Fears about AstraZeneca must be overcome to protect Australians

A nurse administers the AstraZeneca COVID-19 vaccine at a drive through vaccination centre in Melbourne. Picture: Getty Images

After Australia’s exceptional performance in containing Covid-19 in 2020, things have been markedly different in 2021, due primarily to the highly contagious Delta variant.

Towards the end of last year, it became clear a paradigm shift was needed. Any return to a relatively normal life could only occur through a successful uptake of Covid-19 vaccination. It could not be achieved by more of the same isolation approach. Continuing to resort to lockdowns and prohibition on travel as adequate and safe responses, was both damaging and unrealistic.

Opportunity for all Australians to be vaccinated should have been maximised far earlier than eventuated. The knock-on effects of poor supply, faltering communication and an overemphasis on precautions has fuelled apprehension and created uncertainty. Despite the risks to the health of Australians of not being vaccinated and the devastating social and economic impacts of the perpetual lockdowns triggered by outbreaks, there continues to be significant hesitancy in the community. Australia’s standing in global vaccination rates is the lowest of all wealthy economies and even below some countries whose healthcare systems are far less robust and equitable than our own.

A profound wariness has developed about the AstraZeneca vaccine, an unfortunate consequence of an overemphasis in the media and public dialogue regarding the very small risk of three to five in 100,000 doses resulting in the Vaccine-Induced Thrombosis with Thrombocytopenia Syndrome.

The actual risk of death among those who receive the AZ vaccine is even more remote at one in one million yet the AstraZeneca vaccine became labelled as second rate, an idea that should never have been allowed to thrive as it did.

The continued raising of the age limit by the Australian Technical Advisory Group on Immunisation regarding when Pfizer was “preferred” over AstraZeneca created a public perception that it was to be avoided. No one seemed to understand that “preferred” meant exactly that, and notably in a low-risk setting which inevitably has changed. These flames were fanned by the media’s focus on the sensational aspects rather than the more unexciting message that AstraZeneca was available and highly effective, evidence most recently confirmed in The New England Journal of Medicine. The strong and more urgent case for getting vaccinated as soon as possible using whatever vaccine was available was obscured in the controversy and focus on risk.

We lost several precious months early this year in getting people vaccinated and protecting them against the outbreaks that are now causing so much personal hardship and economic fallout. “Preferred” should never have been allowed to signify that the alternative was ineffective. While tragically another death has been recorded recently, bringing the total TTS-linked deaths to six from more than 15,000,000 vaccine doses given (of which more than half have been AstraZeneca), already 967 people have died from Covid-19 in Australia since the pandemic began.

The vaccines work. There is about 90 per cent protection from two doses of either AstraZeneca or Pfizer in preventing hospital admission, risk of intensive care admission or death.

Vaccination not only protects each person receiving it but also those closest to them. Households are a hive of transmission and vaccination dramatically reduces household and workplace transmission, thus having tangible consequences for the person who is vaccinated, as well as their loved ones and colleagues.

Risk estimation can be a bland statistic, or it can be made real when it is contextualised. When compared to the risks of a range of familiar activities, the risks of TTS with an AstraZeneca vaccination can be framed in a more accessible and convincing way.

One in every 1000 women who take the contraceptive pill will develop blood clots. Giving birth (1-2 in 100,000), taking an aspirin (1 in 10,000), hang-gliding (1 in 125,000), scuba diving (1 in 200,000), driving (28 in 1,000,000), taking a bath (1 in 685,000 over a year) and a range of other activities people choose to engage in have far greater chances of death than the AstraZeneca vaccination.

Drinking more than four standard drinks per day makes the risk of an alcohol-related death eight times higher than getting the AstraZeneca jab, yet I doubt this risk is taken into account by many people during these cold lockdown winter nights.

We need to get out of this cycle of lockdowns, and vaccination is the most important tool we have. The consequences of lockdowns go far beyond the immediately visible social and economic impacts.

Postponement of elective surgery and routine day-stay bookings may sound undramatic, but this can mean substantial harm to people’s immediate wellbeing, and their long-term outlook. It may mean continuing pain, immobility, risk of a heart attack, delayed investigations, missed treatments for cancers and severe bone, lung and joint diseases. Some diagnoses won’t be made when they should with delayed treatment and worse outcomes.

The mental health issues for people suffering distress from loss of friends and loved ones, loss of personal connections, loss of their jobs and purpose are huge, and will persist far into the future. It won’t be until we emerge from the pandemic that the true scale of these knock-on effects of the Covid-19 outbreaks – and resulting lockdowns – will be seen.

The more time vaccination takes, the worse the impacts will be.

Vaccination is about social and community gain, not just about individual protection. The case, to be Australian and do it for yourself and for your mates and family, should be put cogently and powerfully through effective messaging and by enabling uptake of vaccination wherever people are located and in whichever venue they feel most comfortable.

Vaccination as a liberation, free of the overlaid precautionary caveats, should be the dominant message, in every language and through leaders on every platform possible. Only then can we share the life we love with people we love, and without the threat of lockdowns and more catastrophic outcomes for our health, our economy and our whole society.

Professor Christine Jenkins is head of the respiratory group at the George Institute for Global Health in Sydney; Professor of Respiratory Medicine, UNSW Sydney; and Clinical Professor, Concord Clinical School, University of Sydney