This represents a vote of confidence in our vaccine supply, which has been riddled with issues since the rollout began. It gives us a fighting chance to reach current targets, which suggest 70% of eligible Australians could be fully vaccinated by November, and 80% by December.
Importantly, given what we know about the high rates of COVID infections in younger people, and the significant role they’re playing in transmission, this is good news. Boosting vaccination rates in this group will be a crucial step towards controlling the virus.
And with some young adults in different states already eligible for the Pfizer vaccine (depending on where they live, their job, and so on), this move will hopefully serve to reduce confusion.
Why vaccinating younger adults is important
Throughout New South Wales’ current COVID outbreak, we’ve heard young people are being disproportionately infected. We’re hearing this in Victoria too.
In part, this is because this group is generally more mobile, both in the nature of their work and social lives. Of course, the latter shouldn’t be relevant under lockdown conditions, but younger adults are also more likely to live in shared households with essential workers from different workplaces.
While 20 to 39-year-olds have made up the highest proportion of cases throughout the pandemic, the growing numbers of older adults now vaccinated could go some way to explaining why younger adults and children are making up an even greater proportion of infections of late.
Worryingly, data from the NSW outbreak also suggests young people are making up a higher proportion of patients admitted to hospital with COVID-19 compared to earlier in the pandemic.
Given young adults make up a high number of cases, it follows they are big drivers of transmission. The Doherty Institute’s recent modelling described young and working age adults as “peak transmitters” of COVID-19, and advocated vaccinating people in their 20s and 30s would reduce overall spread.
It made sense to prioritise people at highest risk of severe outcomes from COVID-19, as well as those in high-risk jobs, for vaccination earlier on. But there’s a fair bit of catch up to do now to get these younger age groups vaccinated.
For example, 33.5% of 35 to 39-year-olds have received one dose of a COVID vaccine, compared to 86.1% of 75 to 79-year-olds. Some 25% of 25 to 29-year olds have had a first dose, compared to 76.1% of 65 to 69-year-olds.
Opening up Pfizer for everyone aged 16 to 39 will allow us to boost numbers in those younger age groups and in turn, reduce infections and transmission.
Don’t dismiss AstraZeneca
This news should be impetus for anyone currently eligible for Pfizer who hasn’t got it yet (predominantly adults in their 40s and 50s) to make an appointment as soon as possible. Because it’s only going to get harder once millions more people become eligible.
For people aged 16 to 39 who are champing at the bit for a Pfizer vaccine, it’s important to be aware you probably won’t be able to get one the day bookings open. It may well be that you have to wait weeks for an appointment.
So if you were already considering getting the AstraZeneca vaccine, or if you’ve already booked an appointment, stick with that.
It’s a highly effective vaccine, the risk of any complication is incredibly small, and the benefits are significant — particularly in areas like Sydney, where we’re seeing high community transmission and young people fighting the virus in ICU.
What about a ‘mix and match’ approach?
While supply of Pfizer is increasing, and we expect to start receiving Moderna next month, daily demand for these mRNA vaccines is still outpacing supply.
One possible way to address this would be to give some people a first dose of AstraZeneca, and then a second dose of Pfizer. This would allow us to start vaccinating more people sooner and stretch the Pfizer supply further.
Ensuring everyone has the rights that come with vaccination
Vaccination is becoming increasingly important, not only in the face of current Delta outbreaks, but for personal movements and freedoms as rules are introduced that recognise the lower risk of infection among the vaccinated.
For example, people travelling from NSW into Western Australia need to prove they’ve had at least one dose of a COVID vaccine.
Meanwhile, some countries around the world are requiring proof of vaccination to visit the likes of museums, cinemas and to dine indoors — activities that might not be open at all in the absence of vaccination.
Broadening the vaccine rollout to younger people now ensures they will have time to access vaccination and won’t be disadvantaged by any such rules down the track.
We’ve been keeping track of how old these people were, and have observed 85% of the COVID deaths up to August 18 (51 out of 60) were among people aged over 60.
