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Australia Everything you want to know about the COVID-19 vaccine

09:00  27 january  2021
09:00  27 january  2021 Source:   abc.net.au

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In a bid to shed some light on the COVID-19 vaccines, we asked you to put your burning questions to three medical experts — Norman Swan (Coronacast), Sophie Scott (national medical reporter) and Kylie Quinn (vaccine expert from RMIT University).

Here's some of your top questions (and you can read the full Q&A here).

Should we wait for a vaccine that makes us immune?

This one comes from Anne Thomson, who asks:

Is a vaccine that only makes us less sick worth it. Should we hold on for a vaccine that makes us immune?

Here's Kylie Quinn:

The jury is still out on exactly how much of an impact these vaccines will have on infection and transmission, but there is promising early data to suggest they will be helpful to some extent.

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The major issue right now with COVID-19 is the fact that we are all not immune at all. This means that when the virus passes through our community, we are all sitting ducks — to either get infected and pass it on very efficiently and/or get very sick.

These waves of incredibly sick people put a strain on our healthcare system, so if we had a vaccine that effectively slows viral spread even a little bit and stops people from getting really sick, it is hugely worth it.

In terms of holding on, vaccines aren't a "one and done" medication. Right now, we are aiming to establish a level of immunity in people that protects them from disease with this first generation of vaccines. But we could build on that immunity by giving them the second generation of vaccines in the future, called a booster shot.

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There will still be people who won't be immune after the vaccine or who can't be vaccinated for some reason. These folks will depend on others being immune to protect them from infection, so it is important to continue to refine our vaccine strategy to a point that we know transmission is stopped- but there's no need to delay building that immunity now.

What happens if I've already had COVID-19?

This next one comes from Delise Wood, who asks:

If you already had COVID, isn't it fact that you are immune and wouldn't need a vaccine? After all, isn't that what a vaccine does — it gives you some of the disease to make you immune to getting it? And wouldn't it be dangerous to have the jab if you are already immune?

Here's Norman Swan:

Very few people in Australia as a proportion of the population have had COVID and antibody testing won't be done prior to vaccination. An immunisation is more likely to be a booster to immunity rather than cause problems.

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Could the vaccine react with other medications?

This one comes from Rosemary, who asks:

What are the side effects? Does the vaccine react with any other medication?

Here's Kylie Quinn:

The TGA have prepared a great document that outlines a lot of people's basic questions with potential vaccine side effects and medications ()

For all vaccines we can expect some mild side effects — importantly, these side effects are also signs that your body is mounting an immune response.

Some side effects are local to the site of the vaccination, like a sore arm, redness or swelling. Others can make us feel a bit off, like fatigue, a headache, chills or a fever. These should resolve quickly and shouldn't get too bad but you can take a paracetamol if you don't feel great.

You will also be asked to stick around for 15 min after the vaccine, just in case you are allergic to one of the vaccine components. There have been very rare cases (about 1/100,000 people) of people developing this allergic response called anaphylaxis after the Pfizer vaccine, but it can be managed effectively by healthcare professionals.

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Also, there are currently no known reactions with other medications but talk to your doctor or pharmacist. And it is recommended to not receive this vaccine and another vaccine on the same day — give it a couple of weeks between vaccines if possible.

Can I choose what vaccine I receive?

This one comes from Zara Tai, who asks:

Will we have a choice which vaccine we will receive?

Here's Sophie Scott:

Hi Zara. Unfortunately, no.

At this stage, the Federal Government has been very clear about who will get which vaccine.

Those first in line are quarantine and border workers, frontline healthcare workers, aged care and disability staff and aged care and disability residents.

This group will get the Pfizer vaccine. It is around 90 per cent effective in preventing you getting sick from COVID. Pretty much everyone else (that includes me!) will be getting the AstraZeneca vaccine.

While it's less effective, Australia will manufacture it here so we will have lots more of it.

How far apart should I get the COVID-19 vaccine and the flu vaccine?

This one comes from Katrina Rech, who asks:

Flu vaccine is also important in the health care setting What is the optimal time interval of flu vaccine and Covid vaccine?

Here's Kylie Quinn:

You are quite right — usually, we are concerned about the flu virus each winter, especially for older individuals or healthcare settings. We do need to make sure that, in vaccinating against COVID-19, we don't impact on the flu vaccine and vice versa.

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The official recommendation from the Australian Technical Advisory Group on Immunisation (ATAGI) is:

  • Not to give COVID-19 and flu vaccines on the same day
  • Optimally, to give them 14 days apart

But, ATAGI also note that there may be situations where giving vaccines closer together or at the same time is the better course — getting a vaccine when available is better than not getting the vaccine at all.

Can vaccines create 'silent spreaders'?

This one comes from Crystal, who asks:

Is it true that the vaccines may create silent spreaders? That the vaccines prevent the disease but not the infection, thus people could be asymptomatic and spread to those who are not vaccinated?

