Holly Seale, UNSW and Jessica Kaufman, Murdoch Children’s Research InstituteThis year is shaping up as the year of the COVID-19 vaccination photo, with the pandemic providing seemingly endless photo opportunities. We’ve seen stock photos of people getting vaccinated in news reports, images of the prime minister receiving his shot and health workers posting #vaxxies on social media.
But evidence shows the wrong images can make some people reluctant to get vaccinated. So our well-meaning efforts to use images to help demystify the vaccination process or share our pride in getting a COVID-19 vaccine can backfire.
Here’s what we can all do to choose and share vaccination images responsibly.
Communicating public health strategies like vaccination can be challenging. There can be complex and unfamiliar technical terms and health concepts, and not everyone can understand them. So pictures play an essential role.
Pictures can draw attention to the message, help people relate to and remember what is being said, and may nudge people to act on a health recommendation. People also rate brochures with pictures more positively than ones with just text.
Pictures not only provide meaning, they have an emotional impact. Images we see on social media can also shape our perception of social norms (what we believe others are thinking or doing) and our behaviour.
Friday essay: COVID in ten photos
In addition to being a bit gruesome, stock photos commonly used in stories about vaccination are often inaccurate. The needle might be in the wrong position, the health worker may be wearing gloves when they are not needed or the liquid inside the needle seems coloured rather then clear.
This may lead new parents, who have yet to really experience the vaccination process, to become anxious. And this negative photo may override any positive vaccination messages accompanying it.
This issue is especially important because when a photo is of someone’s face, it can trigger an emotional response, making it easier for someone to have a strong reaction to that communication.
We know images can help people remember health messages. But if we use an inappropriate photo, such as the wrong needle size or someone looking anxious, this is the image that can stick with us, not the public health messages or statistics we intended to convey.
For some people, photos of needles are so scary this might put them off vaccination. While we don’t know precisely which types of needle imagery could stimulate such a response, we know needle phobia is a real issue. In fact, one survey found 23% of adults have avoided influenza vaccines due to fear of needles. And we don’t want to risk this happening with COVID-19 vaccines.
Whether we are choosing images for news articles or for our personal social media, it is important we consider the potential impact of the photos we use. Here are some tips for choosing the right image:
Frank Bongiorno, Australian National UniversitySome promising polling for Labor in recent weeks has inevitably raised that perennial question for a party whose national triumphs since Federation 120 years ago have been rare: can it win the next election? And in the manner of modern elections, the question soon becomes a more personal one: can it win under its present leader, Anthony Albanese?
My punditry in such matters is likely to be no better or worse than anyone else’s. Apart from polling, the limitations of which have become all too well known, there’s little for most of us to go on.
One place we might look is the quality of an opposition leader’s performance. They really have two jobs, which is one of the reasons no one much likes being opposition leader.
First, they need to keep government accountable, scrutinising its behaviour using parliament, committees such as Senate Estimates, and the media to draw attention to government failings or worse.
Their other job is to make themselves look like an alternative government. They do so by preparing policies, crafting an attractive image, and attending to problems such as weaknesses in the party organisation.
Taking these two roles into account, how well has Labor been doing this under Albanese?
In the aftermath of the 2019 election, as is usually the case after an election defeat, it’s hard for an opposition to get a hearing. The government will usually have an agenda that it pursues aggressively in the flush of an election victory. Few wish to listen to the leader of a party only recently repudiated at the polls.
The months that followed the 2019 election had some of these features. The government pursued massive tax cuts, which Labor supported. But given Prime Minister Scott Morrison’s lack of an agenda – his policy at the 2019 election was to win the 2019 election – there was little for Albanese and Labor to get their teeth into.
That soon changed. Summer is usually a quiet time for both government and opposition. It was on this basis, that Morrison, “Jen and the girls” headed for Hawaii. But the Black Summer bushfires provided Albanese and the Labor opposition with their first chance to lay a glove on Morrison.
While Morrison’s performance was so poor that Albanese needed to do little to look good by comparison, the crisis did damage the government sufficiently to raise Labor’s hopes that the shine gained from “Morrison’s miracle” was wearing off.