We’ve also been taking note of reports on their vaccination status. It appears 96% of those over 60 who have died (49 of 51) were not vaccinated, or had only received one dose.
These deaths are tragic and, in all likelihood, were preventable. So if you’re over 60 and are yet to be vaccinated, now is not the time to hesitate.
Older age increases your risk from COVID-19
Age is a major risk factor for serious illness and death from COVID-19.
A person aged 65-74 is at six times greater risk of hospitalisation and 95 times greater risk of dying compared to an adult under 30.
People over 85 are 15 times more likely to be hospitalised and 600 times more likely to die than 18 to 29-year-olds.
This is why Australia’s vaccination program has prioritised older adults.
So why do people in this age group remain unvaccinated?
Most older Australians are vaccinated
This ranges from 71% for 60 to 64-year-olds, to 86% for 75 to 79-year-olds.
So despite the criticism of Australia’s vaccination program, more than three-quarters of Australians aged 60+ have at least partial protection from COVID-19.
Still, that leaves 1.2 million Australians aged 60+ yet to receive a first dose of any COVID vaccine, despite having been eligible for vaccination for several months.
What are they waiting for?
For a variety of reasons, no vaccine ever achieves 100% take-up. But most Australians over 60 want to be vaccinated. Surveys have shown over 65s are the least hesitant age group. As of August 7, only 6.75% of adults over 65 were unwilling to be vaccinated.
Some people have experienced difficulty accessing the vaccine. In particular, we need to improve access in areas which are more vulnerable to COVID outbreaks.
We can read this to mean they’re waiting for what they perceive to be a “better” vaccine — an mRNA vaccine from Pfizer or Moderna.
Sadly, with the NSW outbreak escalating, and the increasing frequency and likelihood of COVID outbreaks across Australia, some of these folks may die waiting.
AstraZeneca is a highly effective vaccine
The vaccine for which all people aged 60+ in Australia are currently eligible is AstraZeneca.
While adequate supply of the Pfizer vaccine has been an ongoing issue and shipments of the Moderna vaccine are yet to commence, AstraZeneca is being produced in Australia and is widely available.
But not everyone is keen on it.
Some of the lack of enthusiasm surrounding the AstraZeneca vaccine relates to the perception it is less effective than Pfizer.
The most important outcome, however, is prevention of serious illness from COVID-19, and both vaccines perform similarly well on this metric after two doses. Recent modelling from the Doherty Institute assumed an 86% reduction in hospitalisation with the Delta variant after two doses of AstraZeneca, compared to 87% after two doses of Pfizer.
For deaths from Delta, the difference is also very small. The AstraZeneca vaccine is believed to achieve a 90% reduction after two doses, compared to 92% with Pfizer.
Although milder COVID-19 infections occur more commonly in people who have been fully-vaccinated with AstraZeneca, “breakthrough” infections also occur with Pfizer.
So, the benefits of AstraZeneca are clear and the differences between AstraZeneca and Pfizer in terms of effectiveness against the most worrisome outcomes of COVID-19 are very small.
But what about the risks?
Both vaccines have common side effects including pain at the injection site, fatigue and headache. While these side effects are more common with AstraZeneca, they don’t last long with either vaccine.
So that brings us to blood clots. In March, just weeks into the launch of Australia’s vaccination program, reports emerged of a rare clotting syndrome following use of the AstraZeneca vaccine.
Named thrombosis with thrombocytopenia syndrome (TTS) to describe the unusual combination of serious blood clots with a low platelet count, the discovery of this significant complication saw changes to COVID-19 vaccination guidelines in many countries, including Australia.
Deaths from TTS have received extensive coverage in the media, and concern about this condition is undoubtedly a key reason for reluctance towards AstraZeneca.
But importantly, the risk of TTS is small, and becomes lower as you get older (the opposite of the risk from COVID-19). The Australian Technical Advisory Group on Immunisation has estimated below age 60, the incidence of TTS is 2.7 per 100,000 doses. Over age 60 the incidence is thought to be 1.8 in every 100,000 doses.
Of 112 cases of confirmed or probable TTS that have occurred in Australia to date, a total of six people have died. One was over 60 (a 72-year-old woman).
