We need to prioritise teachers and staff for COVID vaccination — and stop closing schools with every lockdown


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Asha Bowen, Telethon Kids Institute; Archana Koirala, University of Sydney, and Margie Danchin, Murdoch Children’s Research InstituteYesterday Victoria announced a snap lockdown to last at least seven days starting from 11:59pm last night.

As part of the lockdown, schools will close and move to remote learning, and today is a pupil-free day while schools prepare to teach online. Only the children of authorised workers and vulnerable kids will continue to be able to learn in person.

It’s another episode of schools being closed seemingly as par for the course in any COVID-19 outbreak. While communities are concerned about the outbreak, the inclusion of schools in the lockdown should be as an extension of controls if transmission is more widespread, rather than the immediate response.

Despite good evidence, the previously developed traffic light system isn’t being used for schools during outbreaks in Australia. There’s currently no national plan to guide states and territories on how to manage schools during COVID outbreaks, and to advise them on the evidence and best-practice. This needs to change.

We argue schools should be prioritised to remain open, with transmission mitigation strategies in place, during low levels of community transmission.

What’s more, if schools are a priority, then vaccinating all school staff is something we should be urgently doing as part of these strategies.

Schools should be a priority

As paediatricians and vaccine experts, we believe kids’ well-being and learning should be among the top priorities in any outbreak.

We advocate for strategies to reduce the risk of COVID transmission in schools during outbreaks, including measures like:

  • minimising parents and other adults on the school grounds, including dropping kids off at the school gate rather than entering the school
  • parents, teachers, other school staff, and high-school students wearing masks
  • focusing on hand hygiene
  • enhanced physical distancing
  • good ventilation in classrooms and school buildings.

On top of this, we believe if schools, teachers and kids are viewed as a priority by decision makers, then vaccinating all school staff should urgently be considered.

Vaccinating all school staff would reassure those who have concerns about being at work in a school environment during a lockdown, and potentially lower the risk of spread in schools even further. This would increase the confidence in schools remaining open.

Kids are not major drivers of transmission

Kids can and do get sick with the SARS-CoV-2 coronavirus, though they tend to get less severe disease.

The best available evidence suggests kids and schools are not major drivers of transmission, even though children can transmit the virus.




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Snap lockdowns have become the new norm in Australia for managing COVID transmission emerging from hotel quarantine. We strongly argue snap lockdowns shouldn’t automatically include schools. Data from overseas, where widespread community transmission is occurring, suggests schools remaining open with public health measures in place hasn’t changed transmission rates very much.

We advocate for schools to remain open, and if a student or teacher attends a school while infectious, the measures in place to test, trace, and isolate the primary and secondary contacts are activated. We have done it before. NSW was able to continue with face-to-face learning and had 88% attendance in term three 2020 even with low levels of community transmission.

When there’s rampant community spread like some countries overseas, this changes the risk-benefit equation and school closures may be needed. The traffic light system has been developed for exactly this scenario.




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We can’t close schools every time there’s a COVID outbreak. Our traffic light system shows what to do instead


But with an outbreak of 30 cases so far, we don’t think Victoria is near the flexion point where school closures are necessary. If there were many more, the risk equation would change, and the traffic light system could be applied.

Also, there’s a different risk equation for primary and secondary school students. Primary school kids are much less likely to transmit the virus than secondary school students. Daycare and early childhood centres remain open in Victoria. The evidence supports at least primary schools remaining open too.

We need a national plan on schools

Our concern is that jurisdictions are reaching for school closures as an almost predictable part of lockdown, without relying on a national plan to guide these decisions. The only current guidelines are the Australian Health Protection Principal Committee’s (AHPPC) statement from February on reducing the risk of COVID spread in schools.

Only about 13% of Australians have received at least one COVID vaccine dose, and ongoing community COVID outbreaks are expected for at least the next year or more. So, we need a proper national plan on COVID and schools. States and territories would benefit from a national plan, as they could lean on it to make informed decisions on schools during outbreaks.

School closures cause enormous strain

Whenever school closures are announced, we hear many parents sigh and say things like “I won’t be able to get any work done!”. Indeed, school closures put enormous strain on families, especially working parents with pre-school or primary school aged children. Younger children require some supervision and are less likely to have the skills necessary to get value out of online learning, compared to older kids in the latter stages of high school who may be more independent.

Challenges might also include poor or no internet, not being able to have relevant supervision, or not having the right devices.

Home learning has a substantial impact on children’s well-being and mental health. Over 50% of Victorian parents who participated in a Royal Children’s Hospital poll in August 2020 reported homeschooling had a negative impact on their kids’ emotional well-being during the second wave in 2020. This was compared to 26.7% in other states. Jurisdictions keep playing into this risk if they keep closing schools.

It’s an absolute priority we find and use ways to support kids to continue face-to-face learning in times of low community transmission, especially primary schools. One important way to do this is to prioritise teachers and other school staff for COVID vaccines.




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Children, teens and COVID vaccines: where is the evidence at, and when will kids in Australia be eligible?


The Conversation


Asha Bowen, Program Head of Vaccines and Infectious Diseases, and Head of Skin Health, Telethon Kids Institute; Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney, and Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute

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

Can I get AstraZeneca now and Pfizer later? Why mixing and matching COVID vaccines could help solve many rollout problems


Attila Balazs/EPA/AAP

Fiona Russell, The University of Melbourne and John Hart, Murdoch Children’s Research InstituteIn the face of changing eligibility for the AstraZeneca vaccine, new variants of the coronavirus and supply constraints, many people are wondering whether they can “mix and match” COVID-19 vaccines.

This means, for example, having the AstraZeneca vaccine as the first dose, followed by a different vaccine such as Pfizer as the second dose, and boosters with other vaccines later on.

While many studies are ongoing, data has recently been released from mix and match trials in Spain and the United Kingdom.