Then came sports rorts. This scandal provided Labor with opportunities to build an argument that this was a mean and tricky government that put winning elections ahead of integrity or fairness. It claimed a ministerial scalp.
Sports rorts was soon overwhelmed by the pandemic. This was very bad news for Labor. Parliamentary sittings were reduced. Worried citizens attended to their private affairs. National cabinet provided a sense of Labor state governments being drawn into the tent with Morrison, while the federal Labor opposition was rendered irrelevant. Morrison even courted the unions with some success.
Governments almost invariably benefit from major crises because they are seen as doers. There are strong pressures to place an increasing range of issues “beyond politics”, a boon for those intent on looting the treasury and bad for public accountability.
The government’s massive spending stimulus made Labor seem particularly irrelevant. There can be no doubt that if a Labor government had tried anything similar, it would have been subjected to the mother of all campaigns by right-wing media.
So, if Albanese and much of his front bench seemed invisible during this period, this is not a matter for which they can be much criticised. And to be fair, several Labor shadow ministers used this period productively to explore what a post-pandemic order might look like.
We complain about our politicians spending too little time reading and thinking. We should notice when they do. This was Labor performing the second of those functions of opposition: crafting an alternative government.
The gods have been kinder to Labor during 2021. The government has been mired in crisis, scandal and sleaze. Labor, meanwhile, has benefited from its slow and steady achievement of greater gender equity during decades in which the Coalition’s performance in this area has deteriorated.
Labor has admittedly had to do little to keep the government accountable in these matters – Morrison’s ineptness and an enterprising group of mainly female journalists have done its job for it – but the party has benefited enormously from having capable women in leadership positions. Albanese has been able to avoid looking like another well-meaning mansplainer when the issues of sexual assault and harassment are in the spotlight.
The blatant failures of the vaccination program have provided new opportunities for the Labor Party to criticise a government that likes to present itself as the saviour of the Australian people in its hour of need – as Psalm 46 would have it, “a very present help in trouble”.
Electors seem less certain. They have returned two state Labor governments in Queensland and Western Australia widely perceived to have kept their populations safe. Other state governments remain popular, even that of Daniel Andrews, despite Victoria’s ordeal of a second wave of infections.
It is not clear how much credit the Morrison government will be able to claim. Dealing competently with the Global Financial Crisis in 2008-9 appeared to win the Rudd government limited credit among voters in the medium term. It was persecuted for a few failures instead.
Albanese’s place in these considerations remains an ambiguous one. Tanya Plibersek seems to have emerged as the most likely alternative and, if Albanese were to falter at the next election, his successor.
The rules adopted by the Labor Party during the second Rudd prime ministership in 2013 make it difficult to remove a leader between elections unless he or she agrees to go. In any case, and leaving aside the party’s split under Billy Hughes in 1916 and the interim leadership of Frank Forde in 1945, Labor has still only once removed a leader without giving him the opportunity to fight an election: Simon Crean in 2003.
As the son of a single mother raised in public housing, Albanese has a backstory that might be attractive to may voters, if they only knew it. He is a consummate political professional in an age of political professionals, admired for his management of parliamentary business during the challenging minority government of Julia Gillard.
Albanese would not have been among the front rank of ministers in the best Labor governments of the modern era — those of Bob Hawke in the 1980s. But that probably isn’t a large mark against him. After all, the general quality of our political leaders has deteriorated since then, too.
At the very least, the turn of the political dial seems to give Labor, and Albanese, a fighting chance.
Kathryn Daley, RMIT University; Belinda Johnson, RMIT University, and Patrick O’Keeffe, RMIT UniversityOf the more than 870,000 Australians who lost their jobs in the first few months of the COVID-19 crisis, 332,200 – or 38% – were young Australians aged 15-24.
By June 2020, as the overall unemployment rate hit 7.4%, the youth unemployment rate spiked to 16.4%, with a further 19.7% underemployed (working fewer hours than they wanted).
As of February the overall unemployment rate had fallen to 5.8%, compared with 5.1% in February 2020. The youth unemployment rate meanwhile was 12.9%, compared with 11.5% the year before, and a further 16% were underemployed.