Based on these statistics, if the 1.2 million Australians over 60 not yet vaccinated all received AstraZeneca, we would expect about 22 to develop TTS and one or two of them to die.
While these are serious albeit rare complications, remember that in NSW, in an outbreak with close to 10,000 cases of COVID-19 diagnosed to date, more than 50 people over 60 have already died and more will unfortunately follow.
Balancing the risks and the benefits
Balancing risks and benefits is key to informed decision-making before taking any medication; none are risk-free.
For those 1.2 million Australians over 60 yet to be vaccinated, the benefits of taking the vaccine available now — AstraZeneca — are high, and for most people will outweigh the small risks.
The threat of COVID-19 is no longer theoretical, especially for those living in Sydney and other major metropolitan cities.
And this year’s jabs will not be the last over 60s receive. While it’s very likely mRNA boosters (Pfizer and Moderna) will be offered in 2022, you’ll need to be alive to get one.
Adrian Beaumont, The University of MelbourneThis week’s Newspoll, conducted August 4-7 from a sample of 1,527, gave Labor a 53-47 lead, unchanged from three weeks ago. Primary votes were 39% Coalition (steady), 39% Labor (steady), 11% Greens (up one) and 3% One Nation (steady). Figures are from The Poll Bludger.
49% were dissatisfied with Scott Morrison’s performance (up four), and 47% were satisfied (down four), for a net approval of -2, down eight points. This is Morrison’s first negative rating since the start of the COVID pandemic in April 2020. Analyst Kevin Bonham said Morrison had the fourth longest streak of positive Newspoll ratings for a PM.
Opposition Leader Anthony Albanese’s net approval was steady at -8. Morrison’s better PM lead narrowed from 51-33 to 49-36.
Newspoll’s COVID questions continued to show declines for Morrison. On overall handling of COVID, he has a 49-48 poor rating (52-45 good three weeks ago and 70-27 good in April). The vaccine rollout had a 59-38 disapproval rating (57-40 three weeks ago, 53-43 approval in April).
With Sydney in an extended lockdown that is likely to last until vaccination rates are high, and current and recent lockdowns in Melbourne and south-east Queensland, people have become frustrated with the slow vaccination rollout.
But the next election is not required until May 2022. Vaccination levels will very likely be high enough by then to reopen. While the economy will be damaged by the lockdowns, past experience in Australia and overseas shows that the economy will recover quickly once the lockdowns end.
The Guardian’s datablog shows 17.8% of Australia’s population is fully vaccinated, while 17.5% has received just one dose (this means 35% have had either one or two doses). Among OECD countries, we currently rank 35 of 38 in our fully vaccinated share. We were last a month ago, but have overtaken South Korea, New Zealand and Costa Rica.
47% of unvaccinated in Essential would take Pfizer but not AstraZeneca
In last week’s Essential poll, 47% of those who have not yet been vaccinated said they would be willing to get the Pfizer vaccine, but not AstraZeneca.
About one in a million people who receive AstraZeneca die from a blood clot issue. Alarmism from the media and health authorities has tainted an effective COVID vaccine. Australians’ reluctance to get AstraZeneca has impaired the vaccination rollout.
ATAGI’s June recommendation that only those aged over 60 be vaccinated with AstraZeneca, and Queensland Chief Health Officer Jeannette Young’s attacks on AstraZeneca have been particularly unfortunate. It took until late July for ATAGI to change its advice on AstraZeneca, and then only for those in Sydney.
By contrast, the UK has vaccinated most of its adult population using AstraZeneca, and AstraZeneca creator, Sarah Gilbert, received a standing ovation at Wimbledon.
Other Essential questions and Morgan poll
In other Essential questions, 50% approved of Morrison’s performance (down one since July), and 40% disapproved (steady), for a net approval of +10. But Albanese’s net approval slumped ten points to -4. Morrison led Albanese by 45-26 as better PM (46-28 in July).
While Morrison’s ratings were stable, the federal government’s response to COVID was rated as good by just a 38-35 margin (46-31 good in mid-July, and 58-18 in late May, before the current lockdowns began).
