We learned on Monday that the Australian Technical Advisory Group on Immunisation (ATAGI) has advised that Aboriginal and Torres Strait Islander children aged 12-15, those who live in remote communities, and those with underlying medical conditions should be prioritised to receive the jab.
With COVID vaccination for kids being such a hot topic, we asked five experts whether we should vaccinate children in Australia against COVID-19.
Four out of five experts said yes
Here are their detailed responses:
If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: email@example.com.
Asha Bowen is co-chair of the Australian and New Zealand Paediatric Infectious Diseases (ANZPID) group of the Australasian Society of Infectious Diseases. She receives research funding from NHMRC.
Catherine Bennett has received NHMRC and MRFF funding, and is an independent expert on the AstraZeneca advisory board.
Julian Savulescu receives funding from the Wellcome Trust. This work was supported by the UKRI/AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1.
Margie Danchin is a member of ATAGI’s working group on vaccine safety, evaluation, monitoring and confidence.
Nicholas Wood holds an NHMRC Career Development Fellowship and Churchill Fellowship.
One question many people are asking is whether the immunity you get from contracting COVID and recovering is enough to protect you in the future.
The answer is no, it’s not.
Remind me, how does our immune response work?
Immune responses are innate or acquired. Innate, or short-term immunity, occurs when immune cells that are the body’s first line of defence are activated against a pathogen like a virus or bacteria.
If the pathogen is able to cross the first line of defence, T-cells and B-cells are triggered into action. B-cells fight through secreted proteins called antibodies, specific to each pathogen. T-cells can be categorised into helper T-cells and killer T-cells. Helper T-cells “help” B-cells in making antibodies. Killer T-cells directly kill infected cells.
Once the battle is over, B-cells and T-cells develop “memory” and can recognise the invading pathogen next time. This is known as acquired or adaptive immunity, which triggers long-term protection.
What happens when you get reinfected? Memory B-cells don’t just produce identical antibodies, they also produce antibody variants. These diverse set of antibodies form an elaborate security ring to fight SARS-CoV-2 variants.
Natural immunity is not enough
Getting COVID and recovering (known as “natural infection”) doesn’t appear to generate protection as robust as that generated after vaccination.
And the immune response generated post-infection and vaccination, known as hybrid immunity, is more potent than either natural infection or vaccination alone.
People who have had COVID and recovered and then been vaccinated against COVID have more diverse and high-quality memory B-cell responses than people who’ve just been vaccinated.
And studies have shown that antibody levels were higher among those who’d recovered from COVID and were subsequently vaccinated than those who’d only had the infection.
Memory B-cells against the coronavirus have been reported to be five to ten times higher in people vaccinated post-infection than natural infection or vaccination alone.
Is one dose enough after COVID?
Some reports have suggested people who’ve had COVID need only one dose of the vaccine. Clinical trials of approved vaccines didn’t generate relevant data because people who’d already had COVID were excluded from phase 3 trials.
One study from June showed people with previous exposure to SARS-CoV-2 tended to mount powerful immune responses to a single mRNA shot. They didn’t gain much benefit from a second jab.
A single dose of an mRNA vaccine after infection achieves similar levels of antibodies against the spike protein’s receptor binding domain (which allows the virus to attach to our cells) compared to double doses of vaccination in people never exposed to SARS-CoV-2.
We need more studies to fully understand how long memory B-cell and T-cell responses will last in both groups.
Also, a single dose strategy has only been studied for mRNA-based vaccines. More data is required to understand whether one jab post-infection would be effective for all the vaccines.
At this stage, it’s still good to have both doses of a COVID vaccine after recovering from COVID.
Does Delta change things?
The development of new vaccines must keep pace with the evolution of the coronavirus.
At least one variant seems to have evolved enough to overtake others, Delta, which is about 60% more transmissible than the Alpha variant. Delta is moderately resistant to vaccines, meaning it can reduce how well the vaccines work, particularly in people who’ve only had one dose.
There’s no data available yet about how effective a single jab is for people who were previously infected with Delta and recovered.
The most important thing you can do to protect yourself from Delta is to get fully vaccinated.
According to a Public Health England report, one dose of Pfizer offered only about 33% protection against symptomatic disease with Delta, but two doses was 88% effective. Two doses was also 96% effective against hospitalisation from Delta. The AstraZeneca vaccine was 92% effective against hospitalisation from Delta after two doses.
