EXPERT REACTION: Vaccine program kicks off in Australia

Coronavirus vaccination truths:

Some people are hesitant about the new vaccines; they tell me their concerns about the mutant virus strains, the novelty of the vaccines and short timeframe of a vaccination roll out in our country.

However, no matter what the vaccine type, the essence of vaccination is the same. It is designed with specific intention to safely train our immune systems to win the fight against the virus, if we were to be exposed in the future. The vaccine-elicited antibodies and B cell memory will protect and prevent severe COVID.

Getting vaccinated is like having a personal trainer for your immune health. Individually, the key issue is to develop long-lasting broad immunity against Coronavirus and any evolving mutant strains.

Collectively, we can achieve herd immunity to protect those individuals that can not be vaccinated or have poor responses to the vaccine.

Life is simply better with immunity.

While it is welcome news that COVID-19 vaccines will be available in Australia from today, a major barrier to full implementation remains community uncertainty resulting in vaccine hesitancy.

A recent ANU survey shows a significant part of the community are uncertain about whether to be vaccinated. This suggest the current government vaccine media campaign despite it costs may not be effective and may even be counterproductive given the evidence in the survey that the level of community uncertainty has increased rather than decreased in recent months.  A successful education campaign needs to be balanced and to address the ongoing uncertainties around the vaccines being used plus their known and potential side effects, alongside their known and potential benefits. 

The two vaccines currently on offer are based on the new use of gene therapies as vaccines, and hence the community needs to understand how these differ to traditional vaccines and what this might mean in terms of the risk-benefit relationship.

There may be some in the community who upon reviewing all the available information decide to wait until more traditional protein-based vaccines become available. Protein-based vaccines have a long track records of safe and effective use for many other infections such as influenza, hepatitis B and human papilloma virus, with high levels of safety in newborn babies through to the elderly. The Australian government has already announced planned purchases of the Novavax protein-based vaccine which has just announced positive Phase 3 efficacy data, and may not be far away. Notably, the greater the diversity of vaccines on offer in Australia, the easier it should be to achieve the high vaccination rates that will be needed for maximal community protection should further local outbreaks occur.

Ultimately, the community will be influenced by facts so definitive data showing the vaccines remain effective long-term and are able to prevent transmission should go a long way towards reducing vaccine hesitancy

New level of protection

The vaccines being offered in Australia will provide a new level of protection for our community. Now we have the tools to help save lives and reduce the social and economic impact of the pandemic. However, ongoing research will remain crucial as the pandemic continues – as we seek to understand how well vaccines are preventing viral transmission and illness, how long they provide protection, and how they can be improved.

Maintain public health measures

Vaccinating our population, and that of the rest of the world, will take quite a bit of time, so it is critical that for the foreseeable future we continue to use public health measures, including physical distancing, hand hygiene, the judicious use of face masks, good ventilation and effective controls at international borders.

The vaccines have been subject to a full, not emergency, review by TGA. We also have the phase 3 trial data and ongoing surveillance by regulatory agencies in the UK and Israel and Europe on the way.
The Pfizer and AstraZeneca vaccine rollout has been carefully planned to protect the community, ensuring that populations such as quarantine, healthcare and aged care workers, as well as aged care residents, are given first priority. Follow up post rollout is being carefully planned in Australia.
 
Effective vaccinations

The higher efficacy of the AstraZeneca vaccine of greater than 80% with a 12 week interdose interval is very encouraging and recommended by TGA.  Both vaccines appear to be effective in the latest figures from Israel and the UK although these are preliminary and may be partly due to lockdown effects.
The reduced efficacy of two vaccines against the South African strain has been shown in small trials but all companies with vaccines on the market are moving swiftly to produce second generation vaccines or boosters, as we do with influenza annually; Australian quarantine has been successful in preventing spread into the community.

Vaccine equity

It is crucial that all countries have timely and affordable access to vaccines, to ensure that the world’s most vulnerable individuals can be protected.
“This particularly includes health workers. Indeed, it is incredibly important to ensure that health workers around the globe are vaccinated, as recently highlighted by WHO Director General, Dr Tedros Adhanom Ghebreyesus, who has stressed that vaccine equity protects people everywhere and strengthens the international community’s ability to stop COVID-19.

Communication and vaccine hesitancy

The roll out of the vaccine is a crucial time to get public communication and messaging right. We want clear consistent messages from government, health professionals and opinion leaders. Messaging needs to be appropriate for diverse audiences and be inclusive of people with lower health literacy and from different cultural and language groups who sometimes get forgotten.
We need broad messaging but also targeted messages for key groups who may be more hesitant, and we need to use social media as well as mainstream media channels.
Being respectful of people who feel uncertain about the vaccine will be important as well as being responsive to their questions and needs. Health professionals have an important role here.  We must also encourage people to carefully consider the source and credibility of their health information and how it applies in Australia.
There is a risk of over focusing on a small minority who are strongly opposed to vaccination. This is a time for the community to come together and recognise the remarkable achievement of the vaccines that will help us get back our lives to a better normal.

There are no concerns about the vaccine’s safety in breastfeeding women or their babies. This means that breastfeeding women can receive the vaccine at any time and do not need to stop feeding before or after.”
“Vaccination during pregnancy is not currently recommended for all women. However, pregnant women who have medical risk factors for severe COVID-19 should consider being vaccinated. Women need to have this discussion with their health provider and weigh up the potential benefits of vaccination outweigh any potential risks. The guidance from the Australian Government and from RANZCOG will be helpful for each woman to make that decision.