Prime Minister Scott Morrison has enthused about there now being “more jobs in the Australian economy than there were before the pandemic”. But that’s true only for those 25 and older: 77,600 more are employed than before the crisis. For those aged 24 and under, 74,100 fewer have jobs.
So clearly the pandemic has hit younger workers the hardest. The reasons for disproportionate impact aren’t complicated. Young people are more likely to work in casual jobs – the first to be excised in hard economic times – and in those sectors most affected by border closures, lockdowns and other measures – retail, hospitality, tourism.
Yet the federal government’s policy responses, injecting billions of dollars into the economy to support businesses and employment, have compounded this impact through deliberate yet flawed policy design.
JobKeeper has kept proportionally fewer young people in jobs. Changes allowing withdrawal of superannuation will hurt them more in the longer term. And JobMaker, the program designed specifically to encourage employment of younger workers, has proven a monumental flop.
The centrepiece of the federal government’s support measures was the A$100 billion JobKeeper program, initially paying a subsidy of $750 a week before tapering and finally being axed at the end of March.
The Reserve Bank of Australia estimates JobKeeper payments kept at least 700,000 workers off the dole queue. But to qualify, employees had to have been working for their employer for a minimum of 12 months.
This disproportionately excluded younger workers – being more likely to be recent workforce entrants, to switch jobs more than older workers, and to be in employed in casual or other forms of insecure work.
To illustrate, Australian Bureau of Statistics data from August 2019 shows young people comprised 17% of the workforce yet accounted for 46% of all short-term casual employees.
Of those employed casually, 26.4% of young people had been with their employer for less than 12 months, compared to 6.5% of those aged 25 and over. So one in four young people employed casually were not eligible for JobKeeper, compared with only one in 16 of their older counterparts.
JobKeeper’s design thus pushed proportionally more younger workers on to the dole queue. It also likely contributed to more of them dipping into their superannuation savings under the provisions announced by the federal government in March 2020.
Those provisions allowed Australians affected by the economic crisis to withdraw up to $20,000 from their superannuation accounts (in two rounds of $10,000 each – one last financial year, another this financial year).
The Industry Super Australia estimated about 395,000 people under 35 completely drained their super accounts.
This emptying of accounts is not surprising given the average superannuation balance by age 30 is about $28,000 for men and $23,700 for women.
But it means many will have considerably less super to retire on. The long-term cost of a 25 year-old withdrawing $20,000 is more than $100,000, compared with about $37,000 for a 50-year-old, according to estimates by financial comparison site Canstar.
Spend now, lose later
There’s also evidence the design of the super-access scheme has allowed unnecessary withdrawals. While those taking out money have had to declare they need the money to pay for essential items (such as rent or bills), there has been no scrutiny of this prior to approval.
Indeed, according to credit-scoring company Illion about two-thirds of the funds withdrawn this financial year was spent on discretionary items such as clothing, furniture, restaurants and alcohol.
As former prime minister Paul Keating has put it, the government has relied on individuals “ratting their own savings” to buttress its own stimulus spending.
The one program meant to specifically address youth unemployment, the JobMaker Hiring Credit, has so far proven a failure. Its aim is to incentivise employers to hire job seekers aged 16 to35 with a weekly $200 subsidy, creating 450,000 jobs over two years. But in late March, Treasury officials revealed it had so far led to just 609 hires.
All unemployment is costly for individuals, families and the wider community. But high and long-term youth unemployment can have particularly dire consequences that reverberate for decades. It creates the risk of “scarring”, suppressing an individual’s job and income prospects over their entire life. That ultimately requires the government picking up the tab.
Youth unemployment was already a significant issue prior to the COVID crisis. Now, with younger people hit hardest by the pandemic’s economic impacts, it’s imperative to ensure an entire generation is not permanently disadvantaged.
Kathryn Daley, Senior Lecturer & Program Manager – Youth Work and Youth Studies. School of Global, Urban and Social Studies, RMIT University, RMIT University; Belinda Johnson, Lecturer and Program Manager, Social Science (Psychology), School of Global, Urban and Social Studies, RMIT University, RMIT University, and Patrick O’Keeffe, Lecturer, Bachelor of Youth Work and Youth Studies, RMIT University
Prafulla Shriyan, Indian Institute of Public Health, Gandhinagar and Giridhara R Babu, Indian Institute of Public Health, GandhinagarAfter genome sequencing of over 10,000 COVID-19 cases in India, researchers have discovered a new variant with two new mutations which may be better at evading the immune system.
