Dear Dr Tim Smith

I’m writing with a question I’ve been thinking about deeply, and I hope you don’t mind me reaching out directly.

As a long-time patient, I’ve always valued your measured, thoughtful approach to healthcare and the trust we share in managing my health. Today, I write not with a medical issue but with a sincere question about a shift in public health policy that’s left me curious - and a little concerned.

As someone who has quietly held some reservations about the broad ‘safe and effective’ claims, I’m concerned that The Therapeutic Goods Administration (TGA), guided by ATAGI, has recently recommended that COVID-19 vaccines are no longer offered routinely to healthy individuals under 18. The rationale, strikingly, is that the “benefits of vaccination are not considered to outweigh the potential harms" - a notable departure from the “safe and effective” messaging we’ve heard consistently over the past few years.

Strangely, this announcement has barely made a ripple in the media, nor has it drawn much commentary from professional associations like the Australian Medical Association. This silence, amid such a significant pivot, raises two questions I’d be grateful to explore with you - perhaps during our next visit.

1. Why now, and why so plainly?
Apart from the earlier withdrawal of AstraZeneca due to rare clotting concerns (which was framed more as a supply issue than a safety one), this is among the first times authorities have publicly acknowledged a clear risk-benefit threshold.

Why the more direct language this time, instead of an “insufficient demand” explanation like AstraZeneca received? What changed in the evaluation or strategy?

2. Where does the risk line truly fall?
The age-based cut-off - under 18 - feels biologically arbitrary. Is there really a sharp and sudden shift in risk-benefit on one’s 18th birthday? (something I find genuinely puzzling). Or might similar concerns apply to adults in adjacent age groups? It leads me to wonder whether this new guidance is the beginning of a broader reassessment.

If I may, I’d also appreciate your perspective on a few related points:

• Has any new guidance emerged on potential side effects - such as myocarditis - in older populations?
  
• For those who’ve already received the vaccine, especially younger patients, is there a follow-up protocol or safety net to monitor or mitigate potential long-term effects?

I fully appreciate that these are complex, nuanced matters - and that speaking candidly hasn’t always been easy for medical professionals during the pandemic.

My intention is not to challenge, but to understand. And I believe thoughtful, open discussions like this are essential - not just for peace of mind, but for informed, balanced decision-making in future care.

I would be very interested to hear your thoughts on these points at your convenience, perhaps during my next appointment.

Thank you for your ongoing care, and for your time and consideration of my queries.

Warm regards,

P.S. For your reference, the specific guidance mentioned can be found in the Australian Immunisation Handbook, under the COVID-19 chapter, within the "Infants, children and adolescents" section. The Handbook is regularly updated by the Australian Technical Advisory Group on Immunisation (ATAGI) and is available on the Department of Health and Aged Care website: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/covid-19