COVID vaccination roll-out FAQ

 
DR TRISH BATCHELOR
Deputy Chief Health Officer
Department of Veterans’ Affairs

Early in 2021, I wrote a column about the how the COVID vaccination roll-out affects you.

As the recent lockdowns have showed us, COVID cases can suddenly appear and spread quickly. As I write this update on 13 August 2021, more than 14 million COVID vaccine doses have been administered in Australia. However, thus far only 19% of the population have been fully vaccinated. With the delta variant spreading so easily and, unlike alpha, affecting children, vaccination is now more important than ever. The situation in America is showing us that COVID is now becoming a ‘pandemic of the unvaccinated’.

Recent data from the UK has shown that both Pfizer and AstraZeneca vaccines remain highly effective at preventing severe disease and hospitalisations from the delta variant.

Here are updated answers to some of the common questions I am being asked about the COVID vaccines in my general practice:

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What are the potential side effects?

Concerns about the AstraZeneca vaccine

There is now clear evidence that an unusual type of blood clot known as thrombosis with thrombocytopenia (TTP) is rarely linked to the Astra-Zeneca vaccine. 

This side effect appears to be related to the first dose of vaccine. There have been no cases of TTP in Australia confirmed after a second AstraZeneca dose. Overseas data suggests this risk is vanishingly small, around 1.8 per million doses.

Current Australian data shows the risk after the first vaccine to be around 2.7 per 100,000 people aged under 60 years, and 1.7 per 100 000 in those aged over 60 years.

On this basis,  the experts at the Australian Technical Advisory Group on Immunisation (ATAGI) have advised that the Pfizer vaccine is preferred in adults aged 59 and under, when not in an outbreak situation.

However, as of early August, ATAGI has stated that in outbreak situations, such as that currently occurring in Sydney, the benefits of AstraZeneca vaccine are greater than the risk of rare side effects for all age groups. 

If you have had your first dose of AstraZeneca without developing this rare side effect, I urge you to get your second dose.

Doctors are now very aware of this rare side effect and have clear protocols for diagnosis and, most importantly, treatment.

So please don’t let this development deter you from getting vaccinated – health experts continue to recommend that all adults get vaccinated against COVID. The Australian population remains highly vulnerable to COVID-19 as most Australians have not been vaccinated and are not immune. 

If you have any concerns please discuss this with your GP.

Please see the Department of Health website for more information.

Concerns about Pfizer

There is now evidence emerging overseas of a slight increased risk of myocarditis and pericarditis after mRNA vaccines such as Pfizer, particularly in males under 30 years of age after the second dose. Myocarditis is inflammation of the heart muscle, and pericarditis is inflammation of the sac that surrounds the heart. Most of these cases have been mild and patients have recovered quickly. Current data shows an incidence of around 40 cases per million doses in males aged 12–29 years, compared to 4 per million in females aged 12–29 years. The incidence for men over 30 years is around 2 per million doses, and 1 per million for women aged over 30.

It should be noted that myocarditis occurs at a ‘background’ rate of around 37 per million in men under the age of 30. In Australia there have been 149 reports of suspected cases of myocarditis or pericarditis following Pfizer vaccination.

ATAGI continues to emphasise that ‘the overwhelming benefits of vaccination in protecting against COVID-19 greatly outweigh the rare risk of these conditions’.

Other potential side effects

All vaccines can cause side effects and COVID-19 vaccines are no different. Side effects show that your immune system is being activated, but having no side effects does not mean the vaccine isn’t working. 

Side-effects from both COVID-19 vaccines are common but relatively mild and short lived – usually less than a couple of days. The most common side effects are injection-site pain (up to 80% of those vaccinated), general muscle aches (up to 50%), general tiredness for a few days (up to 60%) and headache (up to 65%). 

For both vaccines, people under the age of 55 have slightly higher rates of side-effects. For the Pfizer vaccine there tends to be a higher incidence after the second dose, whereas the rates are lower after the second dose of the AstraZeneca vaccine. As with all vaccines, there is a small chance of having a severe allergic reaction known as anaphylaxis. This is easily treated and is the reason why you will be asked to stay at the vaccination centre for 15 minutes after the vaccine is administered.

Flu and other vaccines

The recommended gap between the COVID-19 vaccine and the flu vaccine (and other commonly administered vaccines such as pneumonia, shingles or tetanus) has now been reduced to one week. 

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We currently have two vaccines in Australia – can I choose which one I get? Are they interchangeable? 

Currently the two vaccines available in Australia are ‘Pfizer’ and ‘AstraZeneca’. The vaccines use different technology and have different storage and transport requirements. 

Earlier this year, the Pfizer vaccine was approved for storage in a vaccine fridge for up to 30 days, compared to the previous –70-degree requirement. This has allowed GP clinics to administer the Pfizer vaccine.

Both vaccines require two doses.

ATAGI continues to recommend the use of the same COVID-19 vaccine for both doses unless there are exceptional circumstances such as having had a serious allergic reaction or adverse event after the first dose.

For the Pfizer vaccine, the recommended interval between doses is 3 to 6 weeks. For AstraZeneca, the preferred interval is 12 weeks, unless there is an outbreak situation in which case it is 4–8 weeks.

