The crucial fact is that all the vaccines being administered around the world provide near 100% protection from death and the need for those infected to receive intensive hospital care.
Incredible advances in science have allowed scientists to provide us with a number of vaccines that can protect us from the ravages of a deadly new virus within a year of our first look at this new foe. More than 113 million people have been infected, more than 2.5 million have died, nearly 500,000 are being infected each day with on average, about 10,000 deaths a day.
Providing protection through a global vaccination program could not be more urgent. While the production and distribution of sufficient amounts of vaccine present unprecedented logistical problems, equally important is the enthusiastic participation in the program by individuals confident in the efficacy and safety of the vaccines offered.
There is obvious confusion about just what efficacy in this context entails. Ideally, vaccination against the SARS-2-Cov virus would result in four outcomes. Most importantly, vaccinated individuals would not die if infected, nor would they become so ill after infection that they needed hospital care, which would compromise the safety of hospital staff and the availability of intensive care facilities.
Ideally, after vaccination, individuals who were infected would not experience any non-life-threatening symptoms typical of severe respiratory infections that could result in short term misery and absence from normal activities and they would not be able to harbour live virus in their respiratory secretion that they could pass onto the unvaccinated.
No vaccine available today can guarantee all these outcomes. Early results show that some come closer to achieving these outcomes than others but here is the crucial (very fortunate) fact.
All the vaccines being administered around the world provide near 100% protection from death and the need for those infected to receive intensive hospital care.
All the manufacturers are well aware that these model one versions must be seen as ‘works in progress’. Viral mutations are challenging as they may result in structural changes to the virus that interfere with the ability of antibodies generated by vaccination with the original viral model to neutralise a current infection as the variants will “look different”. Some vaccines appear to be less efficient at responding to variants but still have the capacity to block serious disease and death from infection.
Any international comparison shows we have done well in minimising deaths and severe illness requiring hospitalisation from the Covid virus. This success has been won on the back of huge economic and social costs that few would begrudge but all would like to avoid in the future.
Our major vulnerability has come from the necessity of having some individuals who are infected and infectious come to our shores. Our quarantining program has been largely successful in protecting us but has not been perfect. Border closures, loss of income, mental health stresses and other consequences are the price we have paid for avoiding the catastrophic episodes of illness and deaths so prevalent in other countries.
Just one new case in New Zealand has seen Auckland back in ‘lockdown’ mode yet again.
Our priority in Australia is to have enough Australians immunised for us to be able to relax and not resort to ‘lockdown’ strategies when we discover new infections in our community because we know we won’t see a wave of infections, severe illness, swamped hospitals and death as the vulnerable are protected.
We plan to achieve this insurance using the Pfizer vaccine for a sub-population and the AstraZeneca vaccine for most Australians. The latter is not the best credentialed but it is nonetheless a very good vaccine. We have every reason to believe this vaccine can achieve the crucial outcome, providing enough Australians get immunised.
If in short order we could obtain 55 million doses of the Pfizer vaccine we would no doubt use it for our mass vaccination campaign. We can’t, indeed the promised availability is already under strain. And the latest data from the UK where both vaccines are in use demonstrates that the Pfizer vaccine reduced hospital admissions by up to 85% four weeks after the first dose, while the AstraZeneca cut admissions by up to 94%. We can also manufacture the AstraZeneca vaccine here, an important advantage.
I believe we would be very foolish to continue to risk lockdowns and quarantine dramas for another year or so waiting for more Pfizer vaccine. I disagree with the conclusions from Robin Boyle that:
“Most other countries need to mass vaccinate now but Australia doesn’t. We should forget AstraZeneca and wait for higher efficacy vaccines to avoid having lower overall immunity than those other countries.”
The big picture is that SARS-2 is here to stay. Unlike SARS 1 (circa 2003) and the MERS coronavirus (circa 2011), this new guy is highly infectious, getting more so and in a world as unfair as ours is unlikely to be eradicated.
Like influenza we will live with it, controlling it with vaccine modifications that respond to viral mutations. It is safe to say that none of the vaccines in use today will be in use in four years time. We will all get annual shots of Covid vaccine around the time we get our ‘flu’ shots.
For the near future, we will be stuck with quarantine demands because the immunised can still be carriers and spreaders of the virus. Vaccination passports would not provide all the reassurance we would need to not isolate visitors. So far we have not produced vaccines against any respiratory viruses (such as polio and influenza) that provide ‘sterilising immunity”, the inability to be a carrier of live virus in nasal and respiratory secretions even if vaccinated.
Data shows that vaccines can reduce nasal carriage of the virus following immunisation by about 60%, although that data is very ‘soft’. The problem is that our immune system consists of two partners, one that produces antibodies to protect our organs and tissues and one that protects our inner ‘skin’, our mucous membranes and intestinal tract. When we inject a vaccine into a muscle we set off the protective cascade that stops tissue and organ damage. The challenge is to produce a vaccine that could be administered as a nasal spray so we might have antibodies in our secretions that would neutralise the virus and render us non-infectious. We will get there.
A survey last week suggested 23% of Australians are not yet comfortable about being vaccinated. Stories about wrong doses being given, vaccine wastage and disparagement of the AstraZeneca vaccine are not helping. Nor I suspect are the little cartoon characters the Commonwealth is putting on our screens to tell us how safe and effective are our vaccines. An independent project monitoring online vaccine sentiment for the federal government has reported that anti-vaccination comments surged from about 200 a day to almost 6000, within 20 key Australian anti-vaccination Facebook groups open to the public last week. Ultimate success may be as much about public education as vaccine efficiency.