The NSW government’s response to COVID was rated good by 47% (down seven), the Victorian government’s by 54% (up five), and South Australia’s by 73% (up five). This poll was taken before the new Victorian lockdown.
50% of NSW respondents thought NSW did not lock down hard enough, with 39% believing it to be about the right level and 11% too harsh. For Victoria, responses were 71% about right, 23% too harsh and 6% not hard enough.
By 66-11, voters supported the return of JobKeeper to assist people and businesses affected by lockdowns. By 67-18, voters opposed the recent anti-lockdown protests in Sydney, Melbourne and Brisbane.
A Morgan federal poll, conducted July 24-25 and July 31-August 1 from a sample of over 2,700, gave Labor a 53.5-46.5 lead, a 1% gain for Labor since mid-July. Primary votes were 37% Coalition (down two), 37% Labor (steady), 12.5% Greens (up one) and 3% One Nation (steady).
Federal redistribution finalised
Draft federal electoral boundaries for Victoria and WA were released in March, with Victoria gaining a seat, while WA lost one. Final boundaries were gazetted by August 2, and will be used at the next election.
The WA seat axed was Liberal-held Stirling, while the new Victorian seat of Hawke will be safe for Labor. No other seat changed its notional holder. Ignoring Craig Kelly’s defection, the Coalition notionally starts the next election with 76 of the 151 seats and Labor 69.
ABC election analyst Antony Green has published a post-redistribution pendulum. Labor lost the two party vote by 51.5-48.5 in 2019. For the Coalition to lose its majority, a net loss of one seat is required, a 0.4% swing to Labor under the uniform swing assumption.
For Labor to win more seats than the Coalition, they would need four more net seats for a 73-72 seat lead. That’s a 3.1% swing (51.6% two party to Labor). A Labor majority needs a net seven gains (3.3% swing or 51.8% two party).
Swings are never uniform, but the pendulum suggests that Labor will need a bit more than 50% two party to oust the Coalition. I wrote about Labor’s problems after the last election.
UK COVID data two weeks after “Freedom Day”
July 19 was “Freedom Day” in England, when virtually all remaining COVID restrictions were relaxed. I had an article for The Poll Bludger on August 2, two weeks after Freedom Day. Almost 89% of UK adults have received at least one vaccine dose and over 74% are fully vaccinated. About 95% of English aged over 55 are fully vaccinated.
New UK COVID daily cases were over 54,000 on July 17, two days before Freedom Day, and were predicted to surge to over 100,000. But instead they declined to under 22,000 last Monday, though they have risen back to 27,400 Sunday. Average daily deaths are 86, way short of the horrific January peak of over 1,200.
German polling ahead of the September 26 federal election, and Biden’s ratings and US COVID data were also covered in the article.
Natasha Yates, Bond UniversityIf you are 18 or older, and in an area where there is a COVID-19 outbreak, the best vaccine for you is the one you can get right now. That possibly means you should get the AstraZeneca vaccine, as Pfizer is still in short supply.
This updated advice was given by ATAGI (the Australian Technical Advisory Group on Immunisation), the government’s expert vaccine advisory body, on July 24. Why would it change to recommending either AstraZeneca or Pfizer, after months of preferring Pfizer for younger people?
More young people are being hospitalised, in ICU and dying during this current outbreak in Australia, where the Delta strain is dominating.
Whether this is a function of the Delta strain being more dangerous to young people, or because older people are (as a group) more likely to be protected by already being vaccinated, remains a subject of debate.
So if you are 18 or older and have not been vaccinated yet, you may be asking whether getting an AstraZeneca vaccine right now is the right thing for you to do. To answer this we need to consider the benefits and risks of the AstraZeneca vaccination.
What do vaccines achieve?
When thinking about what any COVID-19 vaccine should achieve, there is an order of priority.
First, it should stop people who catch COVID-19 from dying.
Second, it should reduce risk of severe disease (symptoms bad enough to need ICU treatment).
Third, hospitalisations should go down.
