To vaccinate or not: answers to all your COVID vaccination Qs in one spot

‘It’s very fast paced. I was out for the first day at one of our mass vaccination sites, and we had a policy change for who we could vaccinate in the middle of that first day!’

Rakhi Varma is a Public Health Specialist at Los Angeles County Department of Public Health and is currently involved in the largest ever vaccination drive in the United States of America Her department is responsible for vaccinating a population of 10 million people. 

A year after the country’s first case of the novel coronavirus, the disease rages havoc across families, livelihoods, and economies. To date, more than 400,000 people have died because of the virus in the US, of them the overwhelming majority are Indigenous, Black, Hispanic, and vulnerable socioeconomic groups. 

Public Health Specialist Rakhi Varma masks and shields up for a day of vaccinations. Image credit: Rakhi Varma. 

In Australia, we've had an experience mired with uncertainty, lockdowns, and seen 909 deaths, primarily in our elderly population. The hunt for a preventative measure - a vaccine against COVID-19 - began mere weeks after the DNA sequence of the virus was analysed in January of last year. 

The real and concrete possibility of vaccination then emerged in early November 2020, when the pharmaceutical company Pfizer/BioNTech first announced their preliminary results for an mRNA based vaccine. Since then, we’ve seen vaccines from Astra-Zeneca, Moderna, Novavax making their way into federal government national vaccination plans

But what exactly is involved in vaccination? When and where can we expect to get vaccinated? Which risks are involved, and for which members of our population? And how, if at all, are these vaccines going to allow us to return to a semblance of normal life? 

I spoke with specialists across the board, from public health workers to social scientists, researchers and members of the South Asian communities of Australia, to find out. This is what I found.

Who should you be listening to?

Before I dive into the technical details of vaccination, I want to clarify that any information written here is from verified sources, and doesn’t contain any political or social rhetoric. That kind of information is going to be increasingly difficult to find as we move closer in Australia to the day that the COVID jabs begin, with anti-vaxx conspiracy leaflets being dropped at homes in Melbourne already.

With discussions and arguments taking place online on forums such as Facebook, WhatsApp, and Twitter, it is important to remember that claims surrounding vaccination may come from those with social prowess, but often with little technical knowledge to back it up.

“When it comes to vaccination, social influence is very powerful,” says Professor Julie Leask, from the School of Medicine at the University of Sydney. 

If you do see information from any source, it is easy to verify if that is government mandated information with a Google search. If it isn’t government approved information, perhaps question why someone you trust or follow is sharing that. In the age of content consumption, it is best for us to be as conscious as possible. 

Dipti Zachariah, Statewide and Specialist Programs Team Leader for Multicultural Health Services in Western Sydney, explains that South Asian communities are also likely to rely on their faith leaders and community spokespeople more readily.

Ms Varma also echoed this sentiment when I asked her for advice. 

“I would say to look to trusted members of your community. People who would have some type of scientific background or be able to connect to someone who does, who can provide real information about the vaccine. That has to be someone that you feel comfortable speaking (with). You can ask somebody and hear what they have to say, but if you don’t feel like you can trust that person or feel comfortable with them, it may not actually enter in the way you expect it might.”

 

Having open and rational discussions with people that you trust, like your doctors, community, and family are going to be the most helpful in your vaccination journey.

That being said, let’s jump into the FAQs of COVID-19 vaccination.

The basics - what is a vaccine, and what happens when it’s in your body?

A vaccine can be thought of as a training exercise to teach your body about a new opponent. 

A vaccine is a liquid which contains a small, weakened amount of the virus of interest - in this case, COVID-19. Injecting a small amount of virus allows our body to recognise and mount an immune response by producing fighter proteins called antibodies. For a few days, your body will throw all it has at destroying the viral particles. After this, the body will generate memory cells to remember what the virus looks like for future attacks. It is now trained for the real game. 

On the chance of an actual infection (think about this as a starting whistle at a game), our body will act much quicker and more effectively to counter the viral particles, reducing the severity of disease. Having a booster shot 20-30 days after the vaccine serves to reinforce this training The Australian government has a helpful web page to explain this in over 60 languages

As Dr Shane Huntington from the University of Melbourne explains, vaccination is an insurance policy. It is a step taken today to provide protection tomorrow, much like masks and social distancing are. The difference is, a vaccine primes your body to fight the disease. It is an active policy, which can help protect not only ourselves but our friends, families, and communities.

Understandably, though, there are a few concerns about the vaccine and the process itself.

What about side effects?