Here's Norman Swan:

That is possible, but it's likely that the vaccine will reduce viral load. That means that even if it doesn't prevent infection, it will reduce its spread to an extent. But that's exactly the reason that borders will stay shut and we'll continue with social distancing until we know for sure.

Will vaccines prevent 'long COVID'?

This one comes from Frances Rowland, who asks:

We are told that the vaccines prevent severe COVID developing. Does this include 'long COVID' or only the acute form of the disease?

Here's Sophie Scott:

At the moment, we know getting the COVID vaccine will reduce your risk of developing the acute form of the disease.

It does this by teaching your immune system how to recognise and fight the virus that causes COVID-19.

But the WHO says COVID-19 may increase the risk of long term health problems such as damage to your heart, lungs, brain function, muscles and cause depression or anxiety.

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"Long COVID" occurs when people who tested positive to coronavirus suffer long term complications, such as debilitating fatigue, pain, shortness of breath and cognitive problems.

Even people who had a very mild case of COVID-19 have developed this ongoing symptoms and there are now clinics set up across countries like the U.S and U.K to look after these patients.

It's too early to know whether the COVID vaccine will offer any protection against these long term problems developing.

But given the vaccine can reduce your risk of getting COVID, it stands to reason it would reduce your risk of long COVID too, though there has been no specific study done on this that I have seen.

Could I still catch the virus?

This one comes from Serghei, who asks:

Let's say I test negative, then get the vaccine jab straight after the test. Is it possible I could subsequently catch the virus and test positive two weeks later although I have a level of vaccine protection?

Here's Kylie Quinn:

Good question, Serghei — unfortunately, strong immunity takes time to develop.

After the jab, immune cells are activated and get to work making a protein targeting the virus called an "antibody". After the first shot, a modest amount of antibodies starts to circulate in your blood and it can possibly protect you from disease. That whole process takes 1-2 weeks.

But the Pfizer vaccine is also given as 2 shots, spaced at least 3 weeks apart.

The second shot starts the whole process again, increasing your antibody levels further. Altogether, at around 5 weeks after your first shot (1-2 weeks after your second shot), you will finally have enough antibody circulating to almost certainly protect you from severe disease.

But it isn't clear currently how well the vaccine will protect you from getting infected, as distinct from developing disease.

Potentially, you could get one or even two shots of the vaccine and still get infected by the virus.

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I want to have a baby. Should we wait until after I am vaccinated?

This one is from Eve, who asks:

Hi team! I'm planning on trying for a baby this year. Should we wait until after I am vaccinated (I'm lucky enough to have the luxury of being able to wait a few extra months!) or is it just as safe and effective on pregnant people?

Here's Sophie Scott:

Excellent question Eve, and your timing is absolutely perfect.

The peak body for baby doctors, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, has just put out its official advice for doctors and patients.

In a nutshell, they are not recommending pregnant women get the vaccine as there's limited safety data, as only a small number of pregnant or breastfeeding women were in the clinical trials.

On the other hand, they say there's also no evidence of safety concerns or harm to pregnant women or babies. If you are pregnant and in a high risk group (like a frontline healthcare worker) you would need to discuss whether to get the vaccine with your doctor. So it sounds like if you can get vaccinated first, then get pregnant that might work for you. Good luck!

I'm immuno-suppressed. Can I get the vaccines?

This one comes from "Immune suppressed", who asks:

Can both vaccines be used for the immune suppressed?

Here's Kylie Quinn:

While only the Pfizer vaccine is currently approved in Australia, Pfizer, Modern and AstraZeneca are all approved in the UK for use in immuno-suppressed individuals, with the advice of their healthcare providers.

Here, the Australian Therapeutic Good Administration (TGA) recommends that people with a weakened immune system discuss COVID-19 vaccination with their healthcare provider.

For people with immuno-suppression, we can sometimes be cautious with a certain type of vaccine, known as a live attenuated vaccine. These vaccines are an older form of vaccine that contain very weakened virus — a healthy immune system deals with this weakened virus very effectively but people that are very immuno-suppressed might not control it as well and it could cause disease.

However, these vaccines are newer forms. The Pfizer vaccine is an mRNA vaccine that is completely made "in vitro" in the lab, which means that there is no material that could cause an infection. The AstraZeneca vaccine is a replication deficient viral vector, which is essentially a viral shell that cannot replicate or cause infection.

So, both can theoretically be used in people with immuno-suppression, but you should talk to your doctor about how to best integrate these vaccines into your healthcare plans.

How do I talk to people who are suspicious about the vaccine?

Our next question comes from Stanislaus, who asks:

I increasingly meet people being suspicious about the vaccine. They usually say don't know what's in it or maybe it will cause huge health problems down the line. How do you talk to them?

We've put this one to all three of the experts — here's what they have to say:

Norman Swan:

What I say firstly is that I'll take whatever vaccine is on offer as soon as it's offered to me, and I've looked very closely at the data. If you're not sure, then no-one will force you to have the vaccine.