This data is very promising, and suggests mix and match schedules may give higher antibody levels than two doses of a single vaccine.

While Australia’s drug regulator, the Therapeutic Goods Administration (TGA), hasn’t yet approved a mix and match COVID-19 vaccination schedule, some countries are already doing this.

So how does this work, and why might it be a good idea?

What’s the benefit of mixing and matching?

If the COVID-19 vaccine rollout can mix and match vaccines, this will greatly increase flexibility.

Having a flexible immunisation program allows us to be nimble in the face of global supply constraints. If there’s a shortage of one vaccine, instead of halting the entire program to wait for supply, the program can continue with a different vaccine, regardless of which one has been given as a first dose.

If one vaccine is less effective than another against a certain variant, mix and match schedules could ensure people who’ve already received one dose of a vaccine with lower effectiveness could get a booster with a vaccine that’s more effective against the variant.

Some countries are already using mix and match vaccine schedules following changing recommendations regarding the AstraZeneca vaccine because of a very rare side effect of a blood clotting/bleeding condition.




Read more:
What is thrombocytopenia, the rare blood condition possibly linked to the AstraZeneca vaccine?


Several countries in Europe are now advising younger people previously given this vaccine as a first dose should receive an alternative vaccine as their second dose, most commonly mRNA vaccines such as Pfizer’s.

Germany, France, Sweden, Norway and Denmark are among those advising mixed vaccination schedules due to this reason.

Is it safe?

In a UK mix and match study published in the Lancet in May, 830 adults over 50 were randomised to get either the Pfizer or AstraZeneca vaccines first, then the other vaccine later.

It found people who received mixed doses were more likely to develop mild to moderate symptoms from the second dose of the vaccine including chills, fatigue, fever, headache, joint pain, malaise, muscle ache and pain at the injection site, compared to those on the standard non-mixed schedule.

However, these reactions were short-lived and there were no other safety concerns. The researchers have now adapted this study to see whether early and regular use of paracetamol reduces the frequency of these reactions.

Another similar study (not-peer reviewed) in Spain found most side effects were mild or moderate and short-lived (two to three days), and were similar to the side effects from getting two doses of the same vaccine.

Is it effective?

The Spanish study found people had a vastly higher antibody response 14 days after receiving the Pfizer booster, following an initial dose of AstraZeneca.

These antibodies were able to recognise and inactivate the coronavirus in lab tests.

This response to the Pfizer boost seems to be stronger than the response after receiving two doses of the AstraZeneca vaccine, according to earlier trial data. The immune response of getting Pfizer followed by AstraZeneca isn’t known yet, but the UK will have results available soon.

There’s no data yet on how effective mix and match schedules are in preventing COVID-19. But they’re likely to work well as the immune response is similar, or even better, compared with studies using the same vaccine as the first and second dose. This indicates they will work well in preventing disease.

Might this be one way to help resolve Australia’s slow rollout?

In Australia, we’ve seen many people wanting to “wait for Pfizer” and not have the AstraZeneca vaccine. This is despite the UK’s recent real-world findings that, following two doses, both vaccines are similarly effective against the variants circulating in the UK.

Delays in vaccine uptake have also been due to concerns regarding the very rare but serious blood clotting/bleeding syndrome after the first dose of AstraZeneca, as well as changing age restrictions in terms of who can receive this vaccine.

This caused widespread uncertainty and meant some younger people in some countries in Europe who had already received a first dose were excluded from getting a second dose.

The results from these mix and match studies support the possibility of vaccinating people who have received the first dose from AstraZeneca, with a different booster, if the need arises.

Further studies are underway to evaluate mix and match schedules with Moderna and Novavax vaccines, both of which Australia has supply deals with.

Don’t delay getting vaccinated

As Victoria tackles its current outbreak, many other countries in our region are experiencing a surge in cases too. These include Fiji, Taiwan and Singapore, countries previously hailed as excellent examples of how to manage COVID-19.

These examples highlight the difficulty of sustained suppression in the absence of high vaccination coverage. This will be further exacerbated by the new, more transmissible variants.

The current cases in Victoria are caused by the B.1.617.1 (“Indian”) variant. Both vaccines are effective against the closely related B.1.617.2 variant (albeit a bit lower than against B.1.1.7) and we would expect similar effectiveness against B.1.617.1.




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COVID is surging in unvaccinated Taiwan. Australia should take heed


It’s not clear what kind of evidence regulatory authorities, like Australia’s TGA, would require for a mixed schedule to be approved for use.

While we are waiting, it’s critical eligible people don’t delay getting vaccinated with the vaccine that’s offered to them now. Vaccination is an essential part of the pandemic exit strategy.

It’s likely the vaccination schedule will be modified in the future as boosters may be needed. This is normal for vaccination programs — we already do this each year with the influenza vaccine. This shouldn’t be seen as a policy failure, but instead an evidence-based response to new information.The Conversation

Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist, The University of Melbourne and John Hart, Clinical researcher, Murdoch Children’s Research Institute

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

Incentives could boost vaccine uptake in Australia. But we need different approaches for different groups


Sameer Deshpande, Griffith University and Joy Parkinson, Griffith UniversityAs Australia deals with growing levels of vaccine hesitancy, Chief Medical Officer Paul Kelly has called for incentives to ensure as many people as possible get vaccinated against COVID-19.

Many countries around the world are offering benefits to encourage people to get vaccinated.

These incentives are built on the likelihood people who are hesitant, unmotivated or face barriers to getting vaccinated will embrace vaccination if they receive personal benefits which outweigh any perceived downsides to getting the vaccine, or upsides to not getting it.

Australia would do well to consider introducing some incentives. But they shouldn’t be blanket incentives — they should be part of a larger set of strategies and need to be tailored and targeted to particular groups.

From cash to cows and everything in between

Employers, service providers, and governments in the United States have offered a range of incentives.