Last July, the Lancet Journal for Infectious Diseases reported that most Australians were concerned about  safety, effectiveness, development time, pharmaceutical company motives and needle anxiety. For those who are worried about their needle phobia, Belinda Smith of ABC Science did a helpful piece on ways to deal with it in the lead up to vaccination. 

Image credit: Rakhi Varma

Ms Varma says that these concerns are echoed in the American public who walk through the doors of the LA county vaccination facilities, a shared sentiment across borders. 

“When people come in they ask ‘is it going to hurt’, ‘am I going to feel symptoms afterwards?’, ‘are there side effects?’”. 

She explains to them that “if you feel something, usually it’s for the first day or two, generally mild, it means your immune system is working, the vaccine has activated your immune system”.

For the Pfizer/BioNTech vaccine (which the Therapeutic Goods Administration of Australia has provisionally approved), the TGA states that for a few days after your vaccination, this feeling can manifest as fatigue, headaches, muscle/joint pain, and chills. It makes a lot of sense when you compare these effects to the symptoms of having the COVID-19 disease itself.

 

So these aren't so much ‘side-effects’ of the vaccine that you can expect to feel. Instead, you’re experiencing the intended effects - the effects of your body learning to fight against a new virus. Also, because this is a weakened virus, these symptoms do not persist for more than a couple of days in most cases.

Ms Varma herself has had the Pfizer/BioNTech vaccine, and has observed thousands of people receiving the jab since vaccinations began in January. She works at huge venues such as concert halls and sporting venues like the iconic Dodgers Stadium, and says that for the overwhelming majority, vaccination has been a positive experience.

One of LA county’s many drive through vaccination centres. Image credit: Rakhi Varma

Of course, that isn’t to say that extreme side effects are impossible. Of the 37,586 individuals analysed at the 2-month mark for the Pfizer/BioNTech vaccine, 3 had adverse side effects (less than 0.01% of the vaccinated population). 

You may also have seen headlines about 33 elderly people in Norway dying after vaccination. However, this was less than 0.001% of the elderly vaccinated population, and thorough analysis of their underlying conditions ruled out the vaccine as the cause of death.

Compare this to the fact that globally, 10-15% of people develop severe illness after being infected with COVID-19, and 5% end up in critical care

As Ms Varma says, “When it comes to comparing getting the shot and having some side effects for maybe 24-48 hours, versus having COVID? Getting COVID is so much worse, potentially fatal.”

Okay, so who will get this vaccine, and what are the benefits?

The short version is that most people in Australia over 18 will be advised to voluntarily get this vaccine. This does not apply to those with severe allergies or some immunocompromised individuals. 

A strong vaccinated population may seem unnecessary at this stage because Australia has largely controlled the virus, but that is precisely our dilemma.

Dr Huntington says that “The feeling of urgency is less potent than it is in the US or the UK for example. So we have the age old challenge – convincing people to take a vaccine for a disease that is not present right in front of them”.

However, hotel quarantine leaks (Melbourne is no stranger to these) and community transmission cases are always possible. Therefore even if you are perfectly healthy, have never had the flu before, or have never considered getting the flu shot, you could get COVID-19 and develop severe illness. That is why vaccination is recommended.

The federal government has outlined that this rollout will happen in stages, beginning with quarantine and healthcare workers, and moving toward the elderly and vulnerable. Health Minister Greg Hunt has also confirmed that vaccination will be freely available to anyone living on Australian soil, regardless of citizenship status, and earliest vaccinations are due to begin at the end of this month.

The main reasons for vaccination are simple: protect yourself, your community, and reduce overall COVID-19 transmission. 

Vaccination protects your own body by boosting defense systems. It protects communities through the concept of ‘herd immunity’, where vaccinated people can prevent transmission and reduce risks for those who can’t be vaccinated. 

As a young person, my primary reasons to get vaccinated are out of a sense of safety for my own health, and out of a moral obligation to the rest of my city and state. Living in Melbourne, we’ve gone through some very harsh lockdowns, and vaccination is a strong barrier to help keep lockdowns and border closures to a minimum, and to reduce uncertainty. 

Overseas, similar sentiments echo in wanting to get vaccinated out of a sense of duty, in honour of someone who died due to COVID-19, and to protect others. The hashtag #ThisIsOurShot has over 27,000 posts from healthcare workers and community members who are in the initial stages of vaccination in the US.

When I spoke with my relatives here in Australia, another primary reason for vaccination was to be able to potentially resume travel to see family and friends in our home countries. While we can’t be sure when international travel will re-open and how it will look, we can be confident that vaccination is going to be one of the largest strides in the journey to making it possible.