The thing is, how long will you wait to be sure? Tens of millions of people are already immunised, so we know a lot. Longer-term issues will take a while to be certain about, but the small chance of them has to be weighed against the impact of COVID on individuals and communities.

Sophie Scott:

This can be tricky to deal with. There has been a huge amount of misinformation circulating about COVID-19, treatments and now the vaccine. Much of it gets reshared on social media and uses medical terminology to give it credibility, but uses questionable research and unscientific evidence.

Some people raising concerns about the vaccine are not so much anti-vaccine, but more vaccine hesitant. That means they are genuinely interested in having their safety concerns answered.

So I would show or send them evidence-based information from good websites like the Therapeutic Goods Administration.

You might also give them some hints on how to spot misinformation in online stories.

I like this approach. Look for C-R-A-B-S

Conflict of interest — is the author selling something?

References — has the research been published in a highly regarded peer-reviewed journal?

Author — do they have relevant qualifications?

Buzzwords — do they use buzzwords like danger, big pharma.

Scope — is the person writing outside their scope of practice like a nutritionist writing about vaccine safety?

You can find some amazing highly qualified scientists unpacking misinformation on ABC online, but also on Instagram too. You might like to look at @unbiasedscipod @j_stokesparish and follow me too, @sophiescott2

Kylie Quinn:

I'm trying to educate myself on this too.

My best tip is, start with empathy. Acknowledge that you understand how someone might feel uncertain. COVID-19 has been unsettling and these vaccines are very new — it is a normal human reaction to feel cautious.

Ask the person if they want to talk about vaccines. If they want to talk, you could explore with them why they are cautious — many people are "vaccine hesitant" and just need more information from a trusted source.

Importantly, our friends and family are often that trusted source, so we all need to ensure that the information we share is accurate.

My favourite source is the website for the National Centre for Immunisation Research and Surveillance. It has ‘frequently asked questions' and details exactly what is in various vaccines, as well as the likelihood of rare or long-term impacts.

The Department of Health is also working on information sheets in a range of languages which will be available on their website.

So sharing (good information) is caring- thanks for having these important conversations Stanislaus.

How long until we reach herd immunity?

This one is from Ben, who asks:

What does it take to get from where we are now to effective herd immunity? What kind of time scale would that have?

Here's Kylie Quinn:

It is really hard to say (and probably one for the epidemiologists). Herd immunity is very dependent on a range of factors — a lot of which depend on our behaviours that make viral transmission easier or harder, which together shape the basic reproduction number (R0) of each virus.

For COVID-19, many studies have estimated that the R0 is about 3 (meaning each infected person passes the virus on to 3 others, on average), although this can change with the viral variant and our behaviours.

Importantly, herd immunity will start to reduce the numbers of new cases even with low rates of vaccine uptake or with a low efficacy vaccine, so anything is beneficial.

In terms of totally stopping viral spread through herd immunity, if we can get the R0 to 1, then we could effectively stop the growth in case numbers. Roughly speaking, vaccinating everyone with a hypothetical vaccine that prevents infection 66 per cent of the time would achieve that.

The time scale to achieve that kind of rollout is very challenging to estimate. There will be unexpected delays that crop up, but there is no time like the present to get started and the other benefits of preventing disease begin straight away.

Are the vaccines cross-compatible?

This one comes from Zoe, who asks:

I'll be getting vaccinated at the earliest opportunity, but I am wondering if I'll be able to receive future vaccines if a more effective or targeted version becomes available. Are the vaccines in development now cross-compatible?

Here's Kylie Quinn:

That is an important question and researchers are now turning to focus on this.

Obviously, there are now many different vaccines available around the world — most have been given as what we call "homologous prime-boosts", i.e. the same vaccine one after the other. Each shot of the vaccine raises our level of immunity further and further to the point that people are more and more likely to be protected.

We now need to know how these vaccines work in combination — given as "heterologous prime-boosts", i.e. the different vaccines one after the other.

The Russian vaccine has a head start there. It is giving a first shot of a viral vector called rAd26 and a follow-up shot of a viral vector called rAd5, which we know works really well as a combination in the lab. The current COVID vaccines should be broadly cross-compatible, but some combinations might be better than others and this needs to be tested.

Critically, we are already seeing vaccine manufacturers, such as Moderna, modifying their vaccines slightly to target new viral variants. mRNA vaccines have an advantage as they can easily change the viral target. It is a simple swap. Viral vectors have a disadvantage as they generate immunity against the viral shell, which clear the new vaccine and can limit responses to the new target.

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Vaccine diplomacy: China moves to fill gaps the West leaves behind .
This will be a blessing to many countries, but it also presents very real risks.Fed up with being left behind in the global COVID-19 response, nations in Latin America, Africa and the European Union (EU) have turned to new saviours: Russia and China.

usr: 0
This is interesting!