People with diabetes will be the next priority for COVID-19 vaccine when phase 1b of the rollout commences on 22 March to provide vaccine for people with underlying conditions.

With phase 1a having targeted frontline COVID-19 workers to receive Pfizer’s vaccine (‘Comirnaty’) through clinic hubs, the next phase, 1b,  is planned to deliver up to 15 million doses of the Oxford/AstraZeneca vaccine via GPs to groups including the elderly, Indigenous Australians, other frontline workers and people with specific medical conditions that put them at risk of COVID-19.

In its advice on priority groups for COVID-19 vaccination in Australia, the Department of Health states that the medical conditions conferring risk include people who have diabetes. Other conditions listed include  chronic renal failure, heart disease (coronary heart disease or failure), severe obesity with a BMI ≥ 40 kg/m2, and poorly controlled blood pressure

The vaccination priority list also includes people with conditions such as cancer, chronic lung disease and immunodeficiency or immunosuppression.

People with underlying conditions will need to provide proof of them to demonstrate their eligibility for vaccination via MyHealth record, a health professional referral if required or a declaration form.

In phase 1b, the Oxford/AstraZeneca vaccine will be made available through GPs and Aboriginal Community Controlled Health Services. The government’s COVID-19 information site says that patients will not be able to choose which vaccine they receive and that “specific vaccines will be administered based on availability and subject to any determination made by the TGA.”

In a Diabetes Australia webinar on COVID-19 vaccination, Associate Professor Neale Cohen, Head of Diabetes Clinical Research at the Baker Heart and Diabetes Institute, Melbourne, said most people with diabetes appeared to be included in the phase 1b rollout, though the details were sketchy.

He noted that the AstraZeneca vaccine was only approved for use in people over the age of 18, and therefore would not be. available for use in children with type 1 diabetes.

“I think the evidence is that children don’t seem to get too sick with this anyway, and at the moment they are not approved for that use,” he said.

Associate Professor Cohen added that the verification of diabetes status should be available to the GPs delivering the vaccine from their records, and there would likely be no need for special letters to confirm the status.

Meanwhile, some immunisation experts have suggested that people with underlying medical conditions should be targeted for the Pfizer vaccine because of its higher efficacy over the AstraZeneca vaccine.

Speaking at a Senate public hearing on the rollout of the COVID-19 vaccine on 2 March, Professor Raina MacIntyre of the University of NSW Global Biosecurity Program said she thought that people in group 1b should be getting Pfizer as well, because there was a high proportion of immunosuppressed people in this category.

“I know the oncology society, the haematologists, the clinicians and the specialist societies that look after immunosuppressed patients are concerned because their patients are more at risk of infection and more at risk of severe complications.

Professor Robert Booy, a paediatrician and former Head of Clinical Research at the National Centre for Immunisation Research and Surveillance (NCIRS) at Westmead, NSW, said he agreed, and there should be no logistical problem with delivering Pfizer vaccine via GP practices.

“I also think 1b people could benefit greatly,” he said.

“I’ve had people writing to me from that group, and I’ve said, ‘Well, I don’t know.’ But I think it also needs to be understood that the Pfizer vaccine, although coming in freezers at minus 17, can, once it’s defrosted, sit for five days in a fridge which is monitored before it’s reconstituted at two degrees. So GPs could manage that and they could be very involved in the rollout of Pfizer vaccines.