An emergency doctor from NSW offers advice on how best to engage and educate patients about Covid-19 vaccination using the latest research and population data.

Having been relatively isolated from the virus that ravaged the world for so long, the Delta variant of COVID-19 has well and truly taken hold in Australia.  What we have now that we didn't have when all this began, is a way to protect ourselves. We are fortunate to have access to 3 highly effective, safe and widely available vaccines for COVID-19. As of writing this article, 84% of Australians over the age of 16 have had their first dose of one of these vaccines, with 68.3% being double-dosed. The widespread uptake of these vaccines is a vital weapon against COVID-19, and despite a rocky start to the federal government’s vaccine rollout and some confused messaging, a lack of access to vaccines for low income communities, reconciling the benefits of the vaccine in the face of the unethical history of medicine for Indigenous, Black, Brown and other racialised communities, millions of Australians have rolled up their sleeves and done their part to protect themselves, their families and their communities from COVID-19.  

But the battle is far from won. There are still many people who are yet to be vaccinated before we can safely begin opening up and returning to normality. Fear and denial is so pervasive that even Covid-19 patients who are gasping for breath on the one hand, continue denying the existence of the disease and plot their escape from the hospital. 

As healthcare workers we are responsible for practicing evidence-based medicine and promoting public health initiatives, and this includes counselling our patients on the importance of vaccination. We should all be discussing vaccination with our patients – as an emergency doctor in NSW, discussions about vaccination and the side effects thereof have dominated the last few months of my practice. Like it or not, we are expected to be experts on all things vaccine-related. 

It is important to understand the biases people have when assessing risk, but not to shame them for it. Provide concrete evidence about the relative risk and help them to understand how the risks of contracting COVID-19 compare to the small risks involved in vaccination. 

Listening to your patient is the critical first step to making them feel heard, supported, and informed, so this article aims to give you the tools you need to effectively discuss vaccination with your patients.

Know the Facts – Need-to-know information about COVID-19

Before you embark on your conversation and listen to your patient’s concerns, be prepared with the facts so that you can add them to your discussion when it’s pertinent to do so. 

The endless parade of numbers and statistics about COVID-19 over the course of this pandemic has been overwhelming. Even for the experienced, it is difficult to parse out vital numbers of interest from all this information. As the pandemic is still very recent and ongoing, statistics around the morbidity and mortality of COVID-19 are still evolving. Here is a summary of core statistics in the Australian context that are relevant when counselling your patients. Knowing these is important to appreciate the benefits of vaccination.

COVID-19 is highly infectious:

A person with the Delta-variant will infect, on average, 4 other people. This is twice as infectious as the original Alpha variant. Household settings are the most common source of secondary infection, with a secondary attack rate of 21%. The Delta variant has a household transmission rate 64% higher than the Alpha variant.

The majority of COVID-19 cases are young people:

Below is a breakdown of Australian cases by age compiled by The National Notifiable Disease Surveillance System (NNDSS). 20-29-year-olds are the highest represented group. Children also make up a large proportion of COVID-19 cases. The skew towards under 40s has become much more prominent during the Delta outbreak.

Most cases (80%) are mild and do not require hospitalisation. Moderate-to-severe cases have high morbidity with 5% of cases becoming critically ill and needing intensive care. Exact global hospitalisation rates are difficult to estimate: From available data sets the estimated hospitalisation rates are 7.18% in the USA  and  6.7% in the UK. Australia has a lower hospitalisation rate, currently 5.75% of active cases. Measures including vaccination, supported healthcare accommodation and hospital-in-the-home model care have helped to reduce our hospitalisation rate.

In Australia, 1/5 hospitalised patients are in ICU, 1/10 are on ventilators 

The case-fatality rate (death rate) is 2.1% globally. Australia has a death rate of 1.4% - Elderly people are at higher risk of death. Up to 9.6% for people in their 70s and 30% in people in their 80s. People with pre-existing conditions are also at higher risk. 