Some are centred around entertainment. For example, New York is set to offer free tickets and cheap deals to city attractions, while Alabama residents could take two laps around the Talladega Superspeedway racetrack in their car. Meanwhile, Chicago’s Protect Chicago Music Series is open exclusively to vaccinated residents.

Some incentives have a raised a few eyebrows, like New Jersey’s “shot and a beer” campaign, which offers people a free beer if they’ve had the vaccine.

Some organisations are offering monetary incentives — supermarket chain Publix gives employees a US$125 Publix gift card (approximately A$160) after they receive both doses.




Read more:
Free beer, doughnuts and a $1 million lottery – how vaccine incentives and other behavioral tools are helping the US reach herd immunity


Some incentives deliver smaller benefits with certainty, such as free Uber and Lyft rides to and from vaccination sites around the US.

Others offer a small chance at a big prize, like entry into a weekly US$1 million lottery (roughly A$1.29 million) in Ohio.

We also find incentives aligned with local culture, such as 100 free targets for trap, skeet or sporting clay shooting in Randolph County, Illinois.

And it’s not just the US offering incentives. For example, in India, vaccinated residents can enter a competition to win 5,000 rupees (A$89), while those in a district of northern Thailand could win a live cow.

Do incentives work?

Although it is too early to tell us how well these incentives are working, research on other vaccines has shown financial incentives increase adherence seven-fold.

The Thai region running the cow lottery reportedly saw vaccine registration numbers jump from hundreds to thousands after they announced the incentive.

Importantly, incentives work in tandem with other strategies such as good, clear communication about vaccine efficacy and safety.




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Incentives shouldn’t be ‘one size fits all’

Our research shows understanding what motivates people to participate in health-promoting activities and then tailoring measures to encourage them accordingly improves the effectiveness of the interventions.

This means it’s vital to listen to the public. Australians love fun, sport, spending time with family and friends, and travelling. Any incentive or strategy should consider these values.

Here are five broad groups based on individuals’ willingness and ability to get vaccinated, and strategies which might appeal to each one.

1. The highly motivated

Those who are highly motivated and have good access to vaccination tend to be first to front up when they’re eligible. This group trusts science and the system and seeks information on where and when to get the vaccine.

These people don’t necessarily need additional incentives as they’re motivated by the desire to protect their family and get back to doing the things they enjoy.

That said, the government should specify a threshold of the population that needs to be vaccinated in order to open international borders.

A health-care worker puts a band-aid on a young person's arm after a vaccination.
Not everyone will need an incentive to get vaccinated.
CDC/Unsplash

2. A little hesitant

This group may be somewhat hesitant about vaccine efficacy, and want to take a wait-and-see approach. But they also want to be seen as looking after themselves and others in their community, including the vulnerable. They seek statistics on numbers vaccinated and social approval.

In Singapore, people receive a free #igotmyshot mask to show they’ve been vaccinated. As more people don these masks, people in this group would likely feel encouraged to get a vaccine.

In time, creating barriers to attending public events for those who haven’t been vaccinated, such as a cricket or football match, could also nudge this group.

3. The young and healthy

Young people and those without pre-existing conditions are often less concerned about the health benefits of vaccinations. So while they may not be hesitant, they might be less motivated.

Creative incentives that portray vaccination as fun, easy, and popular within their peer groups are likely to be beneficial. Offerings of free food and drinks, as we’ve seen overseas, could be a good example.

This group is also increasingly socially aware, as we see on the issue of climate change. Tapping into what’s important to them, such as being socially responsible, would be a key way to appeal to this demographic.

While people in this group are broadly not yet eligible to be vaccinated in Australia, the government should think ahead about appropriate initiatives. High vaccination levels in this group will be essential to reaching herd immunity.

4. Where access is challenging

A range of barriers can prevent certain people from being vaccinated. While we’re lucky in Australia the vaccine is free, some people may live in areas with fewer vaccination facilities or where they need to travel greater distances.

Setting up on-site vaccination clinics in workplaces or mobile vans at public transport hubs can assist this group. Offering money to compensate for travel time, fuel and childcare needs would make vaccination more attractive too.

5. Vaccine resisters

Some people resist vaccination due to questions on efficacy and distrust of the system. Incentives may not work for this group — they may even strengthen the determination not to vaccinate.

Communicating data on the effectiveness and safety of vaccines (as compared to the risks) and endorsement from trustworthy ambassadors could be helpful for this group.




Read more:
I’m over 50 and hesitant about the AstraZeneca COVID vaccine. Should I wait for Pfizer?


There’s no “one size fits all” solution to motivate the entire population to get vaccinated. Instead, governments, non-profits and corporations need to consult with communities and create and target incentives accordingly, alongside other public health activities.The Conversation

Sameer Deshpande, Associate Professor, Social Marketing, Griffith University and Joy Parkinson, Research director, Social Marketing, Griffith University

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

No vaccine ‘targets’, but Australians could still be vaccinated by end of year


Driss Ait Ouakrim, The University of Melbourne; Ameera Katar, The University of Melbourne, and Tony Blakely, The University of MelbourneThis week’s budget assumes Australians will be fully vaccinated against COVID-19 by the end of the year, despite Prime Minister Scott Morrison saying the government has no vaccination targets, modelling or forecasts.

Australians are eagerly watching the pace of the rollout, given this underpins a further budget assumption: international borders could re-open from mid-2022.

So are all Australians likely to be offered two COVID-19 doses by the end of the year?

Previous targets

In January, the government was aiming to vaccinate 80,000 people per week. It wanted 4 million Australians vaccinated by the end of March and the entire adult population vaccinated by October.

So far, we have only delivered 2.83 million doses.

The initial vaccination road map was derailed in part due to poor logistics, but more so due to lack of supply and sheer bad luck. Prioritising the AstraZeneca vaccine, with its local manufacturing capacity, seemed like a good bet but this was derailed by the rare — but real — possibility of blood clots.