These vaccines were developed under record pressure, are they good for the long-term?

It is true that humanity has never developed a vaccine this quickly for any disease (see for example the history of the flu vaccine), and that these vaccines all have less than 1 year of data supporting their effectiveness. Questions around their long-term safety and effectiveness are entirely valid and understandable.

We cannot be sure that there are no long term issues with the vaccine, and there is limited data on some subsects of the population. 

It is also equally true that these vaccines have had the support of: unprecedentedly large amounts of funding, years of vaccine research, and cross-nation collaboration on an unseen scale. The pandemic has shown us the very best of rapid scientific, commercial, and production teamwork to make these vaccines happen. 

The LA county team also gets this question regularly - can we trust something that is so new and developed so rapidly? Ms Varma clarifies:

“The technology for these vaccines [Pfizer/BioNTech, Moderna] is very different from previous vaccines, because it uses the mRNA technology. The world saw the SARS outbreak several years ago. SARS is a coronavirus just like COVID-19 is, so we’ve actually been studying coronaviruses for many years. So really, it wasn’t that long for scientists to adapt the research they already had to then match COVID-19. So it actually took many years to develop this vaccine, it was just happening quietly and focused on SARS.”

 

Which vaccine brand is better?

The 95% efficacy rate of the Pfizer/BioNTech vaccine has been constantly compared with the 62% for the AstraZeneca-Oxford vaccine. This may sound like a large difference, and you may be wondering why Australia has committed to producing large amounts of the less effective vaccine.

Reasons vary from logistics of storage, local production capacities, and managing transport across the countries outback for rural and remote areas. The Pfizer/BioNTech vaccine requires special refrigerators and extremely low storage temperatures which can be difficult to manage, whilst the AstraZeneca vaccine is much easier to distribute. 

There’s also the fact that even 62% efficacy is considered sufficient by regulators. 

When I asked Ms Varma this question, she said “When people ask me about any of the COVID vaccines, I tell them ‘actually the flu vaccine is only 50% effective’. When you think about that in comparison with effectiveness levels in the 60 and 90 percent, it’s quite incredible that we have that level of effectiveness”.

From her position in the US, seeing how terrible COVID has been for livelihoods and economies, she urges Australia to get as many people on-board with information about vaccines as possible, and explains that “It doesn’t really matter what brand of vaccine you get, the main thing is getting the one that you can get the soonest you can get it.”

What can we expect during rollout?

Dr Huntington warns that we can expect more debate around vaccination as rollouts begin. Importantly, these debates “mean we are very susceptible to anti vaccination proponents who would seek to derail our programs.”

We can leave the scientific debate up to the professionals, but it is almost certain that we are going to see controversies, stumbling blocks, issues and conspiracies on our screens. Often, it will be anger or politics, or rhetoric and hype, that dominate conversations under the guise of ‘robust’ discussion. 

However, Prof Leask reminds us that “a lot of these debates are often about values and moral intuitions – self determination, protection, quality of life, bodily purity, a fair go, and more”.

As vaccinations approach, questions around protections against mutants and variants, what ifs and what if nots are all beginning to trickle into our news feeds and inboxes. These questions can be important and valid to discuss, and Ms Varma encourages this. 

“Ask questions! It’s a really great time to ask questions. Get a sense of ‘what do I think about this, where am I finding information, who can I trust, do I think my Dr is something I can talk to about this?’ Any good physician will want to answer your questions.”

 

State governments have seen the importance of community leaders in disseminating and explaining COVID-19 information, and have promised to turn to more multicultural and activism groups to help support the country’s diverse population on this vaccination journey. 

“To ensure the campaign reaches all Australians, special committees representing Aboriginal and Torres Strait Islander peoples, people with a disability and the multicultural community are informing the communication approach, ensuring communications are appropriate and disseminated through the best communication channels to these communities.”

 

Taking this time to find and connect with people that you trust, talking and reading as much as you can, is invaluable at this time. You can also use this time to get excited about the vaccine. We’re on the precipice of something incredible in Australia - the country’s biggest ever vaccination drive, with the best technology and scientific minds we’ve ever had. At the very least, it is a step that we can be cautiously optimistic about.


Tanaya Joshi is a Clinical Research Assistant at the Monash Clinical Research / Metro Pain Group and a regular contributor to SAARI. You can connect with her via LinkedIn

Cover image credit: Sara Shakeel, award-winning crystal artist from Pakistan. 

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