Young people are still at risk of death. 1.3% of deaths in Australia have been under the age of 40 years. For deaths by age group, expand the description below the graph to find raw numbers. 

COVID-19, even if mild, has long-lasting effects: 80% of all covid patients have ongoing symptoms beyond their infection, including shortness of breath, fatigue and chest pain. A large study from the UK, published in The Lancet, showed 50% of COVID-19 patients in ICU had failure of at least 1 organ. While the risk is higher in older people, it is still significant in young people, with organ complications occurring in 27% of 20-29 year-olds. The long-term morbidity of COVID-19 infection is difficult to appreciate given the lack of long term data

Useful sources for up-to-date Australian COVID-19 statistics

Department of health: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-case-numbers-and-statistics#cases-and-deaths-by-age-and-sex

COVID Live: https://covidlive.com.au

Listening to your patient is the critical first step to making them feel heard, supported, and informed.

How to Discuss Vaccination with your Patients

Understanding your audience and the causes of vaccine hesitancy

Vaccine hesitancy can be perplexing or down-right frustrating for those of us immersed in the world of healthcare. We can quickly forget that lay people do not have the knowledge, experience or available information that we have regarding COVID-19 or vaccination in general. There are a myriad of factors at play when it comes to vaccine hesitancy, and understanding the context for how your patients feel is vital in helping them to feel confident in getting vaccinated.

Misunderstanding and misinformation

“Confused messaging” comes up a lot when talking about the vaccine rollout, but what exactly does this mean? A deep understanding of immunology, virology or vaccine science is not a prerequisite to get the jab, but we can’t blame our patients for wanting to have a basic understanding of the risks and benefits of vaccination before they roll up their sleeves. Distilling health advice down into a form that is palatable to the general public is a delicate art. 

Medicine is full of uncertainty, and the scientific language used to convey studies and their findings is full of nuance that can be difficult to navigate - concepts like relative risk reduction, statistical significance and bias are complex, and conclusions are never given with 100% certainty. In the pipeline from evidence to public health messaging, information is heavily filtered and refined to its simplest and most easily understood form.

A lot of this due process went out the window during the vaccine rollout. In the haste to disseminate information and encourage rapid vaccination, publications from The Australian Technical Advisory Group on Immunisation (ATAGI) targeted at policy makers, public health officials and doctors were reported verbatim in press conferences, and parrotted incompletely and without context in tabloid headlines and clickbait articles. The general public was struggling to understand unfiltered information that was not intended for them, and understandably people were confused.  The nuance of this advice was stripped away in favour of attention grabbing headlines - Astrazeneca vaccine causes deadly clots.  This confusion created a lot of mistrust in the vaccine rollout early on - the lack of consistent and concise messaging undermined people’s confidence in the public health response, but also the vaccine itself.  The whole thing looked half-baked, and so people were and still are nervous about getting the jab. 

The uncertain messaging around the vaccine rollout contrasted starkly with the unwavering confidence and absolutism of anti-vax propaganda and misinformation. Conspiracy theories spouting  false information about vaccines causing infertility, or being rolled out without proper testing or high death rates from the vaccine that were being covered up offered false and simply stated conclusions. While those who subscribe fully to these theories are the minority, the pervasiveness of anti-vaccine misinformation (often spread by prominent celebrities and influencers) combined with the lack of confidence in public health messaging has created a lot of doubt.

While the federal government and the states have course-corrected in recent months with more vaccination resources targeted towards the general public there is still work to be done to get this information out. 

COVID-19 vaccination – Patient resources

https://www.health.gov.au/resources/collections/covid-19-vaccination-patient-resources  

Is it true? Get the facts on COVID-19 vaccines https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true

COVID-19 vaccine weekly safety report: https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report

For many people, the horse has already bolted. In counselling your patients, expect that you may need to unpack and address a lot of pre-conceived notions and misunderstanding about the vaccine - arm yourself with the answers beforehand.

