant form through which doses are being administered. And 125,260 doses had been provided to the aged and disability services for the residents of that part of that programme. So thank you all very much.