WA News News & Reports National watch on adverse immunisation events
National watch on adverse immunisation events
Written by Dr Alan Leeb
Thursday, 03 August 2017

 
The first rule of medicine is to do no harm. The events of April 2010 led to the development in WA (by the author and Ian Peters with WA Health Department support) of SmartVax, a software application using SMS and smartphone technology for the active surveillance of adverse events (AEFI) following all immunisations. De-identified data is uploaded to a secure central server for analysis and monitoring.

SmartVax is fully automated, integrates with existing patient management systems, is endorsed by the RACGP and free for practices.

A national network now has over 165 sites (over 60 in WA), including general practice, immunisation clinics, Aboriginal medical centres and major hospital immunisation clinics.

The database houses over 500,000 immunisation encounters and over 700,000 individual profiles across more than 50 vaccine brands, including scheduled, private and all travel vaccines. Patient engagement is over 70%.

All medically attended AEFI are notified to the GP’s medical software inbox ensuring a record is incorporated in the electronic clinical record as well as an option of automated notification to WA Health department’s WAVVS as statutory notification.

AusVaxSafety(AVS) is a collaborative initiative led by the National Centre for Immunisation Research and Surveillance (NCIRS) and funded by the Australian Department of Health (DOH).

SmartVax sends AVS de-identified data which analyses it then reports to DOH, Therapeutic Goods Administration (TGA), GPs and, most importantly, the general public. It currently actively monitors the safety of influenza vaccine in all ages, pertussis vaccines in toddlers and young children, and zoster vaccine in adults.

NCIRS provides regular reports to the DOH, TGA, vaccine safety experts and clinicians throughout Australia. Any safety concerns are reviewed by its expert leadership group and if necessary more detailed data analysis and clinical follow-ups of patients.

AVS is the only national AEFI system of its type in the world. The findings are contributing significantly to international data.

For 2017, we can confidently report that there have been no significant safety concerns for adult and paediatric influenza vaccines and no brand variation within the first week of the program. Pertussis has been safely re-introduced to the National Immunisation Program (NIP) at 18 months, and after 12,000 encounters. We have no safety concerns around Zostavax.

The plan over the next three years is for AVS to receive and monitor all vaccines on the NIP and continue to monitor all other vaccines locally.

The ultimate goal is a nationally coordinated, near real-time AEFI system.

By Dr Alan Leeb, GP, Ballajura

Author competing interests. The author co-developed SmartVax. Questions? Contact the author This e-mail address is being protected from spambots. You need JavaScript enabled to view it

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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