In 15-20% of samples from the Indian state of Maharashtra (the state accounting for 62% of cases in the country) a new, double mutation in key areas of the virus has been detected. These are now known as the E484Q and L452R mutations.
Both these mutations are concerning because they are located in a key portion of the virus – the spike protein – that it uses to penetrate human cells. Spike proteins attach via a “receptor binding domain”, meaning the virus can attach to receptors in our cells.
These new mutations include changes to the spike protein that make it a “better fit” for human cells. This means the virus can gain entry more easily and multiply faster. Given what we have seen with other similar mutations, it might also make it harder for our immune system to recognise the virus due to its slightly different shape. This means our immune system may not be able to recognise the virus as something it has to produce antibodies against.
The emergence of these new variants has only been possible because of the continued viral replication in areas with high circulation.
Though the Indian government has said the data on the variants circulating in India (including this new Indian variant and others including the UK strain) are not sufficient to link them to the rapid increase in the number of cases in the country, we think it’s the most likely explanation. The country had managed to bring down the rate in February, but a sudden increase in the number of reported cases is now being reported.
The implications of these developments are greatly concerning – not just for India, but for the rest of the world. Mutations can result in 20% more in-hospital deaths, as we witnessed during the second wave in South Africa. This is because some mutant variants have the ability to spread faster, resulting in sudden surges and, therefore, an overburdened health system.
But there’s hope. Places around the world with higher vaccination coverage such as the UK and Israel are witnessing a steady decrease in cases.
Most of the currently approved vaccines around the world have been found to evoke an immune response to some extent against multiple variants. But no trials have yet been undertaken on the effectiveness of vaccines against these new Indian mutations.
To make it difficult for the mutant strains to develop vaccine resistance, we have to ensure wider and faster vaccine coverage across the world.
Apart from vaccine manufacturers’ efforts to update the composition of vaccines to better deal with new strains, it is important to contain transmission across the world. Countries can use the World Health Organisation’s SARS-CoV-2 Risk Monitoring and Evaluation Framework to help identify, monitor and assess variants of concern, swiftly.
To establish a direct link between a variant and a steep rise in cases in a short time, it is important to use genomic sequencing to link clusters together. But unless contact tracing is done meticulously, it isn’t easy to do so.
It is also important to understand the mechanisms involved in the infectiousness and virulence of the newer variants. For this, lab models are needed to mimic spread and virulence mechanisms efficiently.
To combat the consequences of mutations in India, its pandemic response will have to incorporate several measures. Genomic surveillance will have to be proactive and coincide with the epidemiological investigation of the cluster of cases for early identification and swift action.
As some variants can escape naturally induced immunity, vaccine manufacturers in India will need to develop better vaccines to cover these new variants. Ongoing surveillance and containment measures need to be strengthened to prevent the emergence of new variants by minimising viral replication.
And finally, swift and rapid vaccine coverage is not only necessary but essential for ensuring any modest levels of success in tackling this pandemic.
Prafulla Shriyan, Research Fellow, Public Health Foundation of India, Indian Institute of Public Health, Gandhinagar., Indian Institute of Public Health, Gandhinagar and Giridhara R Babu, Professor, Head-Lifecourse Epidemiology, Indian Institute of Public Health, Indian Institute of Public Health, Gandhinagar
Steven HailThere are many uncertainties about the next federal election, but there is one thing about which you can be almost completely certain. It is the response that both the Prime Minister and the Leader of the Opposition will give when asked this question:
How are we going to pay off our COVID-19 debt?
Scott Morrison and Anthony Albanese disagree on a great many things, but in their answer they will be in perfect harmony.
It will be: “we will need to pay it back in the future by spending less or taxing more — otherwise, we might lack the means to deal with a future crisis”.
They might even talk about “fiscal firepower” — the need to up a budget surplus in order to have something to spend the next time there’s an emergency.