If a vaccine is doing more than these three things, it is a bonus.
We are very lucky the AstraZeneca and Pfizer vaccines not only achieve all three, they also decrease numbers of people suffering illness of any sort (including mild symptoms), and possibly even reduce transmission (making people who have caught COVID-19 less infective).
Do vaccines work against the Delta variant?
Since Delta became the dominant strain of COVID-19 worldwide, researchers have been working hard to see how well current vaccines perform against it.
So far, the news is good. Let’s look at the evidence.
In the United Kingdom where the Delta strain is the cause of the majority of infections at the moment, there were 229,218 COVID infections between February and July. Of these, 12.5% were in fully vaccinated people. These are known as “breakthrough infections” (because they “broke through” the protection of the vaccine).
Of those breakthrough infections, 3.8%, required a visit to ED. Just 2.9% required hospital admission, and less than 1% died.
This means even though the vaccines didn’t fully protect people against disease, they did achieve their primary purpose: to save lives and keep people out of hospital.
Another study in the UK that narrowed down to look at just hospitalisation with Delta strain concludes AstraZeneca is 92% effective against hospitalisation, after two doses.
Although AstraZeneca works to reduce infectivity of the Delta strain, vaccinated people can still transmit it to others.
That’s why it’s so important for vaccinated people to still observe all the other evidence-based ways of reducing spread including wearing masks, social distancing, and lockdown restrictions – at least until we have enough people in the community vaccinated.
But what are the down sides?
Of course there are potential risks from the AstraZeneca vaccine: injection site pain, tiredness, headache, muscle pain, fever and chills are the most commonly reported side effects.
Most of these are mild and temporary, going away within one to two days.
There are also rare but severe side effects: anaphylaxis (two to five per million people), and thrombosis with thrombocytopenia (TTS) – known colloquially as “clots”. The only risk factor that has been shown to predict how likely you are to get TTS after an AstraZeneca vaccine is age.
TTS clots are very different from other blood clots you may hear about. In the same way that having a basal cell cancer removed from your skin does not make you more at risk of getting a brain tumour, having a blood clot in your medical history (or family history) does not make you more at risk of TTS.
In addition, we have effective treatments for TTS now, so the death rate is low.
To keep it in perspective, your risk of getting a blood clot from TTS is still far less than your risk of dying in a car accident in the next year, and most people still don’t think twice about getting into a car.
Obviously, if there is no COVID-19 in the community then the risk from the vaccine will outweigh the risk from the disease – even a tiny risk is bigger than zero.
The reason ATAGI changed its advice to recommend the AstraZeneca vaccine to younger age groups in areas of outbreak is because as soon as COVID-19 starts to spread in the community, the risk of serious disease and death skyrockets. Which makes the vaccine suddenly become a very sensible option in Sydney and other high-risk areas.
How can you get it?
If and when you decide to have the AstraZeneca vaccine and you live in NSW, you can simply book in with any place that is giving it in your area. This may be a GP or state vaccination clinic.
You are not required to see a GP first, but of course you should only book once you’ve had your questions answered and are ready to go ahead with it.
Apart from contacting local providers directly, you can register for vaccination via the eligibility checker here (you fill in your details after completing the checker).
Pharmacies will not be administering AstraZeneca vaccines to people under 40 at this stage.
Finally, I have had in my practice many young people express frustration at being unable to get a vaccine before now, because they see it as a vital step forward for our community and the world.
Their lives have often been hugely disrupted by COVID-19 and they believe the risk of any vaccine is better than continuing with the status quo.
As one patient told me: “I’m young, I live a risky life. Getting this vaccine is the safest thing I have done all week.”
At a time when we’re grappling with so much uncertainty, we need unambiguous information from the federal government about who should have this vaccine.
Instead, it feels very much like we’re swirling in a murky sea of information that is confusing and, at times, seems to be contradictory.
The confusion is compounded by the changing advice from ATAGI. ATAGI, the Australian Technical Advisory Group on Immunisation, is the group of vaccine experts which advises the government.
