ATAGI's June 2021 COVID-19 Vaccine Advice Explained: Pfizer, AstraZeneca and Second Doses
Please note: this article explains advice given in Australia in June 2021. COVID-19 vaccine recommendations have changed several times since then. AstraZeneca has not been available in Australia since 20 March 2023, when the last stock expired (MVEC). For current advice, visit the Australian Government Department of Health or speak with your doctor.
On 17 June 2021, ATAGI made Pfizer the preferred COVID-19 vaccine for everyone under 60, up from under 50. People who had already had a first AstraZeneca dose without serious side effects were told to get their second AstraZeneca dose. Pfizer access for people aged 50 to 59 opened up gradually through clinics and GPs between June and October 2021.
In mid-June 2021, Australia changed its advice on which COVID-19 vaccine people should get. Overnight, many people in their fifties who were booked in for AstraZeneca were told that Pfizer was now the better option for them. It caused real confusion.
Soon afterwards, the Department of Health in Canberra released a short video answering the three questions people were asking most. Below is a plain-English explanation of that update, with the official sources linked so you can check every detail.
What Was the New ATAGI Advice?
The Australian Technical Advisory Group on Immunisation (ATAGI) is the panel of experts that advises Australian governments on vaccination programs, including the COVID-19 rollout. On 17 June 2021 it published revised recommendations on the AstraZeneca vaccine. Here is what changed:
| Age group | Before 17 June 2021 | From 17 June 2021 |
|---|---|---|
| Under 50 | Pfizer preferred | Pfizer preferred (no change) |
| 50 to 59 | AstraZeneca | Pfizer preferred |
| 60 and over | AstraZeneca | AstraZeneca (no change) |
Eligibility did not change. Anyone who was eligible for a vaccine the day before was still eligible. The only difference was which vaccine was recommended for people aged 50 to 59.
Why Did the Advice Change?
ATAGI and the Therapeutic Goods Administration (TGA) continuously review evidence on vaccine safety and effectiveness from Australia and overseas. At the time, ATAGI was meeting every week to look at side effects reported after vaccination (see the TGA weekly safety report).
One of those side effects was thrombosis with thrombocytopenia syndrome (TTS), a very rare blood-clotting condition linked to AstraZeneca in a small number of cases. The weekly reviews showed that TTS was occurring more often among people aged 50 to 59 than first estimated. ATAGI's statement put the risk at about 2.7 cases per 100,000 first doses in that age group. Part of the reason may have been that Australian doctors had become very good at recognising and diagnosing the condition early.
COVID-19 was not spreading widely in Australia at the time. With that in mind, ATAGI decided that for people aged 50 to 59 the benefits of AstraZeneca no longer clearly outweighed this very rare risk. So Pfizer became the preferred vaccine for everyone under 60.
What If I Already Had My First AstraZeneca Dose?
This was the question that worried people most. The answer was reassuring:
- If you had your first AstraZeneca dose without serious side effects, and you had no medical reason not to continue, you should get your second AstraZeneca dose, whatever your age.
- A full course meant two doses of the same vaccine, AstraZeneca or Pfizer. These were the two vaccines approved in Australia at the time.
- Full protection only came after both doses, so people were strongly encouraged to get their second dose on time.
The new Pfizer recommendation applied to people under 60 who had not yet had their first dose. If you want to know what having the Pfizer vaccine was like, read our guide to the Pfizer COVID-19 vaccine, its side effects and aftercare.
I'm Aged 50–59. How Could I Get the Pfizer Vaccine?
The department admitted that adjusting the program would take a little time. It had published ATAGI's advice as soon as it was released so that everyone had the latest information. That meant clinics needed a few days to catch up. Access to Pfizer was planned to open up in five steps:
- Commonwealth vaccination clinics that already offered Pfizer started accepting people aged 50 to 59 from the next day.
- The vaccine eligibility checker on health.gov.au was updated over the following days to show the new eligibility.
- States and territories worked with the Commonwealth so that their own clinics could offer Pfizer to this age group.
- General practices (GPs) began offering Pfizer as well as AstraZeneca. About 1,300 practices were to start over three weeks from 5 July 2021. The rest of the more than 4,000 participating GPs were to follow by October 2021.
- Aboriginal Community Controlled Health Services began offering Pfizer too. Some could do so immediately, and the rest were expected to follow during July and early August 2021.
Practical tip from the update: if you couldn't find a Pfizer appointment, you were advised to check again a few days later. More bookings were being added as clinics switched over.
- On 17 June 2021, ATAGI made Pfizer the preferred COVID-19 vaccine for people under 60, up from under 50.
- The change followed new Australian data on TTS, a very rare clotting condition linked to AstraZeneca.
- People who had already had a first AstraZeneca dose without serious side effects were told to complete the course with AstraZeneca.
- Pfizer access for people aged 50 to 59 opened up gradually through clinics and GPs between June and October 2021.
- Vaccination was voluntary, but eligible people were encouraged to get vaccinated to protect themselves, their families and the wider community.
Frequently Asked Questions
What was the ATAGI advice in June 2021?
On 17 June 2021, ATAGI recommended the Pfizer vaccine (Comirnaty) as the preferred COVID-19 vaccine for people aged 16 to under 60. Before this, Pfizer had been preferred only for people under 50. AstraZeneca stayed available for people aged 60 and over.
Why was Pfizer recommended for people under 60?
New Australian data showed that TTS, a very rare blood-clotting condition linked to AstraZeneca, was occurring more often in people aged 50 to 59 than first estimated, about 2.7 cases per 100,000 first doses. With little COVID-19 in the community at the time, ATAGI judged Pfizer the better choice for this age group.
What does ATAGI stand for?
ATAGI stands for the Australian Technical Advisory Group on Immunisation. It is the expert group that advises the Australian Government on vaccines and immunisation programs.
What is TTS (thrombosis with thrombocytopenia syndrome)?
TTS is a very rare condition in which blood clots form together with a low platelet count. In 2021 it was linked to the AstraZeneca COVID-19 vaccine in a small number of people, and it was most often seen after the first dose.
Should I have taken a second AstraZeneca dose after a first one?
Yes, according to the June 2021 advice. People of any age who had a first AstraZeneca dose without serious side effects, and had no medical reason to avoid it, were told to complete their course with a second AstraZeneca dose.
Could I mix Pfizer and AstraZeneca doses in 2021?
Not under this advice. In June 2021, a full course meant two doses of the same vaccine. The change to prefer Pfizer applied to people under 60 who had not yet had their first dose.
How could people aged 50 to 59 book a Pfizer vaccine?
Commonwealth vaccination clinics began accepting people aged 50 to 59 the day after the announcement, and the online eligibility checker was updated over the following days. About 1,300 GPs started offering Pfizer from 5 July 2021, with the rest of the more than 4,000 participating GPs to follow by October 2021.
Is the AstraZeneca COVID-19 vaccine still used in Australia?
No. All AstraZeneca COVID-19 vaccine (Vaxzevria) stock in Australia expired on 20 March 2023, and newer vaccines are used instead.
Is this advice still current?
No. This article explains the advice from June 2021. COVID-19 vaccine recommendations have been updated many times since then, so check the Australian Department of Health website or ask your doctor for current guidance.
Sources: ATAGI statement on revised recommendations on the use of COVID-19 Vaccine AstraZeneca, 17 June 2021 · About ATAGI · TGA COVID-19 vaccine weekly safety report, 10 June 2021 · MVEC: AstraZeneca COVID-19 vaccines have now expired. Summarised from the Australian Government Department of Health's June 2021 video update. This article is for general information only and is not medical advice.
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