Privilege and (the lack of) perspective

Until recently, most Australians have had very little to do with COVID-19. Most people haven’t had it and don’t know anyone who has had it, let alone died from it. This insulation from COVID-19 has bred apathy in many people about the entire pandemic. They have suffered from loss of work, income stress, and long periods of isolation for a disease that they’ve never seen.  Speaking to colleagues from the UK— many of whom worked on the frontlines in the NHS during the first wave— they are baffled by the lack of urgency among Australians when it comes to getting vaccinated.

Vaccination in general is taken for granted in Australia. As a developed country with ubiquitous childhood vaccination, modern Australians have never seen the ravages of infectious diseases like measles, rubella or polio. The privilege of protection from these diseases fuels the most myopic of anti-vax battlecries—that vaccination is unnecessary because infectious disease is rare.

Where Australians are choosing not to get vaccinated, millions of people in the developing world are desperate to be vaccinated but are unable to do so due to lack of healthcare infrastructure or access. 80% of COVID-19 vaccines have gone to middle or high income countries. Only 2.3% of people in low-income countries have had at least one dose, with vaccination rollout in the developing world estimated to take a further 2 years. Australia even dipped into these stockpiles, purchasing 500,000 doses of the Pfizer vaccine reserved for COVAX— the vaccination program for low income countries.

An Understanding of Risk - Addressing Fears

The human mind is famously bad at evaluating risk. The way we process risk is closely tied to emotion and individual anecdotal experience, and unconscious bias heavily influences how we interpret information. 

Emotional attachment to specific outcomes greatly affects how we evaluate risk or reward situations — gamblers are sure they are going to win, no matter how long the odds. Similarly, the potential risks of an activity are likely to be downplayed if the outcome is desirable— driving, playing sport or swimming are all statistically very risky, but we may not realise or acknowledge the likelihood of negative outcomes.

Fear is also an intrinsic part of how our brains form memories and learn from experiences, and it too highly affects our evaluation of risk. The inflated probability of feared negative outcomes may dissuade us from taking a risk, regardless of how actually small the risk is.

This poor evaluation of risk is extremely relevant in understanding vaccine hesitancy, with the most common reason I see for avoiding vaccination being the fear of side effects. The risk of a serious adverse reaction to a COVID-19 vaccine is incredibly rare (numbers detailed below), but anxiety, misunderstanding and the lack of recent experience to draw on leads many people to overestimate the actual risk of these outcomes. The difference between active and passive risk is also important to understand. Vaccination is something you actively choose to do - you are “putting yourself at risk”. As there is a clear cause and effect relationship between vaccination and negative outcome, the risk is perceived as being higher than something that can happen randomly, like getting struck by lightning, when in fact the risk of COVID-19 vaccination side effects is actually lower.

Paradoxically, I have had patients tell me they are concerned about the risk of vaccine side effects, then immediately tell me that if they got COVID-19 they wouldn’t be worried because the risk of death was “only 1%”, despite that being roughly 10,000 times higher than the risk of death from a vaccine. 

Waiting for the "ideal vaccine"

During the early days of the rollout I encountered many patients who were delaying vaccination in order to ensure they received their “preferred vaccine” - willing to wait several months to receive a dose of the (at the time) short-supplied Pfizer vaccine when doses of Astrazeneca were readily available. Studies have shown that after a few months, the effectiveness levels of Pfizer and Astrazeneca converged. Recently, I have encountered similar sentiments regarding the as-yet unreleased Novovax. 

The perception of one vaccine being superior to another can be formed by a confluence of what we have discussed above - misinformation in the media early on in the rollout which portrayed Astrazeneca as incredibly risky and Pfizer as completely bulletproof, leading many to decide that Pfizer was the only one for them. A similar narrative is being spun around Novovax being better in every way than any other available vaccine. Despite it still being in the trial phase with no real-world rollout as evidence of its efficacy, many lay people have already decided that this unreleased vaccine is the best, and they're willing to wait for it.