A few vaccine manufacturers, including Pfizer, are now planning to use a potential third dose as a booster to combat the Delta variant.
Have you been vaccinated yet? And if you have, are you one of a growing number of people who posted a selfie on social media afterwards? At a time when many people distrust government advertising, vaccine selfies — or “vaxxies” — may well be the secret weapon to encourage more people to get the jab.
Suddenly our Facebook, Twitter and Instagram feeds are filling up with selfies of family, friends and even strangers getting their COVID shot.
But vaxxies are more than mere selfies, as they have a unique social function. They are likely helping normalise the vaccine procedure, reducing hesitancy around perceived risks and increasing vaccine trust within social circles.
As governments and health officials continue to flip-flop on vaccine age requirements, and anti-vaxxers spread falsehoods through social media and protests, the vaxxie might just be a powerful line of defence against vaccine hesitancy.
As of July 21, more than 10.6 million COVID vaccine doses had been administered in Australia. As time passes, more and more people are showing their support by posting about their vaccination experience online.
Normally, we see this type of behaviour demonstrating “civic duty” during elections or with social movements such as Pride or Black Lives Matter. We’re now seeing similar posts involving vaccination, using a variety of hashtags including #vaxxie, #GetVaccinated, #GetVaccinatedNow, #Vaccination and #jab.
In friends we trust
The vaxxie could be a useful tool in encouraging people to get vaccinated. Over the past decade in particular, there has been an erosion of trust in traditional advertising and a huge surge in social media use.
This means word-of-mouth recommendations and reviews from people we know (and even people we don’t) are often considered more “authentic” than standard advertising and government messaging.
Research indicates we look to our friends, family and social groups for guidance during uncertain times. They provide us with subjective norms: the desire to behave as those who are significant to us think we should.
This results in social pressure to engage in certain behaviours. If our family and friends are posting vaxxies, it’s an implicit nudge for us to get vaccinated too. And as reported vaccine shortages continue and demand grows, seeing vaxxies can also increase our fear of missing out (FOMO).
In-groups and out-groups
In the same way one shows support for social movements on social media, sharing a vaxxie communicates your position on vaccinations — you are either pro-vax or anti-vax. Essentially, you are either with us or against us: a hallmark of classic in-group/out-group behaviour.
The psychology of the in-group/out-group is best illustrated using social identity theory. This theory states internal cohesion and loyalty to the in-group exists when the group members maintain a state of almost hostility or assertive opposition toward out-groups — which are often perceived as inferior.
This theory explains spectator behaviour at sporting events. As we see more of our friends sharing their vaxxies, we may desire to be a member of the “in-group”. But to be in this group, we need to get a jab (and show evidence with our own vaxxie).
The in-group pressure may be further increased when we see our political leaders or favourite celebrities get involved. US President Joe Biden, Dolly Parton and Sir Ian McKellen are just some of the icons whose vaccinations made headlines.
Risks of virtue signalling
One of the main risks in posting a vaxxie is it could alienate others through virtue signalling, which is when a person behaves in a way that highlights their own “good” moral values. People on Facebook will often loudly proclaim their support for a certain cause because they want to seem caring or “woke”.
But most of us aren’t impressed by those who overtly express their own moral correctness. There’s a fine line between encouraging others to engage in a certain behaviour and coming across as self-righteous.
There may also be an element of mob mentality at play with vaxxies. Due to excessive pressure from peers, some may find themselves getting vaccinated for emotional (versus rational) reasons. While the pressure to get vaccinated is arguably positive, some individuals may have legitimate concerns which they will suppress in order to conform.
That said, this is not the same as crowd behaviour which is often shrouded in anonymity and involves blindly following others. Vaxxies are personal, identifiable messages and are not anti-social.
Another risk with vaxxies is they may encourage “brand” competition. Vaxxie posters regularly include the hashtag of their vaccine: #pfizer or #astrazeneca.
Given the mixed messaging around AstraZeneca, could a proliferation of Pfizer vaxxies discourage people from seeking out AstraZeneca, at a time when we’re encouraged to take whichever option we can?
Despite the risks, however, it’s clear we will need a variety of tools to encourage people to get vaccinated during this crucial phase of the pandemic. Vaxxies likely have an important role to play on this front.
And as long as they don’t seek to overtly shame or alienate others, they could help engender a strong sense of solidarity as more and more people get the jab.