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The announcement overnight of 10 million doses of Moderna mRNA vaccine this year, and 15 million next year, suggests we will see AstraZeneca quietly shuffled off stage and replaced with Moderna. However, it is unlikely to impact the current timeline.

Could we meet an end-of-year target?

In theory, yes.

Studies suggest around three-quarters of Australians are willing to have a COVID-19 vaccine. If we aim to have 75% of adults fully vaccinated with two doses this year, around 15 million Australians will need to receive 30 million doses over the next seven months.

About half of these people are 50+ or priority populations, and the other half are under 50. So that means 15 million doses before September 30 (assuming we continue using AstraZeneca), and 15 million doses from October 1, when greater stocks of the Pfizer and Moderna vaccine become available in the fourth quarter of the year.




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From now until September 30, we have 100 weekdays left to deliver 12.2 million vaccine doses, or 122,000 per day.

This is twice as many doses per day as we achieved in the past week. But it’s doable if we ramp up our vaccination capacity.

From October 1 to December 24, we have about 15 million doses to administer to vaccinate 75% of all remaining adults. This will mean 250,000 vaccinations per weekday, so doubling the daily number again in the “sprint”.

Again, this is doable if we get all our mass vaccination hubs well-oiled and efficient before then. And probably use weekends, too.

Where it gets more challenging is if many people 50 and over elect to wait for Pfizer or Moderna, meaning an even bigger “sprint”. That would require an extremely reliable supply of these two vaccines before Christmas, well-oiled delivery systems and mass vaccination sites to deliver in excess of 300,000 doses per weekday.

This implied goal of offering vaccines to all adults by the end of 2021 is ambitious, but not impossible.

So when could we open borders?

Australia will still not have COVID-19 resilience (or “herd immunity”, or something approaching it) by the end of 2021.




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If 25% of Australian adults are unvaccinated, plus 100% of children, some 40% to 45% of the population will remain unvaccinated, which is likely too low to achieve herd immunity.

Wholesale opening of our borders then is not possible – the virus would still spread with substantial disease and death.

To meet a mid-2022 target for substantially loosening border restrictions, we will need children to be vaccinated and further vaccination of adults hesitant in 2021.The Conversation

Driss Ait Ouakrim, Research Fellow, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne; Ameera Katar, Data Analyst and Research Coordinator, The University of Melbourne, and Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

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

Mounting evidence suggests COVID vaccines do reduce transmission. How does this work?


Jennifer Juno, The Peter Doherty Institute for Infection and Immunity and Adam Wheatley, The University of MelbourneSince COVID-19 vaccines began rolling out across the world, many scientists have been hesitant to say they can reduce transmission of the virus.

Their primary purpose is to prevent you from getting really sick with the virus, and it quickly became clear the vaccines are highly efficient at doing this. Efficacy against symptoms of the disease in clinical trials has ranged from 50% (Sinovac) to 95% (Pfizer/BioNTech), and similar effectiveness has been reported in the real world.

However, even the best vaccines we have are not perfect, which means some vaccinated people still end up catching the virus. We call these cases “breakthrough” infections. Indeed, between April 10 and May 1, six people in hotel quarantine in New South Wales tested positive for COVID-19, despite being fully vaccinated.

But how likely are vaccinated people to actually pass the virus on, if they do get infected? Evidence is increasing that, not only do COVID-19 vaccines either stop you getting sick or substantially reduce the severity of your symptoms, they’re also likely to substantially reduce the chance of transmitting the virus to others.

But how does this work, and what does it mean for the pandemic?

Vaccinated people are much less likely to pass on the virus

Early evidence from testing in animals, where researchers can directly study transmission, suggested immunisation with COVID-19 vaccines could prevent animals passing on the virus.

But animals are not people, and the scientific community has been waiting for more conclusive studies in humans.

In April, Public Health England reported the results of a large study of COVID-19 transmission involving more than 365,000 households with a mix of vaccinated and unvaccinated members.

It found immunisation with either the Pfizer or AstraZeneca vaccine reduced the chance of onward virus transmission by 40-60%. This means that if someone became infected after being vaccinated, they were only around half as likely to pass their infection on to others compared to infected people who weren’t vaccinated.

One study from Israel, which leads the world in coronavirus vaccinations, gives some clues about what’s behind this reduced transmission. Researchers identified nearly 5,000 cases of breakthrough infection in previously vaccinated people, and determined how much virus was present in their nose swabs. Compared to unvaccinated people, the amount of virus detected was significantly lower in those who got vaccinated.

More virus in the nose has been linked to greater infectiousness and increased risks of onward transmission.

These studies show vaccination is likely to substantially reduce virus transmission by reducing the pool of people who become infected, and reducing virus levels in the nose in people with breakthrough infections.

Why does this matter?

If COVID-19 vaccines reduce the chances of transmitting the virus, then each person who is vaccinated protects not only themselves, but also people around them. Breaking chains of transmission within the community and limiting onward spread is critical to help protect people who may respond poorly to immunisation or may not be able to get vaccinated themselves, such as children, some older people, and some people who are immunocompromised.

This also greatly increases the opportunity to achieve some degree of population (or “herd”) immunity, and a faster easing of social restrictions.




Read more:
We may never achieve long-term global herd immunity for COVID. But if we’re all vaccinated, we’ll be safe from the worst


But what about the limits of vaccines?

Reducing the risk of transmitting the coronavirus relies on developing strong immunity against the virus. But immunity, even from the vaccines, fades over time. Scientists are actively monitoring people who’ve had COVID-19 vaccines to understand how long vaccine immunity is likely to last, and if and when booster shots will be required.




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Why do we need booster shots, and could we mix and match different COVID vaccines?


Variants of the coronavirus are also concerning. These are strains of the SARS-CoV-2 virus that carry changes which make them harder to control by immunisation. Such variants present two major challenges: they can evade vaccine immunity and, in some cases, are also more transmissible.