By October, if all goes to plan, we could be immune to lockdowns and the like. That would be a great outcome.
Professor John Dwyer AO, is an Immunologist, Emeritus Professor of Medicine at UNSW and for many years heavily involved in efforts to improve the delivery of healthcare in Australia. He was the founder of the Australian Healthcare Reform Alliance.
Comments
5 responses to “Vaccination controversy shouldn’t compromise efforts to protect Australians”
My earlier response to Kien:
My model is definitely for vaccination of as much of the population as possible, but with the most effective vaccine(s). Thus, vaccinate the 10 million in the high risk groups asap using the Pfizer we have ordered, then wait until more Pfizer becomes available (assuming that is within a timely period).
I believe Australia has the time and resources to wait until we have enough Pfizer or equivalent for everyone. The national strategy seems to have just one focus: to minimise deaths and hospitalisation. Of course that is an admiral aim, and the planned rollout using a mixture of Pfizer and AstraZeneca will probably achieve that (minimal hospitalisations and deaths).
However, there are other problems to be solved too. With our rollout, most likely less critical cases of covid will still occur and many people in Australia will become sick from it. Thus, other problems to be solved include minimising widespread illness, achieving herd immunity and opening our international borders.
The national rollout is trying to solve a problem that we don’t currently have: we have effectively zero community cases, hospitalisations and deaths. Given our current national policies re quarantine, etc, that will still be the situation in 9 months time, 12 months time. That is, (close to) zeros in all cases. (Other countries have to urgently mass vaccinate their whole populations now because of horrific hospitalisations and deaths.)
Time will tell as to whether AstraZeneca is sufficient to solve these other problems. Whether it provides sufficient immunisation and perceived safety to access aged care facilities, remote indigenous communities, etc. And international travel: if someone is going overseas into a covid hotspot, will AstraZeneca provide the same protection or be equally welcomed as Pfizer or equivalent efficacy?
If someone reads my articles properly, it should be clear that they should definitely be vaccinated. However, they will have to make the choice (if available) as to which vaccine to have.
The federal government has been critical of some states, saying those states don’t have confidence in their quarantine and tracing systems. The federal government needs to have confidence in our current national approaches, to wait until another 30 million doses of Pfizer or equivalent become available.
Hi John,
Many thanks for your contributions – they are very educative and informative.
In your current article, you wrote that you are not happy with my conclusion:
“Most other countries need to mass vaccinate now but Australia doesn’t. We should forget AstraZeneca and wait for higher efficacy vaccines to avoid having lower overall immunity than those other countries.”
My argument is vaccinate the 10 million in the high risk groups asap using the Pfizer we have ordered, then do not rush to mass vaccinate the rest, and wait until more Pfizer becomes available (assuming that is within a timely period).
Most other countries are in dire straits. Following is a reply I made to Kien in a post he made to one of my earlier submissions. It might provide some clarification of my arguments.
First, some of your comments in this article seem to support my concerns:
“the AstraZeneca vaccine is not the best credentialed” and “If in short order we could obtain 55 million doses of the Pfizer vaccine we would no doubt use it for our mass vaccination campaign.”
You say “we would be very foolish to continue to risk lockdowns and quarantine dramas for another year or so waiting for more Pfizer vaccine”.
However, by quickly vaccinating the frontline workers and high risk groups with Pfizer, those risks should be much reduced, given that we have national processes in place that have us as arguably the best performing country in the world for handling covid. There is no need to rush and compromise all the benefits of vaccination unless Pfizer or equivalent is out of reach because it is not obtainable in a timely manner. As I say below in my response to Kien, the federal government needs to have confidence. There is no need for unnecessary haste.
Kien also partly supports my model when he wrote:
“… it might fairly be said that there is less urgency in Australia (with its relatively low infection rate) compared to (say) the UK and US.”
and supports my suggestion that our superfluous/unrequired AstraZeneca could be donated to more needy, poor countries. AstraZenece might be less effective than Pfizer, however, it is very effective in those countries with large numbers of deaths and hospital crises.
He wrote: “Perhaps an argument could be made that Australia could donate its (“less than fully effective”) AstraZeneca vaccine to (say) Indonesia, which presumably needs them more urgently than Australia? What do you think?”
Why should people be blackmailed into accepting rushed, highly experimental vaccines and genetic treatments in order to have a right to their freedom, for a virus which is no threat to the vast majority of people?
The average person may not have a science or medical degree but they are not idiots. They know the virus is no threat and they know these vaccines and treatments have been rushed and are highly experimental. The real idiot would be accepting that risk for absolutely no need.
I am sorry you feel you are being blackmailed into getting a vaccine. The covid 19 vaccines target the spike protein on SARS-COV-2 virus, which it uses to bind to ACE-2 receptors and enter cells. ACE (Angiotensin converting enzyme) receptors are part of the Renin/Angiotensin system which controls blood pressure change when we go from lying or sitting to standing (so we don’t faint). ACE receptors are on all our capillaries, so SARS-COV-2 is not just a respiratory disease but can affect all our vital organs and muscles. The longer SARS-COV-2 is replicating in infected individuals, the more mutants will arise. Some of these mutants may resist some of the vaccines. Enlightened self-interest, as well as altruism, should motivate most people to get vaccinated at the earliest opportunity.
I also disagree with the conclusion attributed to Robin Boyle. However, it might fairly be said that there is less urgency in Australia (with its relatively low infection rate) compared to (say) the UK and US.
Perhaps an argument could be made that Australia could donate its (“less than fully effective”) AstraZeneca vaccine to (say) Indonesia, which presumably needs them more urgently than Australia? What do you think?