Louise Grimmer, Senior Lecturer in Marketing, University of Tasmania; Gary Mortimer, Professor of Marketing and Consumer Behaviour, Queensland University of Technology, and Martin Grimmer, Professor of Marketing, University of Tasmania
Danielle Wood, Grattan Institute; Stephen Duckett, Grattan Institute, and Tom Crowley, Grattan InstituteAt Friday’s National Cabinet meeting, our nation’s leaders put some meat on the bones of their 4-stage plan to reopen Australia.
The plan includes target vaccination thresholds and some details on restrictions that might be lifted at each stage. So far so good.
But the plan raises two major concerns.
First, the reopening threshold is low. We won’t know until we see the modelling, but it looks like the National Cabinet is taking a gamble that the outcomes of re-opening will be at the more rosy end of plausible scenarios.
Second, many important details are still missing, including the timing of each stage and, crucially, the steps the government is taking to get more jabs in arms.
The vaccine coverage thresholds for re-opening look low
The key stage of the plan is stage C. In stage C, the government commits to no more mass lockdowns, and vaccinated Australians can leave the country and return without quarantine.
The government says we need 80% of Australians over 16 vaccinated before we get to stage C.
The over-16 qualifier matters a lot. The virus doesn’t care who is eligible. Children can still transmit the virus and so transmissibility depends on vaccine rates across the population.
Getting to 80% of Australians over 16 I equates to just under 65% of all Australians – far lower than the 80% threshold Grattan Institute recommends for starting to re-open international borders.
The Doherty Institute modelling that informed the plan has not been released. The institute likely presented a range of scenarios. The Australian public have a right to understand the health outcomes in each and the way in which National Cabinet weighed the uncertainty in the modelling.
Committing to a vaccine coverage threshold that is too low risks a rapid surge in COVID cases that could overwhelm our hospitals and impose a high death toll. State governments would almost certainly impose lockdowns to contain this type of spread, pushing “real” reopening further back.
Coverage too low to loosen restrictions for the vaccinated
The steps discussed in stage B also contribute to a greater risk of a disorderly re-opening. Stage B envisages loosening some quarantine requirements and public health restrictions for vaccinated residents.
The main concern is that stage B kicks in at 70% of the eligible population (56% of the total population).
Under almost any scenario, the reproduction number for the Delta strain of the virus is still well above 1 at this point. That means each infected person on average infects more than one other person.
Relaxing international arrival and quarantine restrictions for vaccinated adults – who can still transmit the virus (albeit less so than the unvaccinated) – means more Delta will get in. And allowing exemptions from public health measures for vaccinated residents means the measures to contain the spread of the virus will be less effective.
With only 56% of the population vaccinated, any uncontrolled spread will translate into high rates of serious illness and hospitalisation.
Our governments will be walking a very fine line indeed.
No details on ramping up the vaccine program
The other major concern is the lack of detail about how the National Cabinet plans to ramp up the vaccine program, and timeframes for doing so.
The most concerning line of the prime minister’s Friday evening press conference was “it is all up to us” – suggesting success is largely out of the government’s hands.
Getting enough jabs into arms as quickly as humanly possible is a job for government. We need a step change in the planning and professionalism of the rollout if we are going to have any hope of making these targets in a reasonable timeframe.
Grattan’s Race to 80 report, released last week, set out the necessary steps.
On logistics, it means delivering vaccines not just through GPs but via state-run mass vaccination hubs, pharmacists, schools, workplaces, and through pop-up clinics at community halls, public transport stations, and sporting events.
On messaging, it means high-quality national campaigns but also more targeted messaging for hesitant and harder-to-reach groups, including women, young people, and those from culturally and linguistically diverse communities.
It looks like National Cabinet has not yet considered the crucial question of whether we need vaccine passports in high-risk settings such as restaurants and major events, to encourage people to get the vaccine and to reduce the risks of superspreading events.
And there is no plan to vaccinate children, even though Australia’s regulator, the Therapeutic Goods Administration (TGA), has already approved Pfizer for 12-to-16 year olds.
More to do
Australia can’t afford much more delay. The key planks of the logistics, messaging, and incentive campaigns need to be in place very soon if we are going to substantially increase the pace of the rollout as more Pfizer doses arrive in coming months.
At the same time, governments should release the Doherty modelling to help Australians understand the expected health outcomes under each of the four stages.
Vaccinations are the route back to normal life. This means all Australians have a stake in making sure our governments get this plan right.