Although variants have spread widely throughout the world, there are several pieces of good news on this front. Countries with advanced vaccine rollouts are maintaining good control over the virus. For example, Israel began its mass vaccination campaign during their third wave, and quickly saw a decline in new cases.

What’s more, companies like Moderna are developing updated vaccines to specifically target these variants, with positive early results.

Vaccines don’t mean we should stop preventative behaviours

Right now, the global pandemic is complex. Many countries are quickly rolling out available vaccines, and there are a wide variety of lockdowns and social measures in place.

Yet, the number of new infections each day across the world is at an all-time high and concerning variants are circulating.

As people are vaccinated, there’s a temptation to stop or reduce some important social behaviours such as mask wearing or physical distancing. But, importantly, less transmission is not no transmission.

While vaccinated individuals most likely have a smaller chance of passing on the virus, it’s still important to keep up responsible behaviours into the immediate future to protect those who have not, will not, or cannot be immunised.The Conversation

Jennifer Juno, Senior research fellow, The Peter Doherty Institute for Infection and Immunity and Adam Wheatley, Senior Research Fellow, Department of Microbiology and Immunology, The University of Melbourne

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

We may never achieve long-term global herd immunity for COVID. But if we’re all vaccinated, we’ll be safe from the worst


Gideon Meyerowitz-Katz, University of WollongongIn early 2020, during the first thrashes of the pandemic, we were all talking about herd immunity.

At that stage, many commentators were arguing we should let COVID-19 rip through populations so we could get enough people immune to the virus that it would stop spreading. As I argued at the time, this was a terrible idea that would overwhelm hospitals and gravely sicken and kill many people.

Now we have safe and effective vaccines, we can aim to reach herd immunity in a much safer way. It’s certainly possible we’ll be able to reach and maintain local herd immunity in certain regions, states and countries. However the pandemic ends, it will involve this immunity to some extent.

But it’s still very uncertain whether long-term, global herd immunity is achievable. It’s quite likely the coronavirus could continue to spread even in places with high proportions of their populations vaccinated. It will probably never be eliminated.

However, if we’re all vaccinated, we’ll be largely safe from the worst ravages of the infection even if it does break out.

What is herd immunity again? And what does it mean for us long-term?

There are a few different definitions of herd immunity. Nevertheless, they all deal with the “reproductive number” of a disease, known as the R number. This is the average number of people an infected person will pass a disease on to, at a certain point in time.




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What is herd immunity and how many people need to be vaccinated to protect a community?


The R number depends on how infectious a disease is. Measles is often used as an example, because it’s one of the most infectious diseases. In a group of people among whom no one is immune to the disease, on average one person will pass measles on to around 15 others.

But as more people in the community become immune, either through vaccination or getting the disease and recovering, each infected person will pass on the infection to fewer and fewer others. Eventually, we reach a point at which the R number is below 1, and the disease starts to die out. The R number falling below 1 here is in a population where there are no social restrictions, so the disease starts to die out because of immunity and not because of measures like lockdowns. This is one definition of herd immunity.

However, another potential definition is that herd immunity is a state where enough people are immune in a population that a disease won’t spread at all. One of the more confusing parts of the pandemic is we scientists haven’t always used the same definition across the board.

For example, when we say “reached the herd immunity threshold”, we could be talking about a transient state where we’re likely to see another epidemic in the near future, or a situation where the vast majority of a population is immune and thus the disease won’t spread at all. Both are technically “herd immunity”, but they’re very different ideas.

How’s herd immunity calculated?

COVID-19 has an R number somewhere between 2 and 4 in groups of people where no one is immune. Using a simple mathematical formula, 50-75% of people need to be immune to COVID-19 for the R number to fall below 1 so it starts to die out, in a population with no social restrictions. Some researchers have done more complex versions of this calculation throughout the pandemic, but that’s the basic idea behind them all.

However, herd immunity is a moving target. For example, if everyone in your local population is taking great care to socially distance, COVID-19 won’t spread as much. Therefore, in practice, different cultures spread diseases to different extents, so the R number varies in both place and time.

Vaccines are the ultimate path to long-term immunity

Vaccines give us immunity against diseases, often to a greater extent than contracting the disease itself, and without the nasty consequences of being sick.

Our COVID-19 vaccines are safe and effective. Without going too much into the debate over which one is better, they are all capable of getting us to a point at which the disease would no longer spread through the community. For some vaccines, the percentage of people who we need to immunise is higher. But it’s the same basic idea regardless, and we need to vaccinate as many people as we can to have a shot at herd immunity.

We can already see this happening in some places. For example, in the United Kingdom and Israel, enough people have been vaccinated that even though restrictions are being relaxed, infection rates are staying low or continuing to drop. This is a beautiful sight.

The coronavirus will probably never be eliminated

Even with great vaccines, the problem is complex. There are almost always communities who aren’t immunised, for various reasons, even in countries with large proportions of the total population vaccinated. These small communities can continue to get sick and spread the disease long after the general population has passed the herd immunity line, which means there may always be some risk of COVID-19 outbreaks.

On top of this, new variants of the virus have emerged. Our current vaccines are probably enough to provide most people with immunity to the original strain in the long term. But several variants may substantially reduce our vaccines’ effectiveness as time goes by, so we may need boosters at some point.

What’s more, the global situation isn’t rosy. India and Brazil are currently experiencing horrifying COVID-19 outbreaks. The global case count continues to rise, partially because developed nations have hoarded vaccine doses jealously, despite this being a terrible approach to a pandemic. Rising case numbers anywhere increase the chances even more variants pop up, thereby impacting us all.

Even if we overcome vaccine hesitancy and global inaction, and we immunise most of the world, we may not be protected against the virus forever. Even higher-income nations may never get rid of COVID-19.