There is no doubt that for many people, some of its language has been difficult to make sense of, including the use of vague terms like “preferred”. As in, the Pfizer vaccine is the “preferred vaccine” for those under 60 years of age.
How exactly this should be interpreted by someone trying to make the important decision about whether to get the vaccine is unclear, and raises more questions than it answers.
The public commentary from a number of political leaders, including the prime minister, that ATAGI has been too conservative and too risk averse hasn’t helped either, with the implication ATAGI cannot be fully trusted to provide sensible advice.
The reality is, ATAGI is in an extremely difficult position and is grappling with competing concerns, considerable uncertainty, and a constantly changing landscape.
What is ATAGI’s role?
ATAGI can only give general advice to the government for the whole population.
Its task is to think about the whole population as if it were merged into a single person, or in the case of AstraZeneca, a series of people of different age ranges. It then has to formulate advice based on population-based averages of the benefits and risks of getting the AstraZeneca vaccine, which has a number of limitations.
It’s important to understand context plays a key role in formulating this advice to the government. The risk of the blood clotting and bleeding condition, called thrombosis with thrombocytopenia, from the AstraZeneca vaccine is slightly higher for younger people.
This is only part of what’s driven the advice for Pfizer to be the preferred vaccine for those under 60.
In fact, the risk of dying from this condition is incredibly rare whatever your age.
What has been the bigger driver of the advice is the fact you’re less likely to develop severe disease from COVID if you’re younger, which means the corresponding benefits of vaccination are much lower if you take a narrow view of the benefits of the vaccine being solely the prevention of severe disease.
How did ATAGI draw its conclusions on AstraZeneca?
There are several assumptions in ATAGI’s advice which need to be understood.
Firstly, it calculated the risks and benefits of AstraZeneca across three scenarios — low, medium and high exposure risk. ATAGI has presented its advice assuming a low amount COVID circulating in the community, which has been the case until Sydney’s latest outbreak.
A low amount of COVID in the community means there’s a low chance of severe COVID, which is even smaller for younger people. This means there’s less of a benefit of being vaccinated for younger people, which is what has driven the advice for the Pfizer vaccine to be preferred for younger people.
However, the problem with this low prevalence assumption is we’re vaccinating to protect us not just right now, but also against the future risk of COVID, and future lockdowns, like the situation we’re seeing in Sydney now.
Once you’re in this situation, even if ATAGI changes its recommendations in response to more COVID circulating, which it did on Saturday, in some sense the horse has already bolted.
Another assumption implicit in ATAGI’s advice that it prefers under-60s get Pfizer, is that Pfizer is available and you have the option to get it now.
However, given the limited supply of Pfizer vaccine, the decision to hold off on the AstraZeneca vaccine is not one to get Pfizer, it is one to hold off on getting vaccinated at all. This leaves you exposed and vulnerable to COVID. This is an important distinction to make, which of course will change as we get more Pfizer vaccine.
Another major limitation in the ATAGI advice is the panel, in dealing with population-level data, takes a very narrow view of the benefits of vaccination: the prevention of severe disease.
It doesn’t take into account other benefits that may be relevant to many people. It doesn’t take into account the prevention of long COVID; the benefits of being vaccinated allowing travel and other freedoms; and, most glaringly, the importance many people place on getting vaccinated to protect their loved ones and the community.
These may weigh heavily on individuals but aren’t taken into account when you look at the risk-benefit calculation from a narrow perspective.
So what’s the bottom line on AstraZeneca?
We must remember the AstraZeneca vaccine is a fantastic vaccine.
It does carry a small risk of the blood clotting and bleeding condition, but this risk is incredibly small. COVID is much more of a threat to your health than the vaccine, as we are seeing in NSW right now.
If you’re under 60 years of age, the decision to have the AstraZeneca vaccine is one only you can make. But if you do make it, you should understand the benefits go beyond just preventing severe disease.
Michelle Grattan, University of CanberraWhile still struggling with a current shortage of Pfizer, the Morrison government announced it has secured 85 million doses of that vaccine for future “booster” shots.
This will be made up of 60 million doses in 2022, and 25 million doses in 2023. Delivery will start in the first quarter of next year.