We have seen an incredible response to the pandemic by the world’s health and medical research community. At the beginning of 2020, COVID-19 was an unfolding threat of unknown proportions. Today, just over 12 months later, we have a suite of vaccines supported by robust diagnostic tests, public health measures, and steadily improving treatments for severe COVID-19 disease.
“Many hundreds of Australian researchers have contributed to every aspect of the fight against COVID-19: helping to stop its spread through evolving evidence-based public health measures, improving treatments, developing vaccines, supporting informed communication and reducing the social effects on disrupted families and communities.

The official commencement of the rollout of the vaccines in Australia today can be reasonably considered our official entry into the final phase of the pandemic. The availability of safe and effective vaccines adds another tool into our toolbox to fight COVID-19. As we roll out the vaccines, we start to reduce the threat COVID-19 poses to the community, which means we can more confidently transition towards post-pandemic life.
 
Although there is still a lot of work to do and we have to be patient, the vaccination of front line workers and the most vulnerable in the community will be a game changer in terms of our response to COVID-19. Crucially, the vaccination of quarantine workers will not only make escapes from hotels less likely, but if they do occur, as vulnerable populations get vaccinated, the implications of any escapes are reduced. This hopefully means that there will be less of a need for lockdowns in Australia in the future.
 
As the numbers in the population that get vaccinated increase, and the overall threat the virus poses to us decreases, the need for restrictions becomes less and less. Therefore, we should look forward to being able to do all of the things we took for granted 12 months ago if we can get sufficient uptake of the vaccine by the community.
 
Vaccine hesitancy
 
Throughout the pandemic one of the most difficult things to predict has been the vagaries of human behaviour. For example, who could have predicted that lockdowns would have precipitated a shortage of toilet paper? For this reason, I am not underestimating the level of potential vaccine hesitancy that we may have to deal with over the coming months. You can do as many surveys as you like and you can look to Australia’s great record in taking up other vaccines, but I think we won’t know the true extent of vaccine hesitancy in the community to COVID-19 vaccines until we begin the rollout of the vaccines, and I am concerned that it may be higher than we expect.
 
All this means is that we have to be prepared to work really hard to get the information that the community asks out to people. Individuals will have legitimate questions and concerns that need to be addressed. The key will be to put into practice all that we have learnt about communicating with the public and getting messages across in the earlier stages of the pandemic. We will also need to make it clear that every single concern and worry that individuals may have is understandable and we need to be prepared to address these clearly, directly and honestly. There is nothing that has happened over the past 12 months that can be considered normal and so it is entirely reasonable that some people may be fearful as we start delivering the vaccine. We should be able to reassure anyone with any concerns with evidence based information.
 
We also have to be prepared to fight those disseminating misinformation head on as we address those with concerns about COVID-19 vaccines. This means calling those out who are spreading misinformation and countering any myths that are circulating.

Having safe and effective vaccines available for Australia and the world is a momentous achievement. I have respect and gratitude to all the scientists who contributed to these vaccines. These products will save lives and play a huge part in getting us through what has been a tough period for everyone.

It is good to see the vaccine rollout in Australia. Initial doses of vaccines will go to frontline healthcare workers, aged care and disability care residents and workers and quarantine and border workers. We are already way behind other countries – as of 19th February 2021, around 182 million people from more than 70 countries have received at least one dose of COVID-19 vaccine. 
 
Vaccine hesitancy is concerning but we have seen this in other countries as well. This may be due to various rumours and conspiracy theories, the lack of trust in government and drug companies and mixed messages from experts and researchers about efficacy of different vaccines. Some people are naturally hesitant to new interventions and they will eventually take vaccines. We should consider that Australia has good childhood immunisation coverage but adult immunisation rates (e.g. for influenza and pneumococcal diseases) are generally low. However, vaccine update is expected to improve during epidemics and pandemics.

So, the vaccination program should be started as soon as possible, and community engagement is very important. At this stage we have limited evidence on many aspects of SARS-CoV2 and its vaccines, but we should trust in the TGA and continue the vaccination program. It is very important to monitor vaccine efficacy data (particularly against new strains) and modify the strategy accordingly.

“…the biggest and most consequential product launch in modern history” is how Bloomberg authors Murray & Griffin described the global roll-out of the Covid-19 vaccine. The task is massive as it involves much more than injecting the population: the safe manufacture, distribution, storage and administering of the vaccine to some 7.8 billion people worldwide.  Despite demand created by pressure to save global economies and the scientific endeavour that has gone into developing a safe vaccine, the task will fail if the core principles of logistics are not followed: getting, in the right way, the right product, in the right quantity and right quality, in the right place at the right time, for the right customer at the right cost. We have been assured by numerous health authorities that the vaccinology of companies like AstraZeneca, Pfizer and Novavax is robust but until our logistics and supply chain services deliver the medication safely, we are still vulnerable.  There is significant societal pressure on perfecting this process, but also warding off unethical and accidental disruptors of the roll-out is a priority.  Another issue of concern is if distribution and storage fails and there is a waste vaccination that could have otherwise saved lives.