‘If that’s not enough, I’m not sure what is’: Australia’s COVID-19 vaccine concerns answered

Not everyone wary of the COVID-19 vaccine is an anti-vaxxer – here, an expert answers people’s genuine concerns about getting the jab.

As the world rushes to roll out COVID-19 vaccines, a new group of people has been thrust into the spotlight – those hesitant to get the jab, despite not being anti-vaxxers.

These people are different to those who have strong stances against immunisation in general – they are the ones who have genuine concerns.

In Australia, the major barrier for vaccine uptake is among those who are worried about safety because of how quickly the vaccines are being developed and rolled out.

As part of news.com.au’s Our Best Shot campaign, we’ve spoken to Professor Adrian Esterman, epidemiologist at the University of South Australia, to address these genuine concerns about the vaccine’s safety, efficacy and effectiveness, to reassure people they need not worry.

Got a burning vaccine question you want answered? Prime Minister Scott Morrison will join news.com.au tonight for a live Q+A. To submit your questions, log on to news.com.au’s Facebook page from 7.30pm.

Many Australians are genuinely concerned about the coronavirus vaccine. A guest staying at The View hotel is seen being attended to by paramedics as he is stretchered into an ambulance on January 14 in Melbourne. Picture: Asanka Ratnayake/Getty Images

NOT ENOUGH TESTING

As most people should be aware by now, new vaccine testing goes through three phases with phase three generally testing the candidate in 30,000 people.

“If that’s not enough testing I’m not sure what is,” Professor Esterman says.

Professor Esterman points out that if an adverse reaction happened in one in a million people, researchers would unlikely find it in the 30,000 study.

“But by and large after 30,000 you can be pretty sure it’s safe and works,” he assures people.

THE PROCESS FEELS RUSHED

There’s no denying this one. Professor Esterman says yes, the process has been rushed.

“But there’s a big but – before this hit us when we tried to develop preventive vaccines for other things there is so much red tape and bureaucracy – it all takes months, if not years,” he says.

“What we’ve done this time is do them parallel, all together, so the phases run at same time which has sped the whole thing up. Rather than desperately trying to get funding, there’s been bucket loads spent on it.

“These vaccines have gone through a very rigorous process to make sure they’re safe and work, certainly for western nations. This time it's just been easier because of all the money spent and improvements on process and testing.”

Professor Esterman says Australia is one of the most stringent countries in the world for vaccine approvals.

“The TGA won’t allow it if it’s not safe and effective, full stop,” he says.

LONG-TERM SIDE EFFECTS

Professor Esterman says experts simply don’t have an answer for this concern – yet.

“We won’t know for two or three years but based on previous vaccines it’s very unusual to have long-term side effects,” he says.

The Department of Health says while as yet there has been no evidence of long-term side effects from COVID-19 vaccines, evidence is mounting that the disease itself leads to significant long-term health issues in those that contract severe COVID-19.

“Information about long term protection against COVID-19 disease and long term side effects experienced after vaccination is limited because of the short duration of time and volume of data since trials commenced in July 2020,” a spokeswoman says.

“If you have any concerns about potential long term side effects of vaccines, talk to your health care professional.”

DON’T KNOW ENOUGH ABOUT IT YET

Professor Esterman highlights that as of this month were more than 3000 peer-reviewed research papers published about COVID-19.

“That’s a huge number and it’s changing every day,” he says.

“It’s hard for a professional to stay up-to-date, even harder for the general public. There is actually heaps out there but it needs to be interpreted carefully. There’s still a huge amount we don't know.”

Rest assured, the Australian Government will run a strong campaign to inform all Australians about the vaccines and encourage vaccination.

INADEQUATE RESEARCH

Professor Esterman sums this up simply in saying there is a heap of research and it’s ongoing.

The department spokeswoman says the TGA is actively monitoring COVID-19 vaccine development occurring in Australia and internationally, and is also part of a network of international regulators that meet regularly to discuss the development of COVID-19 vaccines.