Scott Morrison said on Sunday this was “prudent future proofing”, although there is still not definitive advice on when boosters will be needed.
Meanwhile the Australian Technical Advisory Group on Immunisation (ATAGI) has liberalised its advice on AstraZeneca.
It said in a statement on Saturday all people aged 18 and over in greater Sydney, including those under 60, “should strongly consider getting vaccinated with any available vaccine including COVID-19 Vaccine AstraZeneca”.
This was on the basis of the increasing risk of COVID and “ongoing constraints” of Pfizer, the advice said.
Last week Scott Morrison said the government was constantly appealing to ATAGI to review its advice on AZ according to the balance of risk. Many people have shied away from AZ, supplies of which are plentiful, after ATAGI’s caution about it for younger people because of rare blood clots.
Asked about some general practioners being reluctant to give AZ to people under 40, Morrison said he certainly hoped GPs “would be very mindful of the ATAGI advice”.
ATAGI is presently considering whether children between 12 and 15 years old should be vaccinated against COVID, with the government expecting advice in mid-August.
As the crisis continues in Sydney, on Sunday NSW reported 141 new locally acquired cases and two deaths, including a woman in her 30s. This followed Saturday’s report of 163 new cases in the previous 24 hours.
Victoria on Sunday reported 11 new local cases, and is on track to end its lockdown soon, as is South Australia.
Morrison again stressed the lockdown was the primary weapon in fighting the Sydney outbreak.
“There’s not an easy way to bring these cases down. And it’s the lockdown that does that work. The vaccines can provide some assistance, but they are not going to end this lockdown. What’s going to end this lockdown is it being effective.”
But NSW Premier Gladys Berejiklian, who tried unsuccessfully to get the vaccination program refocused on south west Sydney, the centre of the outbreak, has a different emphasis. “Please know that what will get us through this outbreak is a combination of our restrictions, but also of more people being vaccinated”.
Morrison has refused to alter the focus, saying this would “interrupt the rhythm of the national vaccine program”.
The federal government has found 50,000 extra Pfizer doses for NSW. Asked where these came from, Morrison said: “There are small variations in supply and delivery, which from time to time may ensure that there’s tens of thousands of doses that might be free at any given time.”
Morrison condemned Saturday’s Sydney anti-lockdown demonstration attended by thousands of people, which saw violence, dozens of people charged, and more being pursued where they can be identified.
He said it was not just selfish. “It was also self-defeating. It achieves no purpose. It will not end the lockdown sooner, it will only risk the lockdowns running further,” he said.
Asked about Queensland Nationals MP George Christensen, who attended a rally in Mackay, Morrison said: “As for other parts of the country that aren’t in lockdown, well, there is such a thing as free speech, and I’m not about to be imposing those sorts of restrictions on people’s free speech”.
Christensen said on Facebook, “Civil disobedience eventually becomes the only response to laws that restrict freedom. This is what we’ve seen in Melbourne today.”
Pressed on this, Morrison said: “The comments I made before related to an event that took place in Queensland where there are no lockdowns”.
The Prime Minister told the Liberal National Party state council in a virtual address on Sunday: “After a difficult start, the vaccine program is now making up lost ground, and quickly”.
Jonathan Noonan, Baker Heart and Diabetes Institute and Karlheinz Peter, Baker Heart and Diabetes InstituteRepeated COVID-19 outbreaks in Australia have once again highlighted the need for rapid and widespread vaccination. We are extremely fortunate the global scientific community has been able to develop a handful of highly effective vaccines in such a short time.
As with any vaccine or medicine, the COVID vaccines do carry small risks. The rare blood clotting disorder caused by the AstraZeneca vaccine — thrombosis with thrombocytopenia syndrome, or TTS — has largely dominated the headlines.
But we’re also seeing reports of a potentially increased risk of myocarditis and pericarditis (heart inflammation) following the mRNA COVID-19 vaccines, developed by Pfizer/BioNTech and Moderna.
Here’s why this shouldn’t be cause for concern.
First, what are myocarditis and pericarditis?