The good news is that real world data is showing that both of these vaccines are offering excellent protection against both severe disease and death, even against the delta variant. In June, Public Health England released data showing that against the delta variant, the Pfizer vaccine was 96% effective against hospitalisation after two doses, and AstraZeneca was 92% effective after two doses.

Note that it takes around two weeks after the second dose for the vaccine to become fully effective.

If you have had two doses of one vaccine, there is no need to get two doses of the other.

It is likely that booster will be necessary in the future, however the timing for this has not yet been established.

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These vaccines have been developed more quickly than usual – are they safe?

There is a standard process for vaccine development that includes a series of clinical trials and many bureaucratic steps in between. There are also many pragmatic obstacles for new vaccine development, including funding, finding volunteers for trials, low levels of the relevant disease in the community, and slow national approval processes. Due to the incredible impact of COVID-19 on the world, many of these barriers disappeared quickly – funding flowed from everywhere, volunteers were abundant, the level of disease transmission meant clinical trials could be completed rapidly as critical mass numbers of participants were reached quickly and bureaucratic blocks were lifted. 

In Australia, all medicines must be rigorously tested on thousands of people before being registered for use by the Therapeutic Goods Administration (TGA). The TGA has thoroughly assessed the COVID-19 vaccines we are using, and all of the usual regulatory steps have been followed. I have complete confidence in our processes. More information is on the TGA website.

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Is it possible to get COVID-19 from the vaccines?

Absolutely not. It isn’t possible because the vaccines we are using are not ‘live’ vaccines. This also means the vaccines can safely be given to people with weakened immune systems who can’t receive live vaccines such as those for measles.

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Should I get the vaccine if I am pregnant, breastfeeding or planning pregnancy?

Women who are planning pregnancy or who are breastfeeding can safely receive the vaccine. 

On 9 June, ATAGI and the Australian College of Obstetricians recommended that pregnant women be offered a Pfizer vaccine at any stage of pregnancy. Global surveillance data on large numbers of pregnant women receiving the Pfizer vaccine has not identified any safety concerns. However, there is strong evidence that severe outcomes from COVID infection are more likely in pregnant women.

If you are pregnant I would recommend discussing this with your GP.

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If I’ve been vaccinated, do I still need to follow handwashing and physical distancing behaviours? 

The short answer is yes, at least for now and until a significant proportion of the population has been fully vaccinated.

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If I’ve been vaccinated, do I need to strictly observe lockdown protocols?

Yes. Lockdown protocols apply to the vaccinated and unvaccinated alike unless you are told otherwise.

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What is herd immunity and when will that be achieved?

Herd immunity occurs when enough people in a community are immune to a disease such that person-to-person spread can no longer occur. We still don’t know if herd immunity can be achieved by COVID-19 vaccines as this depends on a number of factors, including understanding what percentage of the population needs to be immunised, and how long the vaccine is effective for. At this stage, it is considered likely that booster doses will be required in the future to sustain immunity, but we just don’t know.

What is clear is that the more people vaccinated, the less likely it is that COVID-19 can spread. That is why it is so important to get vaccinated, not just for yourself but for the community.

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What should I make of all the claims out there that the vaccines are not safe?

Please don’t listen to rumours. Always refer to the federal and your state or territory health department websites for the most up to date information, or discuss any concerns you have with your GP.

While some medical conditions may be detected in the post-vaccination monitoring period, that does not mean they are caused by the vaccines. Countries are doing very careful post-vaccination monitoring on the various COVID-19 vaccines and any detected adverse events are being carefully examined by Australian experts. This is why the link to TTP has been so quickly established despite it being such a rare occurrence.

Vaccines have been a major contributor to improvements in global health over the past century. Globally, vaccines save 5 lives every minute. I urge you all to get the vaccine when you become eligible.

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I do not have a Medicare Card or number, can I still receive the vaccine free of charge?

If you don’t have a Medicare card or number, you can still get the COVID-19 vaccine.  However it is recommended you call Medicare on 132 011 first to check you are not enrolled with Medicare. The staff member will help you to either enrol in Medicare or to apply for an Individual Healthcare Identifier (IHI) if you don’t already have one. Even if you are not in Medicare, you will have an IHI if you get a DVA pension or benefit.

Having a Medicare number in no way conflicts with your usual Veteran Card entitlements, but will make it easier to access your immunisation record online. 

If you elect not to register for a Medicare number, the state and territory governments offer an over the phone appointment booking service. To book a COVID-19 vaccination appointment over the phone please contact the relevant state or territory service below.

• Australian Capital Territory – (02) 5142 7700
• New South Wales – 1800 571 155
• Victoria – 1800 675 398
• Queensland – 134 268
• South Australia – 1800 254 787
• Tasmania – 1800 675 398
• Northern Territory – (08) 8095 8034
• Western Australia – 13 COVID (13 268 43)

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If I don’t have a Medicare number, will I still be able to access my immunisation record?

Yes, you can still access your immunisation record. If you don’t have a Medicare number and you want to access your immunisation summary online, you can do this with myHealth Record in myGov. You will need to link myHealth Record to your myGov account, using your IHI. See the My Health Record website for more information. You can also call the Australian Immunisation Register on 1800 653 809 and press option 4 and ask for a copy to be mailed to you.

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