“The urgency of the global pandemic means that researchers and developers all over the world are prioritising the development and assessment of COVID-19 vaccines,” she says.

“The TGA will only register and approve a COVID-19 vaccine if its benefits outweigh the risks, following its complete assessment of data.

“Once the first batches of an approved vaccine are available, the TGA will also assess these doses before they are distributed for use.”

A vaccine is the best way for Australians to return to a ‘COVID normal’ life. Picture: Jenny Evans/Getty Images

A VACCINE WON’T BE EFFECTIVE FOR THIS VIRUS

Professor Esterman says the big thing here is the difference between efficacy and effectiveness.

Efficacy is how well the vaccine does in phase 3 trials, while effectiveness is how well it will do when it's rolled out in the general public.

“The problem with that is the people who enrol don’t necessarily represent the general public,” he says.

“You can’t guarantee the efficacy you get in those trials will work in the same way as the general public.”

He says while the WHO has mandated that any vaccine approved must have a 50 per cent efficacy, it hasn’t actually defined what it means by that.

Professor Esterman says most of the vaccines are targeting prevention of symptomatic disease and it was unclear if they will be effective at stopping transmission.

“This is important because if we’re trying to achieve herd immunity we want a vaccine to stop transmission,” he says.

“There’s a pretty good chance it will stop transmission in a percentage of people but we don’t know yet.”

While the Pfizer/Biotech study protocol indicates they will look at prevention and transmission, it’s their secondary outcome (the first being prevention of symptomatic COVID-19). Basically they will measure it, but they don’t have the data yet.

“Australia is in a very lucky position,” Professor Esterman says, pointing out our cases are low enough that we aren’t in a hurry to stamp the virus out.

“In the UK where it’s rampant, if everyone had it, it would really dampen the epidemic down. It would take a while but it would eventually stop it.”

CONCERN AROUND ALLERGIES AND REACTIONS

While there has been several cases of phase 3 trials being stopped because of allergic reactions or elderly and frail people dying after getting vaccinated, Professor Esterman says those things are being studied as we speak and experts aren’t sure if the deaths can be attributed to the vaccine.

RNA VACCINES COULD BE UNSAFE

Professor Esterman says we do know the messenger RNA vaccines (Moderna and Pfizer/Biotech) do cause mild reactions in most people, be it a fever or diarrhoea.

“That’s expected and these usually pass within 24hrs,” he says.

“There’s a whole process to make sure they are safe and they won’t be allowed by the TGA if they’re not. These people are experts in the field.”

The TGA will closely monitor the safety of the COVID vaccines, as it does for all medicines and vaccines supplied in Australia, so that it can detect and respond to any emerging safety issues.

THE RISK/THREAT FROM COVID-19 IS LOW

When you ask Professor Esterman on this one, he barely stifles a laugh. Perhaps it’s not a genuine concern, after all.

“This is the tin foil hat brigade,” he says, pointing toconspiracy theorists and anti-vaxxers.

“It is not low. We are still discovering things about it. When it hit we thought it was mainly a respiratory disease. It’s not. It causes blood clotting … there’s a whole thing called long-term COVID now.

“Admittedly the vast majority that have died are elderly but it can cause serious damage in children.”

The Department spokeswoman says while Australia has largely been spared the high death tolls associated with widespread community transmission seen in other countries, outbreaks of COVID-19 continue to emerge within the Australian community and the threat of widespread transmission remains, particularly with the emergence of more infectious strains.

“Safe and effective COVID-19 vaccines will reduce the severity of the disease and ideally be effective to reduce its transmission,” she says.

I DON’T NEED IT

At the end of the day, Professor Esterman says everyone has the right to say that.

“But then they’re putting everyone at risk and reducing the chance of getting herd immunity,” he says.

An effective vaccine is also a way to move forward into a “COVID normal” life.