There are three main types of heart inflammation: endocarditis, myocarditis, and pericarditis. These involve inflammation of the inner lining of the heart, the heart muscle, and the outer lining of the heart respectively.
Viruses, including the SARS-CoV-2 virus that causes COVID-19, are the most common cause of myocarditis and pericarditis. Essentially, the inflammation the immune system generates to combat infections can inadvertently lead to inflammation of the heart.
In the very rare cases of myocarditis and pericarditis observed after vaccination with a COVID mRNA shot, it’s possible a similar thing might be happening. That is, the vaccine causes the immune system to generate some level of inflammation so it’s prepared to mount a response against SARS-CoV-2, and this inflammation is partially misdirected to the heart.
But the risk is very small, and the conditions are treatable.
What’s the risk?
The exact incidence of myocarditis and pericarditis following vaccination is still being defined, and it remains to be proven that mRNA vaccines are truly the cause of these conditions — although it seems likely.
In Australia, of roughly 3.7 million doses of the Pfizer vaccine administered up to July 11, the Therapeutic Goods Administration (TGA) reports there have been 50 cases of suspected myocarditis or pericarditis. This suggests a risk of one per 74,000 vaccines. The TGA notes most people who developed these conditions have recovered or are recovering.
However, given the relatively small number of vaccinations administered in Australia, it’s important to consider more complete data from countries with higher vaccination rates.
The United States’ Centres for Disease Control and Prevention (CDC) had received 1,226 reports of myocarditis following 296 million doses of mRNA vaccines administered up to June 11. This equates to a risk of roughly one in 240,000 doses. These cases were mostly in young men and predominantly occurred after the second dose.
Independently from vaccines, myocarditis occurs in roughly 23 per 100,000 people worldwide per year (we don’t have reliable figures for pericarditis). This shows us there’s a much lower risk from vaccination than exists in the population generally.
Symptoms to look out for
Normal side effects of COVID-19 vaccines include headache, fever, chills, muscle or joint pain, fatigue and nausea.
In contrast, chest pain, irregular heartbeat, heart palpitations, shortness of breath and light-headedness could indicate myocarditis or pericarditis. Symptoms of these conditions have generally occurred within seven days of vaccination. Anyone who experiences these symptoms should seek medical attention.
In most cases, myocarditis and pericarditis can be successfully treated with anti-inflammatory drugs, such as aspirin and corticosteroids.
While this very small risk of heart inflammation following vaccination may be alarming, it’s crucial to understand the risk of heart damage following severe COVID-19 is far greater.
COVID-19 and heart damage
Damage of the heart muscle is a common consequence of coronavirus. Research shows it occurs in up to 28% of patients hospitalised with COVID-19.
Importantly, the risk of death is markedly higher in COVID-19 patients who sustain heart muscle damage. While we need further research to understand precisely how COVID-19 damages the heart, myocarditis and pericarditis are major causes of the heart damage found in COVID-19 patients.
The benefit outweighs the risk
The recent limits applied to the use of the AstraZeneca vaccine in younger age groups suggests the relatively low risk of COVID-19 in Australia justifies being highly selective over vaccine use.
But while Australia has done incredibly well at containing COVID-19, the risk of transmission here remains high given the global COVID-19 situation. We’re seeing this daily as we contend with outbreaks and lockdowns around the country.
Myocarditis and pericarditis are potentially associated with the mRNA vaccines, but these complications are extremely rare, most often mild, and seem to be treatable.
As has been the consistent message from the medical and scientific communities throughout this pandemic, the benefit of COVID-19 vaccines significantly outweighs the risk of rare side effects. This is particularly true for the highly effective mRNA-based vaccines as COVID-19 continues to spread around the world.
Jonathan Noonan, Research Officer, Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute and Karlheinz Peter, Interventional Cardiologist, Alfred Hospital; Professor of Medicine and Immunology, Monash University; Professor and Head, Department of Cardiometabolic Health, University of Melbourne; Lab Head, Atherothrombosis and Vascular Biology and Deputy Director, Baker Heart and Diabetes Institute