Illawarra GPs are fielding calls from concerned patients after major changes to the advice around the AstraZeneca vaccine were announced on Thursday night.
Prime Minister Scott Morrison said the rollout will be urgently re-examined after the government received medical advice against using the AstraZeneca vaccine for people under 50 because of the very small risk of blood clots.
This means those younger health and aged care workers who have not yet been vaccinated will be offered the Pfizer shot.
Bulli Medical Practice is one of 17 GPs from Thirroul to Kiama - and 1000 centres nationwide - which have been approved to administer COVID-19 vaccines in Phase 1b of the national rollout.
Practice co-director Dr Julie Blaze said the rollout had been going smoothly, with around 400 patients receiving the AstraZeneca vaccine each week.
"It's challenging of course - it's a big logistical exercise to keep it efficient, to keep up with changing guidelines," she said.
"We've been well aware of the concerns about adverse reactions internationally, and have been taking that into account through our consenting process by informing patients.
"Now we have clear guidelines from ATAGI (Australian Technical Advisory Group on Immunisation) that by and large people under 50 should not get the AstraZeneca vaccine, we are following those."
The government had urgently sought the advice following evidence overseas of a link between the AstraZeneca vaccine and blood clots, with some deaths resulting. There has been one clot case in Australia, a man in his 40s.
"The risk of blood clotting is low, the Federal Government is exercising an abundance of caution, which is good," Dr Blaze said.
"However people over 50 can feel very confident to get the vaccine as long as the requirements are met. And those under 50 who've had it, and haven't experienced any rare side effects, are fine to go ahead with their second dose after three months."
Dr Blaze said any side effects usually appeared between day four to 20 after the vaccination, and anyone with serious concerns should seek prompt medical attention.
"Our staff are aware of the changing guidelines and have all the information patients need," she said. "We'll know in the next few days how this will affect existing and future bookings."
The phones at Helensburgh Respiratory Clinic and Parkes Street General Practice were busy on Friday morning too - with around 20 patients cancelling their appointment to receive the AstraZeneca vaccine.
"We started the rollout on March 24, and since that time have administered around 3000 vaccinations," Dr Cindy Htet said.
"Because we are in the 1b rollout most of those have been people aged over 70, or Aboriginal people aged over 55.
"However we have also had people with underlying medical conditions and high-risk workers under 50 who've had the vaccine.
"On Friday we did have cancellations from 15 to 20 patients aged under 50, however some with chronic conditions aged under 50 decided to go ahead as they are at high risk of complications from COVID-19."
Dr Htet said staff were working to reassure patients about the vaccine rollout in light of the changes.
"I truly believe vaccination is important - our country is very lucky to have not been as seriously impacted by COVID-19 infections as other countries like the US and UK," she said.
"In our practice, out of 3000 vaccinations, there has been no anaphylaxis or any other serious reactions to the AstraZeneca vaccine."
Meantime the change does not affect the rollout at Wollongong Hospital's vaccine hub - and at satellite locations at Shellharbour, Shoalhaven and Milton-Ulladaulla hospitals - which are administering the Pfizer vaccine to frontline workers.
The AstraZeneca vaccine doesn't require the super-cooling requirements of Pfizer, so more clinics can facilitate its use.
Explaining that the Pfizer vaccine should be preferred over AstraZenica for those under 50s, ATAGI said, "This recommendation is based on the increasing risk of severe outcomes from COVID-19 in older adults (and hence a higher benefit from vaccination) and a potentially increased risk of thrombosis with thrombocytopenia following AstraZeneca vaccine in those under 50 years".
But it said AstraZeneca can be used in adults under 50 "where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits."