PNG and Fiji were both facing COVID catastrophes. Why has one vaccine rollout surged and the other stalled?


Hannah Peters/Getty Images

Ian Kemish, The University of QueenslandThings were looking very bad three months ago for both Papua New Guinea and Fiji. The two Pacific countries were each looking very vulnerable to the COVID Delta variant, albeit in different ways.

On July 10, PNG recorded its first official Delta case, and the nation’s health professionals were soon warning the combination of very low testing rates, high percentage of positive tests and an extremely slow vaccine rollout provided a “recipe for a major spread”.

Fiji was already in the thick of it at the time. After the deadly Delta strain entered the country via a quarantine breach in April, per capita infection rates became the highest in the world in the middle of the year.

Daily infections reached more than 1,800 in mid-July – a huge number for a country of only 900,000 people. The crisis caused 647 deaths.

Fast forward several months and PNG and Fiji are heading in opposite directions. More than 95% of eligible Fijians over the age of 18 have now received their first jab, and 80% are now fully vaccinated.

By contrast, PNG is in the grips of a major wave, with less than 1% of the total population fully vaccinated. PNG is trailing much of the world.

Why have two Pacific countries, which share Melanesian cultural connections, handled their vaccine rollouts so differently?

Not a matter of geography or vaccine supply

Fiji’s daily infection rate today is 4% of what it was at the peak, and it’s falling. Less than 50 new cases are currently being reported on average each day.

In PNG, the official infection rate is now averaging just under 300 new cases per day, but this drastically understates the reality of what is happening in the country.

Extremely low testing rates simply cannot be relied upon. The country’s own health data reportedly shows 2.6 million cases of flu- and pneumonia-like symptoms over the last year, and Port Moresby General Hospital is now reporting positive COVID testing rates of 60%. Like other hospitals across the country, it risks being overwhelmed by the virus.




Read more:
The Pacific went a year without COVID. Now, it’s all under threat


It’s not simply a vaccine supply issue. At this stage of the global crisis, PNG, like Fiji, has received substantial vaccine deliveries – principally from Australia, New Zealand and the COVAX vaccine delivery initiative.

In fact, thousands of PNG’s early deliveries went to waste because the health authorities were unable to use them. The PNG government has recently made the best of a bad situation by re-gifting 30,000 vials donated by New Zealand to Vietnam.

We can also set aside any suggestion Australia, as the major regional donor, is somehow favouring one country over the other.

The Australian government has put a high priority on providing vaccines to both countries in recent months. Its assistance has also extended to education and logistical efforts, along with targeted medical emergency teams and support for those with expertise and capacity on the ground.

Nor is it really a matter of distribution.

PNG’s geography does present some challenging physical barriers to distributing vaccines – its legendary mountainous terrain and the remoteness of many of its inhabitants are well known.




Read more:
Australia wants to send 1 million vaccine doses to PNG – but without reliable electricity, how will they be kept cold?


But companies from Digicel to South Pacific Brewery manage to penetrate the most inaccessible areas with their products despite these difficulties. And the authorities manage to deliver the vote across the nation every five years in what is one of the world’s most extraordinary democratic exercises.

With its own rugged terrain and dispersed populations across multiple islands, Fiji has also faced major physical impediments to its vaccine rollout.

The major difference: leadership and belief

We get closer to the problem when we think in terms of trust, understanding and belief.

Fijians have embraced the vaccination rollout almost as one, following the guidance of their medical authorities and falling in line with the firm “no jabs, no job” policy of its prime minister, former military commander Frank Bainimarama.

In PNG, the term “vaccine hesitancy” understates the problem. One survey earlier this year showed worrying low willingness to take the vaccine, and another survey of university students showed a mere 6% wanted it.

Vaccine patrols have received death threats in some areas, and any politician who speaks out in favour of vaccination risks a political backlash. Strong efforts are now being made to overcome this problem, with the health authorities preparing a fresh approach and iconic figures such as rugby star Mal Meninga supporting the publicity effort.

These dramatically contrasting pictures cannot be explained fully through differences in education standards, or the quality of medical advice and attention.
To be sure, Fiji leads PNG in these respects – Fiji has 99% literacy compared to just over 63% in PNG, according to the latest available figures. And while Fiji’s medical system has its challenges, the decline in PNG’s health services due to chronic lack of investment puts it in a very different category.




Read more:
Pacific nations grapple with COVID’s terrible toll and the desperate need for vaccines


In PNG, trust in leadership has flagged following decades of frustration with growing wealth inequality and concerns over governance and transparency.

Rather than trust official sources, people often look to Facebook and other social media for their information, and are thus vulnerable to the dangerous nonsense peddled by the anti-vaccination movement in the west.

I know how quickly Papua New Guineans tap into what’s happening in neighbouring Australia, too. They will have seen how the public debate here has dented confidence in the AstraZeneca brand – the mainstay of their own vaccine supply.

But perhaps most troubling of all is the sense that many Papua New Guineans have developed a fatalistic belief that COVID is just another health challenge to add to the litany of other serious problems facing the country, among them maternal mortality, malaria and tuberculosis.

It’s almost as if they believe this is all somehow PNG’s lot. But it doesn’t need to be.The Conversation

Ian Kemish, Former Ambassador and Adjunct Professor, School of Historical and Philosophical Inquiry, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, COVID vaccines don’t stay in your body for years


Vasso Apostolopoulos, Victoria University; Jack Feehan, Victoria University, and Maja Husaric, Victoria UniversityAs Australia strives to reach its national COVID vaccination targets, there’s unprecedented focus on the biological effects of vaccines.

While there’s an enormous amount of information available online, it’s increasingly difficult to discern truth from falsehood or even conspiracy.

A common myth of vaccines that has appeared in recent months is the accusation they remain active in the body for extended periods of time – a claim which has increased vaccine hesitancy in some people.

However, vaccines are cleared from your body in mere days or weeks. It’s the immune response against the SARS-CoV-2 virus that appears to last for a long time.

This isn’t due to the vaccines themselves remaining in the body. Instead, the vaccines stimulate our immune system and teach it how to respond if we’re ever exposed to the coronavirus.

Let’s explain.

How do vaccines work?

All vaccines, no matter the technology, have the same fundamental goal – to introduce the immune system to an infectious agent, without the risk that comes from disease.

The vaccine needs to follow a similar pathway a virus would have taken to produce an adequate immune response. Viruses enter our cells and use them to replicate themselves. So, the vaccines also need to be delivered in cells where proteins are produced, which mimics a component of the virus itself.

The COVID vaccines all do this by delivering information into our muscle cells, usually in our upper arm. They do this in different ways, such as using mRNA, like Pfizer’s and Moderna’s, or viral vectors, like AstraZeneca’s.

Regardless of the technology, the effect is similar. Our cells use the genetic template in the vaccine to produce the coronavirus’ spike protein, which is a part of the virus that helps it enter our cells. The spike protein is transported to the surface of the cell where it’s detected by the immune cells nearby.

There are also other specialised immune cells nearby, which take up the spike proteins and use them to inform more immune cells – targeting them specifically against COVID.

These immune cells include B cells, which produce antibodies, and T cells, which kill virus-infected cells. They then become long-lasting memory cells, which wait and monitor for the next time it sees a spike protein.

If you’re exposed to the virus, these memory B and T cells allow a faster and larger immune response, destroying the virus before it can cause disease.




Read more:
Revealed: the protein ‘spike’ that lets the 2019-nCoV coronavirus pierce and invade human cells


So what happens to the vaccine?

Once they’ve initiated the immune response, the vaccines themselves are rapidly broken down and cleared from the body.

The mRNA vaccines consist of a fatty shell, which encapsulates a group of mRNA particles – the genetic recipe for the spike protein. Once this enters a cell, the shell is degraded to harmless fats, and the mRNA is used by the cells to produce spike proteins.

Once the mRNA has been used to produce proteins, it’s broken down and cleared from the cell along with the rest of the mRNAs produced by the normal function of the cell.

In fact, mRNA is very fragile, with the most long lasting only able to survive for a few days. This is why the Pfizer and Moderna vaccines have to be so carefully preserved at ultra-low temperatures.

The vector vaccines (AstraZeneca and Johnson and Johnson) use an adenovirus, which is harmless in humans, as a vector to deliver a genetic template for the spike protein to the cells.

The vector virus has all of its infectious components removed, so it’s unable to multiply or cause disease. Then a genetic template for the spike protein is inserted into the vector.

Once the vaccine is injected, the vector virus binds to your cells and inserts its genetic components, before the shell breaks down and is removed.




Read more:
How long does immunity last after COVID vaccination? Do we need booster shots? 2 immunology experts explain


The viral machinery gets the genetic template into the control room of the cell, the nucleus, where it takes advantage of our normal protein building activity. The vaccine doesn’t cause any alteration to our DNA.

Normally, this would cause the cell to start producing more copies of the virus, but since this was all removed, all that’s produced is the spike protein.

Again, after making a large amount of the spike, the genetic templates are broken down in a matter of days or weeks.

What about the spike protein?

While the vaccines themselves are rapidly removed, what then happens to all the spike proteins that are produced as a result?

They’re identified as foreign by the immune system and destroyed – teaching the cells to recognise the coronavirus in the process.

The spike proteins are fully cleared from the body after a few weeks. In this time, they don’t appear to leave the vaccination site (most often your upper arm).

But antibodies specifically targeting the spike protein produced by your immune system remain in the body for many months after vaccination.

The vaccines also stimulate your immune system to produce memory immune cells. This means even once antibody levels diminish, your immune system is ready to produce more antibodies and other immune cells to tackle the virus if you’re ever exposed to it.




Read more:
How long does immunity last after COVID vaccination? Do we need booster shots? 2 immunology experts explain


The Conversation


Vasso Apostolopoulos, Professor of Immunology and Associate Provost, Research Partnerships, Victoria University; Jack Feehan, Research Officer – Immunology and Translational Research, Victoria University, and Maja Husaric, Senior Lecturer; MD, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Relying only on vaccination in NSW from December 1 isn’t enough – here’s what we need for sustained freedom


Dan Himbrechts/AAP

C Raina MacIntyre, UNSW; Anne Kavanagh, The University of Melbourne; Eva Segelov, Monash University, and Lisa Jackson Pulver, University of SydneyThe latest New South Wales roadmap to recovery outlines a range of freedoms for fully vaccinated people in the state when 80% of those aged 16 and over are vaccinated.

Unvaccinated people will remain restricted, but will have the same freedoms by December 1, when 90% of adults are expected to be vaccinated.

The relaxing of restrictions will occur in three stages, at the 70%, 80% and 90% vaccination mark, with many restrictions dropped by December 1.

This includes relaxing the 4 square metre density rule to 2 square metres in most indoor venues; and no indoor mask mandates in most venues except public transport, airports and for front-of-house hospitality staff.

The problem is, other countries such as Israel already tried relying mostly on vaccines to relax restrictions – and failed, albeit at lower vaccination levels than NSW is aiming for.

Vaccines alone may not enough to protect against the highly contagious Delta variant.

So who is most vulnerable under the current plan, and how should the NSW reopening plan change to protect these groups and the wider population?




Read more:
NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly


Vulnerable group 1: children

About 20% of the population is under 16 years. The 80% adult target corresponds to less than 70% of the whole population, leaving plenty of room for Delta to spread.

One in three children aged 12 to 15 have had a single dose of vaccine, but it may be next year before this age group is fully vaccinated.

Another 1.2 million NSW children under 12 will remain unvaccinated. This is the largest unvaccinated group. With no requirements for unvaccinated primary school children to wear masks, and no plan to ventilate classrooms, outbreaks will almost certainly occur.

Children sit in a classroom, raising their hands.
Children generally get a mild infection from COVID but a small proportion need care in hospital.
Shutterstock

In the US, counties with school mask mandates had much lower rates of COVID in children than counties that did not mandate masks. One unvaccinated teacher who took off her mask to read to a primary school class resulted in 26 people becoming infected.

While children get mild infection compared to adults, around 2% of children who get Delta are hospitalised. Of these, some will require ICU care and a proportion will die. This becomes more apparent when there is high community transmission, and high case numbers in unvaccinated children.

The Doherty report estimates 276,000 Australian children will be infected in the first six months after reopening in the most likely scenario, with 2,400 hospitalisations, 206 ICU admissions and 57 child deaths in that time.

Vulnerable group 2: Aboriginal people

Aboriginal communities in NSW are especially vulnerable to epidemics, contracting COVID and getting severe disease.

There are relatively more children in the under 12 age category in Aboriginal communities, which leaves a much higher proportion of the community unvaccinated.

We saw in the Wilcannia outbreak that a high proportion of cases were in children.




Read more:
COVID in Wilcannia: a national disgrace we all saw coming


Despite this, vaccination rates for Aboriginal communities continue to lag about 20% behind the rest of NSW.

Allowing unrestrained travel into these communities before vaccination rates are high enough to afford protection may be disastrous.

Vulnerable group 3: regional NSW

Remote and regional communities are also vulnerable, because of fewer health services and difficulties with access to care.

An outbreak would disproportionately affect regional NSW.

Vulnerable group 4: people with disability

People with disability, many of whom have significant health conditions, are also at high risk.

Vaccination rates for NSW participants in Australia’s National Disability Insurance Scheme lag state rates by about 14% despite being prioritised in the national rollout.

In the UK, 58% of COVID deaths in the United Kingdom were among people who had a disability. People with intellectual disability were eight times more likely to die of COVID than the general population.

Vulnerable group 5: people with cancer and other conditions

Adults and children living with cancer and other conditions that suppress the immune system may have a poorer response to COVID vaccines, and may need a third dose.




Read more:
Why is a third COVID-19 vaccine dose important for people who are immunocompromised?


The need for third dose boosters in susceptible people is recognised and programs to deliver these are underway in many countries.

Some are vaccinating specific groups: the United States and United Kingdom are providing boosters to all people 65 and 50 years and over respectively.

Others, such as Israel and many European nations, are starting with older adults and immunosuppressed people, and later including the rest of the population.

Australia is yet to formulate such a plan.

Older person's arm with a bandaid after being vaccinated.
Some countries have already started giving boosters.
Shutterstock

Children under 12 years with cancer (not yet eligible for vaccination), also deserve to be protected, by vaccines and/or other measures to stop the spread of COVID in the community.

The consequences of overwhelmed health systems on timely diagnoses and treatment of cancer and other serious illness is already being seen in NSW.

A layered plan for a safer reopening

Currently available vaccines alone will not be enough to control Delta. We will need layered protection including safe indoor air, testing, tracing and masks to continue our lives freely when lockdowns lift.

Here’s what we propose:

1. Implement vaccine targets for at-risk groups

We need to make sure no disadvantaged group is left behind, and that vaccine targets are met for all these groups.

For Aboriginal people, we recommend 85-90% targets be met.

For other groups such as people with disability, particularly those living in congregate settings, higher vaccine targets should also be considered.




Read more:
Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities


2. Make indoor air safer

NSW needs a plan to address indoor ventilation, because the virus is airborne.

This has already occurred in Victorian schools, and should be an important part of lifting restrictions in NSW.




Read more:
From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen


The plan should ensure homes, businesses, schools and other public venues have safe indoor air, and that the community is as well informed on safe air as it is on handwashing, so that people are empowered to mitigate risk in their own homes.

3. Maintain high rates of testing and tracing

We must maintain high testing capacity, make rapid antigen testing widely available, and improve contact tracing capacity.

Suggestions of stopping QR code scanning and thereby reducing contact tracing capacity are misguided, and will result in a resurgence of infection.

We do contact tracing routinely for all serious infections such as TB, meningitis and measles, and need to continue this for COVID-19.

4. Plan for booster doses

We also need to address waning immunity from vaccines and be pro-active about booster doses, particularly for those with reduced immunity or who are immunocompromised, and for health care workers.

For the rest of the population, there is enough real-world evidence protection starts to wane as early as five to six months after vaccination.

It is urgent we address this for health workers and other priority groups such as aged care residents, who were mostly vaccinated six months ago or longer. This is not only for their own safety but to prevent health system collapse from under-staffing due to illness or burnout.

Let’s avoid future lockdowns

In the post-lock down world, NSW will likely face a Delta resurgence if multiple restrictions are simultaneously relaxed, as we have seen in countries overseas.

Dropping most restrictions is also likely to result in repeated stop-start lockdown cycles, prompted by health system strain when cases surge.

Only layered, combined protections will provide a chance of safer and sustainable re-opening until we await the promise of second generation vaccines, boosters and smarter vaccine strategies.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of Melbourne; Eva Segelov, Professor of Oncology, Monash University, and Lisa Jackson Pulver, Deputy Vice-Chancellor, Professor of Public Health and Epidemiology, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

With a post-lockdown Victoria in sight, the more we can contain transmission now, the easier the road ahead


Catherine Bennett, Deakin University and Hassan Vally, La Trobe UniversityVictoria’s roadmap out of lockdown, released today, marks an important milestone. It’s a clear commitment to delivering on the National Plan, and provides much-needed clarity on where we are heading and what the next few months will look like. It is staged and sensible, striking the balance between opening up and maintaining a level of control over transmission.

The roadmap charts a course of staged reopening as more Victorians become vaccinated. It’s informed by modelling from the Burnet Institute, which makes some sobering predictions on the number of cases and the strain on our health system, no matter what course we take from here.

It steps us through what things will look like as we move from 80% of those aged 16 and older having had at least one dose, to 70% fully vaccinated, through to and 80% and beyond.

The potential risk of easing restrictions will be managed through a continued focus on outdoor activity and leveraging the lower risk of infection and, even more so, hospitalisation, in the growing number who are fully vaccinated.

Having a clear vision for where you are heading can make all the difference, especially when the time horizons are now within weeks. We need this, as it will still be a difficult transition through “the gateway” to living with COVID.

Balancing the risks

The roadmap was only one of five scenarios the Burnet team modelled and is in fact the least cautious. But the decision was taken to balance these risks with the direct and indirect health costs of delaying the easing of restrictions further.

The modelling forecasts twice the peak in case numbers, ICU admissions and deaths under the proposed path compared with staying under lockdown, or the other more restricted scenarios.

But it also shows that maintaining high levels of testing can mitigate some of this additional risk.

We have a road out, and one we can make less costly by testing when symptomatic, and abiding by the public health orders now the end is in reach.

So what does the plan say?

When 80% of Victorians have had a single vaccination dose

At 80% single dose coverage among those aged 16 and over, expected by September 26, the travel limit in Melbourne will extend to 15km.

Outdoor activities such as basketball, golf, tennis will be allowed, subject to the same people limits as picnics: two adults if unvaccinated, or up to five fully vaccinated.

In regional Victoria, final year VCAL (Victorian Certificate of Applied Learning) students will be allowed back to study onsite. Masks will no longer be required for beauty or personal care services.

When 70% of over-16s are double dosed

October heralds the staged return to partial onsite schooling, with further changes once 70% of those 16 and older are fully vaccinated, expected by October 26.

This marks the official ending of what we know as lockdown.

The curfew will also end in metro Melbourne and outdoor hospitality will open to those fully vaccinated.

Weddings and funerals will be allowed outdoors for up to 50.

Students from all years will be able to return to face-to-face learning for at least part of the week in both Melbourne and regional Victoria.

Regional Victoria will also see further easing with up to 30 fully vaccinated patrons allowed indoors in hospitality venues.

When 80% of over 16s are double-dose vaxxed

When we get to 80% double dose coverage, projected for November 5, all of Victoria will share the same more modest restrictions.

Indoor activity will open further for those fully vaccinated, including retail, and caps will lift to 150 for organised indoor events and 500 outdoors.

Private gatherings of up to 30 people outdoors will be allowed, but only ten guests are allowed in the home, the setting deemed the highest risk.

Masks will only be required indoors.*




Read more:
We’ve become used to wearing masks during COVID. But does that mean the habit will stick?


By the end of the year

By year’s end, as we exceed 80% of adults fully vaccinated and aim for 80% including 12- to 15-year-olds, more visitors to the home will be allowed, possibly extending to 30 by Christmas.

International travel might be possible by then too, at least to low-risk countries.

Interstate travel will also be on the cards, although this might be limited to New South Wales and ACT until other states also move to living with the virus.

Why lift restrictions on outdoor activities and for the vaccinated?

It makes sense to use outdoor settings and individual and population vaccination protection to progress on this road out to manage transmission risk.

Remaining unvaccinated is a greater risk now, even with these rules in place – 204 people in hospital this week, and only 1% of these fully vaccinated.

Vaccine passports won’t be a permanent fixture, but allow us to do more things earlier than otherwise possible.




Read more:
Vaccine passports are coming to Australia. How will they work and what will you need them for?


But it could be worse – or better

It’s important to recognise that the steps along the way may end up looking somewhat different depending on case numbers, perhaps for the better.

Lower case numbers as we start this transition will put us in a better position, as the Doherty modellers reported last week. So the more we contain transmission while in lockdown, the easier the road ahead and lowest impact on hospitals.

The immediate challenge has not changed. We still need to do everything we can to keep case numbers from rising and, if possible, bring them down. We still need to get vaccinated as quickly as possible and push coverage in those over 16 up to 80%, and beyond.

What has changed is that we can see clearly where we are heading and how our hard work to prevent further waves while waiting for the vaccine roll-out now translates into greater freedoms in coming months.

This is a critical transition period that will test us all, and it helps to see vaccination levels that can provide some relief within reach after a gruelling 18 months. With the end of this “pre-vaccine” phase within sight, a final push to control transmission over this last stretch makes this a safer and quicker passage through the gateway to living with the virus.

If we do better than the Burnet modelling assumes by getting tested when symptomatic, vaccinated or not, and abiding by the rules in place, we will come in well under the forecast case and death counts.

Victoria and NSW are watching and learning from each other as each state eases out of lockdown while keeping a level of control over the virus. Success will reassure other states and territories of how this can work, and allow Australia to once again be open for business.




Read more:
NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly


*Correction: This article originally said masks would only be required outdoors. This has now been corrected.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University and Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, COVID-19 vaccines don’t affect women’s fertility


Shutterstock

Michelle Wise, University of AucklandSome women are holding off on being vaccinated against COVID-19 because of concerns the jab could affect their fertility, at times taking to social media to voice their concerns.

Anti-vaccination campaigners appear to be fuelling these fears and misleading women into thinking the vaccine may affect their chance of getting pregnant now or in future, or increase their risk of a miscarriage.

But there is no research evidence to support these claims. The science shows COVID vaccines have no effect on fertility, do not impact the chance of a miscarriage, and are safe and effective while pregnant.




Read more:
Should pregnant women have a COVID vaccine? The evidence says it’s safe and effective


COVID-19, however, can cause severe disease in pregnant women. Currently one in six of the most critically ill COVID patients in the UK are unvaccinated pregnant women.

Where did the fertility myth come from?

Myths about the vaccine affecting fertility can be tracked back to websites in the United States, which highlighted a claim by a European doctor in December 2020, while the vaccine was in Phase 3 trials.

In a blog post which has since been deleted, he hypothesised there were proteins in the placenta which have similarities with the spike protein in the virus. He thought antibodies in the vaccines that block the spike protein might also attach to the placenta.

But the viral and placental proteins are not similar enough that we would expect this to happen; studies have now confirmed this.




Read more:
Pregnant or worried about infertility? Get vaccinated against COVID-19


What else does the science say?

Since the vaccine rollout began, six billion doses of COVID vaccines have been administered around the world, including Pfizer and Moderna, the recommended vaccines in Australia for under-60s, including pregnant women. Pfizer is the only vaccine offered in New Zealand.

There has not been a concurrent epidemic of infertility nor miscarriage.

Young woman in mask, outside in the sun, smiling.
No fertility-related safety issues have been detected.
Shutterstock

Several populations of women have been followed up after vaccination. Women who have received COVID vaccinations have no difference in markers of ovarian follicle (egg) quality compared to unvaccinated women.

Studies have demonstrated no difference in embryo implantation rate for women who had received vaccination against COVID prior to having in vitro fertilisation (IVF) compared to unvaccinated women.

Studies have also looked for an effect of the vaccine on male fertility. These have demonstrated no change in sperm volume, concentration, motility (the ability to swim the right way) and total motile sperm count when comparing samples taken before and after COVID vaccination.




Read more:
COVID-19 could cause male infertility and sexual dysfunction – but vaccines do not


What about in pregnancy?

Studies have also looked specifically at miscarriage. If antibodies against the spike did cause problems for the placenta, we would expect to see miscarriages. This is not the case.

The science is also clear the vaccine is safe in pregnancy. In studies of pregnant women in Canada and the United States who received the vaccine, minor side effects were similar to non-pregnant adults, and pregnancy complications and baby outcomes were similar to the background rate.

Pregnant woman in mask sits on bedroom floor, looking at laptop.
Pregnant women experience the same minor side effects as the rest of the population.
Shutterstock

Research has shown there’s additional benefit of vaccination in pregnancy, with the baby gaining some protection against COVID. Antibodies have been found in cord blood and in breastmilk, suggesting temporary protection for babies (called passive immunity).

Getting vaccinated at any stage of pregnancy will provide this additional benefit.

What about future fertility?

The COVID vaccine – like every other vaccine you received during childhood, and like the flu vaccine that you get every flu season – induces your body to create an immune response. The components of the vaccine itself are broken down by the body within hours.

In other words, COVID vaccines don’t stay in your body. After vaccination, you are left with antibodies ready to act in case you get exposed to the COVID virus in the future. There is no link with infertility or miscarriage.




Read more:
No, COVID vaccines don’t stay in your body for years


Women who are pregnant, planning a pregnancy or are concerned about their future fertility might still have concerns or questions about getting a COVID vaccination. If this is you, talk to your own doctor or midwife who can discuss the science with you and answer any questions in a non-judgemental way.

Dr Erena Browne, Registrar in O&G at Auckland District Health Board, co-authored this article.The Conversation

Michelle Wise, Senior Lecturer, Department of Obstetrics and Gynaecology, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus Update: Australia


Keeping workers COVID-safe requires more than just following public health orders


Shutterstock

Stephen Duckett, Grattan InstituteSo far in the pandemic, state public health advice has been front and centre of public messaging about protecting the community from the spread of COVID-19.

But merely following the public health orders won’t necessarily meet employers’ obligations to protect staff from COVID, especially as restrictions ease in the Eastern states.

Protecting employees from COVID is good for staff, of course, and also good for the organisation because it will reduce the potential for staff being off sick.

Vaccination alone won’t guarantee a COVID-safe workplace. Even double-vaccinated people can be infected. Vaccination reduces the chance of infection by between 60% (AstraZeneca) and 80% (Pfizer). And double-vaccinated people can also transmit the virus, although again at a much lower rate.

As part of the scientific advisory group OzSAGE, we’re issuing guidance to employers about creating COVID-safe working environments. We propose organisations follow a four-level hierarchy of COVID controls.

Employers need to consider four key areas.
OzSAGE

Level 1: vaccination and working from home

The most effective protections against COVID are vaccinating to reduce the risk of infection, and limiting interactions with infected people. These are the two standard public health measures seen in state public health orders.

Employers should encourage employees to get vaccinated by providing:

  • leave or paid time off to get vaccinated
  • reliable and up-to-date information on the effectiveness of vaccinations
  • the details of the locations nearby where vaccinations are available
  • on-site vaccination, if possible, for shift workers and those who can’t easily attend a GP or vaccine hub appointment
  • incentives, such as additional annual leave days for vaccinated workers.

In some circumstances – especially where the organisation is responsible for caring for people at a higher risk of infection – mandatory vaccination of employees might also be considered.




Read more:
If you’re going to mandate COVID vaccination at your workplace, here’s how to do it ethically


Staff should be encouraged to work from home if that’s possible, while risk of infection is still high. Working from home doesn’t eliminate the risk of COVID, but it eliminates the risk of contracting (and transmitting) COVID in the workplace.

Putting in place “hybrid” working arrangements reduces the number of people in the workplace at any one time, and therefore the risk of transmission.

Level 2: safe indoor air

State public health orders have essentially focused on density limits. These are important, but don’t guarantee good ventilation and clean air.

COVID spreads by aerosols. Respiratory aerosols from breathing and speaking accumulate in indoor spaces, resulting in increasing risk over time.

Poor ventilation (stagnant air) in public buildings, workplaces, schools, hospitals, and aged care homes contributes to viral spread.

Masked woman with a clipboard surveys a storeroom.
Poor ventilation is a risk for transmitting COVID.
Shutterstock



Read more:
Australia must get serious about airborne infection transmission. Here’s what we need to do


Good ventilation is a key part of reducing the risk of COVID transmission.

As the number of people inside a space increases, CO₂ will increase to varying degrees, depending on the effectiveness of ventilation and the volume of the space. Measuring carbon dioxide (CO₂) is therefore a useful surrogate indicator to assess the relative infection risk of COVID in an indoor space.

It’s recommended employers invest in CO₂ monitoring and use that as a trigger to reduce occupancy and/or increase the provision of outdoor air and HEPA (high-efficiency particulate air) filtering to ensure the risk of COVID-19 is appropriately mitigated.

Having automated alerts (in non-HEPA filtered areas) from CO₂ monitors will prompt action to improve ventilation or leave the workplace.

Level 3: administrative measures

Organisations should be ready to manage COVID outbreaks – especially in New South Wales and Victoria, where public health contact tracing is at capacity.

Organisations might also use regular rapid antigen testing (where practical and feasible, considering cost and logistics), to prevent or limit outbreaks when people are shedding the virus but are asymptomatic.

Man holds rapid COVID testing stick.
Rapid tests can help detect COVID in those with no symptoms.
Shutterstock



Read more:
Rapid antigen tests have long been used overseas to detect COVID. Here’s what Australia can learn


The risk of an organisation-wide shutdown can be minimised by creating work bubbles – teams coming to work on different days – and other measures to reduce physical interactions.

Staggering work hours to reduce congregating at lift spaces is another useful, low-cost strategy.

Level 4: masks

COVID-19 is an airborne disease, so the use of masks is integral to reduce transmission and to offer some protection if there is any breakdown of other controls.

Masks are also essential because 30–70% of transmission may be asymptomatic: from infected people who look and feel well and may not be aware they are infected.

Basic cloth masks and surgical masks reduce the transmission of COVID. The effectiveness of masks increases when they fit snugly on the wearer’s face.




Read more:
Evidence shows that, yes, masks prevent COVID-19 – and surgical masks are the way to go


Workers should be provided with appropriate fitted masks and should be trained in how and when to use them. At a minimum, where workplaces are in areas with community transmission of COVID, masks should be worn whenever workers are indoors.

Rates of COVID are still high in NSW, Victoria, and the ACT. Employers, especially in those jurisdictions, should review their work health and safety plans to ensure their workers and customers are properly protected.

This article was co-authored by occupational and environmental physician Karina Powers, engineer and scientist Kate Cole, Flinders University Professor Richard Nunes-Vaz, and other members of the OzSAGE advice for business working group.The Conversation

Stephen Duckett, Director, Health and Aged Care Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health workers are among the COVID vaccine hesitant. Here’s how we can support them safely


AP Photo/Damian Dovarganes

Holly Seale, UNSW; Margie Danchin, Murdoch Children’s Research Institute, and Ruby Biezen, The University of MelbourneGiven the caring nature of their profession, the general public might assume there isn’t any vaccine hesitancy among health workers. It can surprise (and anger) the community when health workers protest the introduction of COVID vaccine mandates.

In France, around 3,000 health workers have been suspended because they were not vaccinated. In Greece, health workers have protested against mandatory vaccination plans. Similar scenes have played out in Canada and New York State.

In Australia, health workers have reportedly joined protests in Melbourne and Perth. A small number of unvaccinated staff members are challenging vaccination mandates in the NSW Supreme Court. Beyond the hospital sector, there are reports of staff members leaving the aged care sector following the introduction of mandates.

Hesitancy among health workers broadly reflects concerns in the wider community. But the risks of being unvaccinated in health settings mean we should acknowledge these concerns and support informed decision-making.




Read more:
‘Living with COVID’ looks very different for front-line health workers, who are already exhausted


A range of concerns

Over 90% of health workers in NSW and Victoria have received a COVID vaccine. But there remains a small percentage of people who work at hospitals and other clinical settings who are vaccine hesitant or want to choose the vaccine they receive.
NSW health figures suggest that currently about 7% (or 7,350 staff members) remain unvaccinated.

Internationally, prevalence of COVID vaccination hesitancy in health workers ranges from 4.3 to 72% (average 23%).

In the US, one in four hospital workers in direct contact with patients had not received a single dose of a COVID vaccine by the end of May.

A study conducted in the first few months of this year found while most health workers intended to accept a COVID vaccine, 22% were unsure or did not intend to vaccinate. These findings tallied with a study in Italy that found 33% of health workers were unsure or did not intend to vaccinate.

The top three reasons for health workers to be hesitant echo the same concerns expressed by some in the wider community: vaccine safety, efficacy and side effects.

Earlier surveys overseas showed less than a third of health workers felt they had enough information around COVID vaccines. And, just like the wider community, health workers are vulnerable to misinformation and sometimes have insufficient understanding about how vaccines are developed.

A group who identified themselves as health workers staged a peaceful protest in Melbourne.

The risks

While hospital patients are more likely to be the source of hospital COVID outbreaks, unvaccinated health and aged care workers still pose a risk to patient and resident safety. Transmission of COVID to or between unvaccinated health workers poses a risk to the wider community including their families and friends.

Beyond the risk of transmission, there is also the impact vaccine-hesitant health workers have on wider vaccine confidence. Health workers are seen as credible sources of information and are trusted by the community.

There are videos on social media, YouTube and TikTok of individual health workers speaking about the COVID vaccines, often repeating misinformation regarding the safety or effectiveness of the vaccines or expressing uncertainty. The potential impact of these viral videos may be heightened compared to those featuring speakers who don’t work in health professions. University of Washington researcher Rachel Moran, who examines internet misinformation, says such health workers are

leveraging the credibility of medical professionals to create a false impression that there is considerable debate about COVID vaccines among doctors and nurses when, in reality, there is a consensus about their efficacy and safety.

Crowd of protesters
In New York, crowds rallied last week against city-wide COVID vaccine mandates for public school teachers and state-wide mandates for health-care workers.
EPA/JUSTIN LANE



Read more:
‘Are you double dosed?’ How to ask friends and family if they’re vaccinated, and how to handle it if they say no


How can we all stay safe?

Moving forward, we must acknowledge three things when it comes to health workers and vaccine hesitancy:

1. Don’t judge

While there is a moral imperative and duty of care for health workers to receive the COVID vaccine, we should ensure unvaccinated staff members have the opportunity to discuss vaccines in a non-judgemental way.

As with the general public, we need to find out who health workers trust and connect them with trusted resources to alleviate their fears. This might be done via hospital websites, discussions with their primary health-care providers or evidence-based information.

2. Work out what works

Unlike the community setting, there has been a gap in funding to develop and test resources and interventions focused on supporting health and aged care worker vaccine uptake.

Understanding the specific strategies that work to support vaccine uptake, without having to move directly to mandates, is important from not only a patient safety perspective but an occupational health and safety lens.

These findings are relevant for COVID and other occupational vaccine programs.

3. Ensure supply and access

Prior to introducing a mandate, there needs to be adequate supply and equitable access to vaccines. We need to ensure people have the opportunity to review vaccine safety and effectiveness data and to get the vaccine of their free will.

Careful planning, consultation and communication with key groups can improve acceptability of mandates.

In the coming weeks, more health workers are likely to resign or be dismissed for failing to comply with the COVID mandates. There will be those in social media who will call out the situation as the “right move”. But some health workers will become privately or publicly vocal on the issue and will cast doubt on the vaccine. It is important we prepare for these situations, especially in regional areas where there may be fewer voices and greater trust in long-serving health workers.




Read more:
The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal


The Conversation


Holly Seale, Associate professor, UNSW; Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute, and Ruby Biezen, Research Fellow, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘Are you double dosed?’ How to ask friends and family if they’re vaccinated, and how to handle it if they say no


Shutterstock

Jessica Kaufman, Murdoch Children’s Research Institute and Julie Leask, University of SydneyThe weekend is approaching, your fridge is stocked with cheese and you’re eager to organise a COVID-compliant picnic with other fully vaccinated adults which your local rules stipulate. But choose your guests wisely — only fully vaccinated people can attend, and fines apply if the rules are broken.

These new rules, coming into effect in New South Wales and Victoria, place the responsibility for policing vaccination on individuals. Vaccine passports may eventually allow businesses to check people’s vaccination status on entry, but there is no app to scan before gathering for a picnic or home event.

So how do you find out who’s vaccinated, and what do you do with that information?

How do you start the conversation?

Vaccination can feel like a loaded topic, something you might not want to discuss if you can avoid it. But it doesn’t have to be a minefield. We can actually take some tips about approaching tricky personal topics from the field of sexual health.

First, try to talk about vaccination before you’ve confirmed plans with someone, and before you’ve communicated the plans to others. Once you’re already at the picnic, the stakes are much higher. You’re more likely to either go along with something that doesn’t feel right to you or end up in an argument.

Offer your own vaccination status first. You could say something like

FYI, I got my second dose last month. These new rules mean everyone coming will have to be vaccinated. Have you had both doses? I want to make sure we’re OK to go ahead.

Keep the question casual. Asking someone’s vaccination status is reasonable in these circumstances — it isn’t because you don’t trust the person.

What if the person says no?

Don’t jump to conclusions. Depending on your relationship with the person, you may want to find out more. When approaching a conversation about COVID-19 vaccines, start with an open mind and be ready to listen.

Ask them if they’d like to talk about why they aren’t vaccinated. Maybe they have some specific concerns, maybe they’re waiting for an appointment or for a different vaccine to the one available to them now.

Let them share all their concerns before you jump in and try to answer or correct them.

If they’re open to it, you can help them weigh up the risks and benefits of the vaccines, share some facts about safety and effectiveness, or tell them what convinced you to get vaccinated.

Talking about your own experience can help normalise vaccination.

The person you’re talking to might not be on fence about the vaccine — they might be strongly opposed to it.

If that’s the case, your best strategy may be to establish your position and close the conversation. You could say:

OK, that’s not what I believe. But either way, we have to follow the rules.

Arguing with people who strongly oppose vaccination is rarely — if ever — effective, and it could ruin your relationship.

A woman looks at her phone.
Try to talk about vaccination before you’ve confirmed plans with someone, and before you’ve communicated the plans to others.
Shutterstock

While rules are in place that exclude unvaccinated people for the time being, it’s not necessary to cut someone out of your life because they aren’t vaccinated.

As those rules are relaxed and we move from suppressing COVID-19 to living with COVID-19, we will need to re-calibrate our risk assessments.

Of course these decisions are personal, but if you and your family are fully vaccinated, the risk of catching COVID-19, particularly in an outdoor environment, is significantly reduced.

If you have children too young to currently get vaccinated, the risks from COVID-19 are low except in certain circumstances so you’ll need to weigh health risks against social benefits.

Social exclusion leads to more conspiratorial thinking — in other words, cutting people off when they believe in conspiracy theories often leaves them to go further down the rabbit hole, unchallenged by alternative views.

You may have more positive impact by maintaining a relationship, within your boundaries, and role modelling the behaviour you believe in.

What about the picnic?

If your friend is a bit hesitant or firmly against getting the vaccine, your picnic with them will have to wait.

When you explain this, you may want to distance yourself from the rules. For example, you could say:

The new rules say… Unfortunately it sounds like we can’t get together for now. It’s only a temporary thing — we should all be able to get back to normal in a few more weeks.

You didn’t make the rules, but we’re all living with them for now. If relevant, convey how important the relationship is.

From the beginning, managing COVID-19 well has required us to take the evidence, abide by public health orders and, when we can choose, weigh the risks of an activity against the benefits.

For these sensitive social negotiations around vaccines, masks and other measures, we will need to communicate with care to keep connecting with each other as safely as possible.The Conversation

Jessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children’s Research Institute and Julie Leask, Professor, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.