The strange thing is that although this is for them the safest answer to give, and although it is the conventional wisdom, it simply isn’t true.
Consider the following chart. It shows the general government debt as a share of gross domestic product in six countries with similar monetary systems to Australia’s, just prior to the pandemic, and then a year later.
You cannot help but notice that four of the other five countries had more general government debt than Australia before the COVID crisis, and Japan’s national government had four times as much government debt as Australia.
It made no difference to their ability to spend as needed to support their economies during the pandemic, none whatsoever.
This means it’s wrong to suggest that our government wouldn’t be able to support its economy, even if it didn’t pay back its COVID-related debt.
You might imagine (it’s been said) that more government debt would drive up interest rates, but of late that hasn’t been the case either.
Indeed, the rate of interest on 10-year Japanese government bonds has been close to zero for five years, because it has been held there by the Bank of Japan.
Or perhaps you think that more government debt will lead to higher inflation. In Japan and elsewhere that hasn’t happened either. Japan has had the lowest average inflation rate of these six countries.
So many myths.
The pivot the Coalition is taking to winding back spending with the end of JobKeeper and the withdrawal of a liveable JobSeeker payment isn’t needed, and is also unwise.
The reluctance of the Labor Party to support a non-poverty unemployment benefit, and its promise to avoid net spending commitments in its election platform, are also unjustified.
Especially in an economy where labour force underutilisation (unemployment plus underemployment) remains over 14%. Nearly two million people are either unemployed or underemployed.
Many more are in insecure employment, including hundreds of thousands whose jobs are now at risk because of the failure to replace JobKeeper with something such as with a federal job guarantee.
It isn’t as though the Australian Greens are speaking from a fiscal script which is that different. The Greens obsess over costing their policies and finding extra tax from resource companies and billionaires to “pay for” their commitments to full employment, social security, education, healthcare, and investment in renewables.
They may not talk so much about repaying the debt, but they do not want to be accused of adding to it.
Like the bigger parties, the Greens are reluctant to challenge the narrative of the federal government as a household, with a budget it must manage in order to avoid insolvency.
But the household metaphor is another myth, and it needs to be challenged.
The federal government’s finances have nothing in common with those of a household, however wealthy that household might be, and nothing in common with any business, big or small, or even state and territory governments.
None of these are currency issuers. They have to generate income or borrow before they can spend, and their borrowing puts them at risk of insolvency.
Our federal government is different, like the national governments of Japan and the United States. It is the monopoly issuer of the Australian-dollar-denominated currency.
The government does not need to increase taxes in order to increase spending, and it doesn’t even need to borrow. Its Reserve Bank issues currency for it all of the time, every day.
Federal government spending is funded when it is authorised, usually by parliament.
Having spent its currency into existence, the government usually offers savers the opportunity to convert that currency into treasury bonds, which usually offer a better rate of interest than transaction accounts with a bank.
Our government chooses to sell treasury bonds – it doesn’t need to.
This means it can’t be held hostage by the bond market. It can’t be forced into insolvency or austerity. The selling of bonds doesn’t constitute borrowing in the normal sense of the term. It is better described as a way of winding back the money supply.
At the end of the life of the bond (when the “loan” comes due) it can pay it off (swapping cash for the bond). Or it can issue a replacement bond if it doesn’t want to inject more money into the economy.
It’s not just me saying that. It is also a senior economist with the US Federal Reserve, David Andolfatto, in December in a paper published by the St Louis Fed.
Together these considerations suggest we might want to look at the national debt from a different perspective. In particular, it seems more accurate to view the national debt less as a form of debt and more as a form of money in circulation.
President Biden is listening to voices like Andolfatto’s. Australian politicians are not. Ours continue to see federal deficits as a burden on future generations, when they are not that at all – they supply financial resources to the present generation.
The national debt is nothing more than the dollars the government has put into the economy and not yet taxed back out. Deficits matter, but not the way Albanese and Morrison seem to imagine. They matter because if they get too big, they might stoke too much inflation.
In an economy with spare capacity (unemployment and underemployment) and with wage setting institutions that make it difficult to argue that there will be significant persistent inflation in the foreseeable future, there is no reason at the moment to wind back spending, not until unemployment and underemployment are much lower.
