Currently about half of the population of Australia is directly impacted by the delta variant of COVID. This pandemic is one of, if not the most, significant health events of our times and is affecting all countries. In Sydney we are seeing huge challenges in getting on top of the current transmission, with spread happening mainly in families and essential workplaces.
The question on everyone’s lips is ‘How long will this go on for?’ and we are not just talking about this current lockdown, but how long before we no longer live on the brink of yet another lockdown? What is clear, and was predicted by epidemiologists at the start of the pandemic, is that until you get some level of herd immunity, either through vaccination or most of your population getting the virus, every country will just see sequential waves of disease. Even countries with high rates of previous infection and reasonably high vaccination rates, are seeing multiple waves. So, why bother with vaccination? Can’t you still catch COVID even when you’ve been vaccinated? Is one vaccine better than another? Why does the advice change all the time, and who can I trust?
This blog intends to try and answer some of those questions, and provide some information that is accurate at the time of this blog being written. The information may change in the future and I”ll explain a little bit more why below.
Before I go any further though, one of the biggest problems is that if you listen to your friend down at the pub, or someone on facebook, or even the ‘experts’ in the media, you’ll hear many different statements and opinions. Some of these are good and accurate, some are partially accurate, some are just personal opinion without fully understanding it, and some are just wildly wrong and even harmful. So how do you know who to believe? As a health professional with expertise in epidemiology, sometimes I find it hard to navigate all the information out there and am frustrated by people saying different things. What I try to do is go back to the facts, listen to a variety of opinions and understand where things are clear, and where things are not clear.
And that’s what I’m trying to do in this blog. If anything is unclear or you have more questions then get in touch!
Why do we need vaccines?
Without vaccines, our only option is to just live with COVID and accept it, a bit like we do with other diseaseas like the common cold, or the flu and that was how they managed the last major pandemic in the early 1900’s, the Spanish flu, which eventually faded out, but not before causing massive waves of death. So why don’t we just ‘let COVID rip’? Well, for one, we have seen clearly from overseas that when millions of people are infected, hundreds of thousands of people are admitted to hospital and thousands die. This overwhelms the hospital system meaning that not only could you die of COVID, but also they have no room when you have a heart attack, or stroke, or develop cancer. Therefore death rates of those common illnesses go up as well.
But also, we are seeing that the COVID virus keeps mutating and many of these mutations are worse than the last (for example this delta strain). As long as you have widespread transmission of COVID, you will keep seeing mutations. And that means that even if you’ve had COVID before you can catch it again, and maybe worse than before.
So the evidence now is absolutely clear, this is worse than the flu. The flu has not overwhelmed hospitals and health systems like COVID has overseas. The flu does not cause long term impacts like COVID. A study of just under 3000 cases from the first waves in Australia last year followed those people until they had fully recovered from their COVID symptoms. Although most people recovered within a month, at three months, 5% (about 150 people) were still having significant symptoms including fatigue, neurological problems, and chest pain. If we let the whole of Australia get COVID then over 1.25 million people, including younger people, will have long term chronic illness, which we don’t know how to treat yet.
Therefore, our best way of dealing with COVID is either with treatments for those that get it (very few successfully identified so far, but research is ongoing) or vaccination.
What vaccines do we have and do they work?
We currently have access to the Astra-Zeneca and Pfizer vaccines, and will be getting the Moderna vaccine later this year as well. All these vaccines have been widely used around the world and have been credited with preventing thousands of deaths and hospitalisations in many countries. The effectiveness of Pfizer and AZ (which are available at the moment in Australia) are excellent against the delta variant, with over 90% effectiveness against hospitalisations and death. These are outstanding efficacy rates for vaccines. Several other vaccines that we use commonly may only have 50 to 60% effectiveness (which is still enough to manage some diseases). Unfortunately, COVID is very transmissible, and requires highly effective vaccines, and so we are incredibly fortunate that we have so many vaccines that are so effective.
However, even if you’re vaccinated, you can still catch and spread COVID to others. This is not a failure of the vaccine, its designed to stop you getting very sick and dying. Studies from the UK have shown that Pfizer and AZ vaccines do reduce your risk of passing it on by about 50%, but until we have large portions of the population vaccinated, the Health department still wants vaccinated people to stay home and socially distance along with people who aren’t vaccinated.
What vaccine should I get and why does the advice keep changing?
As I write this blog, people over 40 yrs can book in to get Pfizer, however supplies are limited until September and its almost impossible to find an appointment for Pfizer at the moment unless you are a prioritised worker. Until yesterday, AZ was recommended for over 60s due to the widely reported clotting risk, however today (24th July) ATAGI (the government’s advisory committee on vaccines) has now recommended anyone over 18 in Sydney consider getting AZ due to the rapidly spreading COVID outbreak.