It’s quite likely this virus will never be eradicated (eliminated from every country across the globe). There may be places where the disease is gone, where local campaigns are successful, but there’ll also be places where the disease is still spreading.




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COVID-19 will probably become endemic – here’s what that means


What does this mean for Australia?

This presents a challenge for Australia. We have virtually no local COVID-19 transmission, so there’s no real risk from the virus as long as our border controls hold steady.

However, we probably can’t maintain this level of vigilance forever. And even with our very effective vaccines, we may not have long-term herd immunity — of any definition — to COVID-19.

At some point in the future, it’s likely we will see some cases of COVID-19 spreading in even the safest places in the world, including Australia.

Even so, getting vaccinated enormously reduces your risk of severe outcomes like hospitalisation and death. We should aim to vaccinate as many people as possible, while acknowledging that the future is inherently uncertain, and herd immunity is a challenging goal.The Conversation

Gideon Meyerowitz-Katz, PhD Student/Epidemiologist, University of Wollongong

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

I’m over 50 and can now get my COVID vaccine. Is the AstraZeneca vaccine safe? Does it work? What else do I need to know?


from www.shutterstock.com

Meru Sheel, Australian National University; Cyra Patel, Australian National University, and Margie Danchin, Murdoch Children’s Research InstituteFrom today, Australians aged 50 or older are eligible to receive their COVID-19 vaccine from special respiratory clinics or mass vaccination hubs in some states. Appointments with selected GPs are available from May 17.

However, a recent poll shows many people over 50 are hesitant to get vaccinated, particularly with the AstraZeneca vaccine earmarked for them. That’s mostly due to reports of very rare, but serious, blood clots that can develop after vaccination.

So it’s understandable why people want to know about any safety issues and how they relate to age. It’s also natural to want to know how well the vaccine works to protect people over 50.

Here’s what we know about this safe and effective vaccine from clinical trials and around 136 countries using it so far.

Does the AstraZeneca vaccine protect people over 50?

Clinical trials, which have included more than 57,000 people to date, found the AstraZeneca vaccine to be safe and effective.

When researchers pooled the results from four large trials — including about 8,600 vaccinated people and a similar number of unvaccinated persons — there were 81% fewer COVID-19 cases in vaccinated people than in unvaccinated ones. No one who got the vaccine was hospitalised due to COVID-19.

While the studies haven’t been designed specifically to look at efficacy in distinct age groups yet, there is good evidence the AstraZeneca vaccine protects both the elderly and younger adults from COVID-19. In clinical trials, adults aged 18-55 and those older than 55 had similar immune responses.

How about serious disease and death?

When it comes to protecting people from serious disease, there’s good news again. We have data from England and Scotland that one dose of it reduces COVID-19 hospitalisations by 80-88% in the elderly, similar to that of the Pfizer vaccine (88-91%).

Based on our understanding of how vaccines work — generally, vaccines are more effective in younger adults — it’s safe to assume the vaccine is at least 80% effective in preventing severe COVID-19 in people over 50.

Emergency sign
We want to avoid people ending up in hospital with serious COVID-19. With the AstraZeneca vaccine, hospitalisations are down around 80%.
from www.shutterstock.com

What about the new variants?

New variants of SARS-CoV-2, the virus that causes COVID-19, affect the efficacy of the AstraZeneca vaccine, but only slightly for the B.1.1.7 strain (the UK variant). It’s about 70% effective against this strain, compared with about 82% for the original strain.

However, there have been some concerns about protection against the B.1.351 strain (the South African variant). This is because the AstraZeneca vaccine provides less protection against mild COVID-19 disease in people infected with it.

Does the AstraZeneca vaccine limit spread of COVID-19?

We still need more long-term data to say for certain whether the vaccine prevents transmission of COVID-19.

However, preliminary UK research provides some welcome news. Researchers looked at more than 365,000 households and nearly one million contacts of COVID-19 cases. They found the vaccine reduced transmission from people vaccinated with one dose by 40-50%. This is great news in terms of slowing the spread of the disease.

How safe is the AstraZeneca vaccine in people over 50?

Both clinical trials and real-world data confirm the AstraZeneca vaccine has a good safety profile similar to other vaccines commonly used in Australia.

Side-effects are common and are mostly mild to moderate, with few recipients needing medical attention. The most common are reactions at the injection site, fatigue, headache and muscle pain. These occur in half to three-quarters of people under 55 after their first dose, and are less common in older people. The side-effects generally start within 24 hours and last around one or two days, and indicate your immune system is working.

In Australia, data from the AusVaxSafety vaccine surveillance system shows about 22% of people vaccinated with the AstraZeneca vaccine missed a day or more of work or studies as they were unwell. Fewer than 2% needed to see a doctor.




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What about the blood clots I’ve been hearing about?

Serious reactions to the vaccine have been very rare, one of which includes thrombosis with thrombocytopenia syndrome, which is on everyone’s mind right now.

This is a very rare condition in which blood clots (thrombosis) and low levels of platelets (thrombocytopenia) occur 4-28 days after receiving the vaccine. This can lead to disability and 20-25% of people with these clots die.

About six in every million people vaccinated with the AstraZeneca vaccine develop the condition. And it tends to be more common in people under 50. Other than younger age, there are no other risk factors for these clots we know of yet.

In Australia, there have been six cases of this type of blood clotting: one person in their 30s, four in their 40s, and one in their 80s. Of these, a person in their 40s has died from it.




Read more:
What is thrombocytopenia, the rare blood condition possibly linked to the AstraZeneca vaccine?


As Australia is largely COVID-free, is it worth me getting the AstraZeneca vaccine?

The risk-benefit analysis for Australians right now differs depending on the amount of COVID-19 in the community, your age and the availability of alternative vaccines.

Based on a small amount of data so far, the risk of these blood clots after the AstraZeneca vaccine, for people aged 50-59 is about 0.4 per 100,000 and for those aged 60-69, 0.2 per 100,000.