For the Greens, there is no need for them to tie themselves in knots, arguing on the one hand that they need to shrink coal mining to address climate change and on the other that they need to raise taxes from the mining industry to pay for government services.
Taxes collected from the mining and other industries (and form individuals) don’t fund federal government spending. It is self-funded. And the limits on spending are not imposed by tax receipts and the ability of the government to borrow. They are imposed by the availability of productive capacity in our economy and our ability to use that capacity without stoking inflation.
When our leaders are next asked, “how are we going to pay off our COVID-19 debt”, they ought to take a deep breath, look the interviewer in the eyes, and say “we don’t need to, because it is not debt in the conventional sense of the term”.
They ought to tell the public the truth. It’s a novel idea, perhaps, but it would lead to a better educated public and a fairer and better-managed economy.
Steven Hail, Lecturer in Economics
Michelle Grattan, University of CanberraThe vaccine rollout was thrown into fresh uncertainty on Thursday night after the government received medical advice against using the AstraZeneca vaccine for people under 50 because of the very small risk of blood clots.
Most immediately, this means those younger health and aged care workers who have not yet been vaccinated will be offered the Pfizer shot. This may involve delays.
These people are in the cohort currently being vaccinated, together with over 70s who are unaffected by the new advice, which went to the government on Thursday evening.
Scott Morrison said the later stages of the rollout will now urgently be re-examined and re-calibrated. He said it was “far too early” to say what impact it would have on the rollout’s timetable.
The government’s deadline for all eligible people who want a vaccine to receive at least one shot by the end of October is set to blow out.
Vaccine purchases will also be reviewed.
Morrison unveiled the advice from the Australian Technical Advisory Group on Immunisation at a hastily summoned press conference on Thursday night, also attended by Health Minister Greg Hunt, Chief Medical Officer Paul Kelly, and Health Department Secretary Brendan Murphy.
Morrison said he had received the advice “in the last 15 minutes”.
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.
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.”
Under 50s who’ve already had one AstraZeneca dose without serious adverse effects can be given a second dose, the advice said.
ATAGI described the possible blood clot side effect as “rare but serious”.
Advice is being provided to GPs involved in the rollout.
This is the latest difficulty to hit the rollout. The government this week stressed the main problem was shortage of supply, with AstraZeneca doses from Europe being held back and CLS, which is manufacturing the vaccine locally, not gearing up to the one million weekly target as fast as expected.
As of Thursday, one million doses of one or other of the two vaccines had been administered in Australia. At present Australia only has the two vaccines available.
Morrison stressed that decisions were up to individuals and their doctors – this was advice only.
“There is not a prohibition on the use of the AstraZeneca vaccine for persons under 50. There is an expression of a preference.”
Kelly said a clot was very rare. “At the moment, it seems to be around four to six per million doses of vaccine. It’s only been found in the first dose of the AstraZeneca vaccine, usually within four to 10 days after that vaccine. But it is serious, and it can cause up to a 25% death rate when it occurs.”
In a late night statement AstraZeneca said it respected the government’s decision based on advice to recommend AstraZeneca’s vaccine be used in those over 50.
It noted that, “Overall, regulatory agencies have reaffirmed the vaccine offers a high-level of protection against all severities of COVID-19 and that these benefits continue to far outweigh the risks”.
The recommendation came after the European Medicines Agency (EMA) found a “possible link” between the vaccine and blood clots. The EMA also said blood clots should be listed as a “very rare” side effect of the vaccine.
It’s important to note there’s still no conclusive evidence the vaccine is causing the clots, as so few have been reported. However, evidence there is a link is increasing, which has prompted more focused monitoring.
The benefits of getting a COVID vaccine still far outweigh the risks. I would still be encouraging everyone to be vaccinated with the AstraZeneca vaccine.
Prime Minister Scott Morrison said this morning “there’s nothing to suggest at this stage that there would be any change” to Australia’s current rollout strategy. The Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation are currently reviewing the data and latest advice from Europe and the UK.
Blood clotting events linked to vaccination are being called “vaccine-induced prothrombotic immune thrombocytopenia” (VIPIT).