So why is the advice changing and what is this clotting risk?
The only problem with Pfizer at the moment is that we just don’t have enough of it to vaccinate everyone, otherwise everyone could go out and get it as soon as they want. More is coming in September/October and there should be plenty to go around then for anyone who wants a shot. That’s the only reason why they are limiting it to over 40s. Its highly safe and effective for anyone, even for teenagers. There are some reports coming out of the US about a small risk of inflammation of the heart (myocarditis) in younger people, but they tend to recover and its very mild. But its good to discuss risks and benefits openly. Every drug has side effects (even Panadol and Aspirin) and so every discussion is a about risks vs benefits.
The reason why the advice changed for the AZ vaccine is that it became apparent that one of that vaccine’s side effects is causing unusual blood clots. These are not the same type of blood clots that you can get when you fly, or take the oral contraceptive pill, or have surgery. They are much rarer and occur in different places in the body. The risk is about 1 clot for every 50,000 doses of AZ. So if you filled the Sydney Cricket Ground with people and vaccinated them all, 1 or 2 might get a clot. For those who get a clot, the risk of dying is about 3% (or 3 in a hundred). So, overall, your risk of dying from the AZ vaccine is just under 1 in a million. Super rare. In comparison the risk of dying during an operation, or in a car accident, is more like 1 in 400,000.
So, why did the advice change? The ATAGI group of experts were balancing the risk of COVID, with the risk of clots. When we had no COVID in Australia, the risk of clots was higher than the risk of COVID. But now that COVID is spreading in Sydney again, the risk of catching, getting seriously ill or dying of COVID, is now greater than the risks associated with the vaccine. At the moment in Sydney, about 18% of people diagnosed with COVID are being admitted to hospital including many people under the age of 50. Thankfully we aren’t seeing too many deaths at the moment, but don’t underestimate how sick those people in hospital are, or the high risk of chronic disease even after discharge.
This is why the advice changes, ATAGI simply balances the risks and benefits at any given time. At the moment, they are recommending that everyone over the age of 18 strongly consider getting vaccinated.
Do I have to get vaccinated?
No, vaccination is never mandatory. This includes all vaccinations given in Australia, even the ones we all get as children. However, what may happen is that if you want to work in certain occupations where the risk of COVID is very high (such as aged care, or health) you may not be allowed to work in those areas without vaccination – this is similar to the ‘no jab, no play’ rules for childhood vaccinations. We may find eventually as well that there are things you are only allowed to do if you are vaccinated (such as flying overseas, or even interstate). This is fully legal.
So, why should I get vaccinated?
Firstly, to protect yourself against COVID. This is a nasty disease and is going to be around for years to come, quite possibly with many different variants that may be even nastier than delta. You may be lucky and get it mildly, but do you want to take that risk?
Secondly, to protect your loved ones. You may get COVID mildly, but may pass it on to your family who then get sick and may die. No-one wants to do that.
Thirdly, to protect those that can’t get vaccinated. A small proportion of people cannot get these vaccines, due to various reasons. If enough people get vaccinated then we reach herd immunity and we can protect those amongst us who are vulnerable and can’t get a vaccine even if they want to.
Personal reflection
To finish with, a few personal reflections. For me, as soon as I was eligible, I booked in to get vaccinated (I got Pfizer). So did my husband (he’s had one dose of AZ, waiting for his second one). For us, we trust the science (I have looked into it in some detail) and are keen to do our bit to protect ourselves, our parents, and others, as well as play a part in getting our society back to some semblance of normal. As a Christian, I also see getting vaccinated as a way for me to love others, to play my part in getting ahead of this disease and protect others around me who can’t (or choose not to) get vaccinated. This is not to judge anyone who doesn’t get vaccinated, simply noting that vaccination for me fits into the biblical imperative to love my neighbour as myself. I also don’t see vaccination as a lack of faith that God will protect me and my loved ones from disease. The Bible doesn’t promise that Christians will not suffer or get sick, and in fact when the Israelites were wandering around the desert for 40 years, they had clear guidance for social distancing of people who had infectious diseases (check out Leviticus 13!). God provides us with brains, scientists and medicine to use with wisdom.
I fully understand that some of you might have genuine concerns and questions about this. I am always happy to have a chat through these issues without judgement or prejudice, just get in touch with me directly, through Steve, or the church webpage. These are important issues to deal with and I’m really happy to help work through the facts with you while you make a decision.
Dr. Ruth Griffiths
Ruth has been a member of our 9.30am congregation for the last three years, married to Nev, and Mum to Ally and Emmy. She is a medical doctor and epidemiologist, and has worked in medical research for the last 16 years.