But the risk of getting severe COVID-19 or the risk of admission into intensive care from COVID-19 is much higher for the over 50s — nearly ten-fold higher than the risk of clots after the vaccine.

It’s about 6.5 per 100,000 people aged 50-59 and 7.0 per 100,000 for people aged 60-69, based on data from Victoria’s second wave in July 2020. There are different risk-benefit calculations for different scenarios.

In a scenario similar to the second wave of COVID-19 in Victoria, the risk of ICU admission due to COVID-19 is much higher than the risk of blood clots from the AstraZeneca vaccine.
from the Australian Government Department of Health

Australia has almost no disease in the community. However, this could change very quickly if there were new outbreaks. We also have no alternative to the AstraZeneca vaccine for most people over 50 (more Pfizer vaccine is not available until the last quarter of 2021). So balancing the risks and benefits of the vaccine, is extremely challenging. People may not perceive their risk of COVID-19 as high enough to warrant vaccination and are preferring to wait, perhaps six months or more until other vaccines are available.

However, the potential benefits of the vaccine go far beyond what we’ve already mentioned. Vaccination will contribute to the prevention of long COVID-19 (symptoms that linger for months) as well as increased ability to move around freely in society, including being able to attend large events. Vaccination will help us avoid lockdowns or school closures, allow us to travel overseas and return to normal life.




Read more:
A balancing act between benefits and risks: making sense of the latest vaccine news


How do I get vaccinated?

You can use the government’s vaccine eligibility tracker to check whether you can receive your COVID-19 vaccine from today, and to make an appointment.

This will give you details of the state- and territory-run vaccination clinics near you that are open from today (not all are taking appointments for the over 50s yet). From May 17, you can receive your vaccine at some GP clinics.

Two doses of the AstraZeneca vaccine are needed for best protection, preferably 12 weeks apart.The Conversation


Department of Health/The Conversation, CC BY-ND

Meru Sheel, Epidemiologist | Senior Research Fellow, Australian National University; Cyra Patel, PhD candidate, Australian National University, and Margie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children’s Research Institute

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

To abandon vaccination targets is to abandon the mantle of leadership


Peter Gahan, The University of Melbourne and Jesse E. Olsen, The University of MelbourneThe Australian government has abandoned its ambitious targets to have the adult population vaccinated by the end of October. It has, in fact, abandoned having any target.

We all sometimes find ourselves in tough positions and just want to call it a day. But this decision is not what we should expect from the nation’s leaders when so much is at stake. It also goes against decades of research and evidence on the importance of goal-setting.

In January Prime Minister Scott Morrison said the plan was to have four million Australians vaccinated by the end of March, and the entire adult population by the end of October. At the start of April, however, the actual number was less than 842,000. (As of April 15 the number was just over 1.4 million doses.)

Then, on April 11, in a video posted to his Facebook page at 11:35pm, Morrison announced there would be no more targets. “We are just getting on with it,” he said.

But without any target, what is the “it” we should be “getting on with”?


Australia's vaccination score card as of April 4 2021.
Australia’s vaccination score card as of April 4 2021. Don’t expect to see any more of these.
Australian Government/Department of Health, CC BY-SA

Imagine if at your next work meeting the boss echoed the prime minister’s words that “one of the things about COVID is it writes its own rules” and said something like:

This quarter, rather than set targets that can get knocked about by every to and fro, we are just getting on with it.

Will these words inspire your team to succeed?

According to leadership research, good management necessarily entails influencing others to achieve goals or objectives. This is a point made even in introductory undergraduate management textbooks.

To abandon goals or targets is, by definition, to abandon the mantle of leadership.




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When goals work

Study after study has demonstrated why setting ambitious targets is important for virtually any activity — from turning a couch potato into a marathon runner, to putting an astronaut on the Moon, to building a driverless car.

Of course, just setting an ambitious goal is not enough. Done poorly, they can be discouraging and undermine performance, and even lead people to behave unethically. To work, people and organisations need to have the capabilities and resources to address unexpected twists and turns, as well as strategy to manage risks and overcome any barriers that crop up.

But so long as goals are set with these things in mind, they help achieve results, driving creativity, innovation and performance.

We already see evidence of this in COVID vaccinations overseas.

The US government’s Operation Warp Speed, the private-public partnership to develop and distribute multiple vaccines in record time, started with this goal:

to deliver tens of millions of doses of a SARS-CoV-2 vaccine — with demonstrated safety and efficacy, and approved or authorised by the US Food and Drug administration for use in the US population by the end of 2020, and to have as many as 300 million doses deployed by mid-2021.

The goal was both ambitious and specific, defining the “it” that everyone should “get on with”. It formed the basis for planning that has started paying dividends after a year of death and economic destruction.

Goal setting and effective leadership

The federal government’s decision to abandon goals goes against research the Commonwealth itself commissioned just a few years ago.

In 2015, the federal Department of Employment and Workplace Relations funded the University of Melbourne’s Centre for Workplace Leadership to survey more than 3,500 Australian workplaces about how the quality of management and leadership affects productivity and innovation.

The Study of Australian Leadership, which surveyed both private and public sector organisations, found very basic management practices to be among the most important drivers of organisational performance and innovation. These basic practices include setting clear and ambitious targets, communicating them, and regularly monitoring progress.

Scott Morrison communicates via a Facebook video on April 11 that the Australian government has abandoned vaccination uptake targets.
Scott Morrison communicates via a Facebook video on April 11 that the Australian government has abandoned vaccination uptake targets.
Facebook

Leading rapid implementation

Given the evidence, any government with claims to having competent leadership should be setting and communicating a clear and ambitious goal for its vaccination roll-out.

Successful roll-outs in other countries show this should be done in consultation with local and regional governments, health professionals and key players in the public and private sectors (who must also be involved in the design and implementation of strategies and processes).