In these rare instances, clots are forming in a patient’s blood, and not just in veins but in arteries and other rare locations like the brain and abdomen. This is also paired with low platelet counts (cells needed for the blood to clot).
It appears, in these instances, the body’s response to the vaccine is triggering an “off target” immune response that is attacking platelets. Limited data that is yet to be peer reviewed suggests antibodies targeting platelets cause them to become activated and trigger clotting. This autoimmune response also targets the platelets for destruction, reducing their level in the blood. So platelets are either tied up in clots or are eliminated. Both processes contribute to “thrombocytopenia” (low blood platelet count).
Like infections, vaccines trigger an immune response, so when receiving any shot that stimulates a robust immune response there’s a small but real risk your immune system will generate “off target” effects. In these rare instances, these effects can lead to autoimmunity, which is an immune response that attacks your own cells.
The numbers of clots reported after the AstraZeneca are very small, so we don’t exactly know how common they are. But they appear to occur at a rate between one in 25,000 and one in 500,000.
The UK’s vaccine advisory board said there were 79 cases of blood clotting issues among more than 20 million people given the AstraZeneca vaccine. That’s a chance of about 0.0004%, or one in 250,000.
Researchers haven’t yet identified any specific risk factors so far for the development of blood clots following COVID vaccination. We need to understand as quickly as possible what these are if indeed a causal link is established.
Some have suggested there could be a link with women taking the contraceptive pill having a higher risk of blood clots after receiving the AstraZeneca vaccine. But there’s no evidence for this at all. As far as I know, information on whether women receiving the vaccine are taking the contraceptive pill isn’t captured. Perhaps it’s something to consider going forward.
Young people don’t appear to be at particularly higher risk of blood clots linked to the vaccine. The publicised cases of blood clots have occurred in mostly women under 60 years of age.
One reason the UK is able to advise younger people to receive other vaccines is because it has other vaccine options, including the Pfizer and Moderna shots. Offering the under 30s an alternative vaccine isn’t really going to hinder the rollout, which is going very well in the UK.
But this isn’t the case in Australia. The AstraZeneca shot is the only one we have guaranteed supply of, given CSL is producing it in Melbourne.
It’s important to remember the AstraZeneca vaccine is a very safe and effective vaccine. It’s also easier to store and distribute than the Pfizer vaccine.
It’s important to note we’re in uncharted territory. This is the first time in modern history we’ve been in a situation where we’ve needed to roll out a vaccine to deal with a pandemic.
We’re also using new vaccine technologies that we’ve had to expedite to try and get on top of this virus as soon as possible. These new technologies, including AstraZeneca’s, have never been tested at this immense scale until now.
There are a lot of unknowns, but certainly the scale in which were doing this means we’re going to see very rare adverse events linked to these vaccines.
At this stage the priority is still to vaccinate as many people as possible, as quickly as possible.
My primary concern is ongoing high levels of transmission across the world. The more cases there are, and longer we delay vaccinating people, the higher the likelihood is of new variants of the virus emerging.
Even though we have very low COVID-19 case numbers in Australia currently, we’ve seen regular outbreaks stemming from hotel quarantine. We can’t predict what’s going to happen in the future. The longer the virus is waiting at our doorstep, the greater the risk we’ll have another outbreak and end up in lockdown and much worse — and nobody wants that.
Anthony Zulli, Victoria University; Maja Husaric, Victoria University; Maximilian de Courten, Victoria University, and Vasso Apostolopoulos, Victoria UniversityThe federal government has asked Australia’s medical and vaccine regulators to urgently consider the European Medicines Agency’s finding of a possible link between the Oxford/AstraZeneca COVID vaccine and rare blood clots.
This follows reports over recent weeks of blood clots in a small number of people around the world who had received the AstraZeneca vaccine, including one man who was hospitalised in Melbourne.
Scientists have termed the condition “vaccine induced prothrombotic immune thrombocytopenia” (VIPIT). But what does this actually mean, how significant is the risk, and what are the implications for Australia’s vaccine rollout — which is currently relying predominantly on the AstraZeneca jab?
As indicated by its name, VIPIT is a form of something called thrombocytopenia.
Thrombocytopenia is a condition whereby the numbers of thrombocytes (very small blood particles, or platelets) are markedly reduced. Platelets form clots to stop bleeding, so when you don’t have enough platelets in your blood, your body can’t form clots. This can lead to excessive bleeding.
The condition has a genetic component, but can also arise from more than 300 common medicines, including penicillin and certain pain killers. Quinine, which is added to tonic water for flavour, can also very rarely cause thrombocytopenia.
The symptoms of VIPIT can include severe headaches, abdominal pain, seizures and visual changes. These are similar to the symptoms of thrombocytopenia unrelated to the vaccine.
In rare cases of thrombocytopenia, clots can develop in the vessels draining blood from the brain. The European Medicines Agency said it had received reports of 169 cases of brain blood clots in people who had been vaccinated with the AstraZeneca shot.
In severe cases, thrombocytopenia can be fatal. There have been deaths from blood clots reportedly associated with the AstraZeneca vaccine, including 19 in the United Kingdom.
So how could this vaccine potentially cause thrombocytopenia? The “prothrombotic immune” part of the name denotes it’s caused by an over-activation of the immune system, which gives us a clue.
The AstraZeneca vaccine prompts cells to make a specific part of SARS-CoV-2 (the virus that causes COVID-19), called the spike protein, which the virus uses to attach to cells when infecting us.
The vaccine stimulates our immune system to generate antibodies against the spike protein, which then primes the body to mount an immune response against SARS-CoV-2, if it encounters the virus in the future.
But in some people, the AstraZeneca vaccine seems to produce antibodies that react with platelets, making them stick together, leading the blood to clot. This in turn reduces circulating platelet numbers, and hence the thrombocytopenia.
These antibodies are similar to those found in some people on a blood thinning drug called heparin. The immune response to heparin generates antibodies that bind to platelets. This can lead to blood clots in some people, called heparin induced thrombocytopenia. As many as one in 20 patients receiving heparin develop thrombocytopenia.
Keeping in mind we’re yet to establish cause and effect, it’s a possibility that the biological mechanism by which we believe heparin leads to thrombocytopenia could be the same biological mechanism by which the AstraZeneca vaccine might.
Naturally occurring thrombocytopenia affects about one in 30,000 adults a year in the United States.
As for the suspected vaccine-induced kind, according to data collated by the Thrombosis and Haemostasis Society of Australia and New Zealand, VIPIT is as rare as one in 500,000 people. But the society notes the data are incomplete.
Different countries have reported different rates. Norway, for example, has so far reported one in 25,000 vaccinated adults under the age of 65 have experienced low platelet counts, bleeding, and widespread thromboses (blood clots).
Of course, the possibility that some of these cases of thrombocytopenia may have occurred regardless of the vaccine makes understanding vaccine-induced cases more complicated. But taken together, thrombocytopenia appears to be more common in the general population than among those who have been vaccinated.
As we continue to vaccinate the world, it’s likely small subsets of people will continue to experience this complication. Whether we can establish a causal link between the AstraZeneca vaccine and thrombocytopenia is subject to continued investigation.
Amid this ongoing investigation, some countries, such as Norway, have paused their rollouts of the AstraZeneca vaccine. Others have restricted use of the vaccine in certain groups, like Canada, which is using it only for adults older than 55, who may have higher risks from COVID and lower risk of blood clots. Meanwhile, the UK has pledged to make other vaccine options available for younger people.
We will wait to see how the Australian experts respond. But for the general adult population, we agree with the current guidance from bodies including the European Medicines Agency and the World Health Organization that the benefits of the AstraZeneca vaccine outweigh the risks.
That said, it’s not unreasonable to be cautious. You should monitor for these symptoms up to 28 days after receiving the jab:
If you’re experiencing any of these symptoms and you’re concerned, seek medical advice.
Anthony Zulli, Associate professor, Victoria University; Maja Husaric, Senior Lecturer; MD, Victoria University; Maximilian de Courten, Professor in Global Public Health and Director of the Mitchell Institute, Victoria University, and Vasso Apostolopoulos, Professor of Immunology and Associate Provost, Research Partnerships, Victoria University