Given the federal government’s own limited capacities at the local level (public hospitals, for example, are run by the state and territory governments), its engagement with other stakeholders must be meaningful — not just lip service. It must also resist the urge to control everything.

Let there be goals

When faced with complex problems, getting agreement on ambitious goals can be extremely powerful. Nor does it need to take forever, as is often claimed. Australia’s response to the pandemic in 2020 largely shows this.

There will be challenges with meeting targets. Vaccine supplies are limited. There will be hiccups. But abandoning any sense of ambition is not the answer.

Because COVID “writes its own rules”, as Morrison has rightly pointed out, the federal government should pursue multiple alternative paths to achieving its goals. In other words, it should not put all it eggs in one basket, as it did with its plan to rely on local GPs to deliver vaccines, rather than use “vaccination hubs” as other nations have done.




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Australian vaccine rollout needs all hands on deck after the latest AstraZeneca news, mass vaccination hubs included


Abandoning vaccination targets now undermines all that has been sacrificed to be in the relatively good position the nation is now in. The economic and social costs, as well as the potential further loss of life, will mount unless the Morrison government reconsiders its misguided decision.

It must put aside concerns about the political fallout of missing targets. We cannot “get on with it” without leadership that defines the “it” to be gotten on with.The Conversation

Peter Gahan, Professor of Management, Faculty of Business and Economics, The University of Melbourne and Jesse E. Olsen, Senior Lecturer, Dept of Management & Marketing, Faculty of Business & Economics, The University of Melbourne

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

What is Novavax, Australia’s third COVID vaccine option? And when will we get it?


Jamie Triccas, University of SydneyAs AstraZeneca is no longer the preferred vaccine for Australian adults under 50, attention is turning to what other COVID-19 vaccine options are in our arsenal.

The federal government has ordered 40 million doses of the Pfizer vaccine, which will become the mainstay of the rollout, while AstraZeneca will continue to be administered for people over 50 in the current phase 1B.

The federal government also this week ruled out using Johnson & Johnson’s one-shot vaccine.

But Australia does have a deal for a third vaccine, by US biotech company Novavax. The government has ordered 51 million doses of this vaccine, though it’s yet to be approved by Australia’s drug regulator, the Therapeutic Goods Administration (TGA), which is expected to make a decision in the third quarter of the year.

At this stage, Novavax would be made offshore and imported, although Melbourne-based biotech CSL can make the vaccine if requested by the federal government.

How does the Novavax vaccine work?

The Novavax vaccine is given as two doses, similar to the Pfizer and AstraZeneca shots already being used in Australia.

It can be stored for up to three months at fridge temperature, which differs from the Pfizer mRNA vaccine which needs to be kept at ultra-low temperatures. In saying that, the TGA said last week the Pfizer vaccine can be stored at normal freezer temperatures for two weeks during transport, and at fridge temperatures for five days — though must still be kept ultra-cold after transport and in the long-term.

A graphic comparing Australia's three vaccine options
Comparing Australia’s three COVID-19 vaccine options.
Jamie Triccas, made with BioRender, CC BY-ND

The vaccine also uses a different technology to the Pfizer and AstraZeneca vaccines. It’s a “protein subunit” vaccine; these are vaccines that introduce a part of the virus to the immune system, but don’t contain any live components of the virus.

The protein part of the vaccine is the coronavirus’ “spike protein”. This is part of the other COVID-19 vaccines in use but in a different form.




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The Novavax vaccine uses a version of the spike protein made in the lab. The spike proteins are assembled into tiny particles called “nanoparticles” which aim to resemble the structure of the coronavirus, however they cannot replicate once injected and the vaccine cannot cause you to get COVID-19.

In order for these subunit vaccines to generate strong protective responses, they need to include molecules that boost your immune system, called “adjuvants”. The goal of these adjuvants is to mimic the way the real virus would activate the immune system, to generate maximum protective immunity.

Novavax includes an adjuvant based on a natural product known as saponin, an extract from the bark of the Chilean soapbark tree.

How effective is the vaccine compared to those already in use in Australia?

The interim data from phase 3 testing, released in March, was very encouraging. When tested in the UK in a clinical trial including more that 15,000 people, the vaccine was 96% effective at preventing COVID-19 disease for those infected with the original strain of the coronavirus.

This compares well to the Pfizer vaccine, with an efficacy of 95%, and recent data from AstraZeneca demonstrating 76% efficacy against COVID-19.

The Novavax vaccine is also safe. In early clinical testing the vaccine caused mainly mild adverse events such as pain and tenderness at the injection site, and no serious adverse reactions were recorded. In the larger trials, adverse events occurred at low levels and were similar between the vaccine and placebo groups.

What about protection against variants?

In the UK trial, the vaccine maintained strong protection against disease in people infected with the B.1.1.7 “UK variant”, demonstrating 86% efficacy.

This is good news because the B.1.1.7 variant is now dominant in many European countries, is more transmissible and deadly than the original SARS-CoV-2 virus, and is responsible for most of the cases that have arisen recently in Australia.




Read more:
The UK variant is likely deadlier, more infectious and becoming dominant. But the vaccines still work well against it


Less encouraging is protection against the B.1.351 variant first identified in South Africa, which can evade immunity that developed in response to earlier versions of the virus. The efficacy of Novavax’s shot dropped to 55% in protecting against COVID-19 symptoms from this variant. Protection against severe disease however was 100%, indicating the vaccine will still be important in reducing hospitalisation and death due to this variant.

Novavax, along with the other major vaccine companies, are developing booster vaccines to target the B.1.351 variant. Novavax are planning to test a “bivalent” vaccine, which targets two different strains, using the spike protein from both the original Wuhan strain and the B.1.351 variant.




Read more:
Why we’ll get COVID booster vaccines quickly and how we know they’re safe


The Conversation


Jamie Triccas, Professor of Medical Microbiology, University of Sydney

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