Choice is an important factor in forming this bias. As discussed above, people are very attached to choices they have already made, and will selectively pay attention to information that favours their viewpoint - reinforcing the perception of their chosen vaccine as infallible, while demonising other options. People want the best, but this can cause them to miscalculate the risk as a zero-sum game—a choice between their preferred vaccine or no vaccine at all. They may fear that settling for an “inferior” vaccine will leave them less protected than if they had waited for their chosen one, or that they are individually at a high risk of a rare side effect from one of the other vaccines.

In reality, no vaccine is 100% effective or completely risk free - this is an important concept to discuss with your patients to break down their implicit biases. Ultimately, the differences in efficacy between different vaccines is miniscule, but the difference between being vaccinated by any vaccine and no vaccine at all is massive—with non-vaccinated patients making up the majority of Covid-19 deaths and ICU admissions in Australia. The best vaccine is the one most readily available to you. Waiting weeks to get your preferred vaccine, or months for a mythical super vaccine to come out puts you at significant risk while you are unvaccinated.

Having a working knowledge of the available vaccines is vital to allow you to discuss the relative risks and benefits with your patients, and to address any concerns or biases they may have.

This perception of “passive risk” being lower is relevant to how Australians assess the risk of contracting or dying from COVID-19. Until now, we haven’t had much direct experience with COVID-19, and so people perceive the risk as much lower than it actually is. Paradoxically, I have had patients tell me they are concerned about the risk of vaccine side effects, then immediately tell me that if they got COVID-19 they wouldn’t be worried because the risk of death was “only 1%”, despite that being roughly 10,000 times higher than the risk of death from a vaccine. Research also shows the risk of dying from Covid-19 is 11 times higher for unvaccinated adults than for fully vaccinated adults.  

It is important to understand the biases people have when assessing risk, but not to shame them for it. Provide concrete evidence about the relative risk and help them to understand how the risks of contracting COVID-19 compare to the small risks involved in vaccination.

The Covid-19 Vaccines and What You Need to Know

There are currently 2 vaccines that are approved and widely available in Australia - Vaxzevria (AstraZeneca Vaccine) and Comirnaty (Pfizer Vaccine). The Moderna Vaccine has just been provisionally approved – as I have no experience with this I will not be covering it.

ATAGI (Australian Technical Advisory Group on Immunisation) is responsible for providing guidance about vaccination.  Detailed information on both vaccines, as well as resources for patients and healthcare workers are available through the Department of Healthwebsite. 

Is it true? Get the facts on COVID-19 vaccines - Find accurate, evidence-based answers to questions or misinformation about COVID-19 vaccines

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true 

How COVID-19 vaccines are tested and approved

https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/how-covid-19-vaccines-are-tested-and-approved 

Safety data for COVID-19 vaccines in Victoria - https://mvec.mcri.edu.au/vaccinesafety/ 

I will briefly cover the important aspects and frequently-asked questions about these vaccines as a jumping-off point for you to get your head around them.

General Advice about both vaccines

They are safe: Both vaccines have been extensively trialled prior to their rollout in Australia. Serious adverse effects are rare, and health regulatory bodies including Australia’s Therapeutic Goods Administration closely monitor side effects to ensure they are safe.

Mild side effects are common: These occur with both vaccines and include fevers, muscle pains, headache and generally feeling like shit. These resolve within a few days and do not have any long-term consequences.

They are effective: Both vaccines are effective in reducing the chances of death, severe disease and transmission of COVID.

Vaccine Effectiveness – A reference table

From the Doherty Institute Modelling

What does “effective” mean?

In counselling scores of patients on vaccination, I run into this question a lot. Yes, you can still get Covid-19 if you are vaccinated. When measuring vaccine effectiveness, getting the disease is only one outcome of interest. Other important metrics are the chances of symptomatic disease, hospitalisation and death.

The meaning of the number is also important to understand. 90% effectiveness in preventing death means that, when comparing an unvaccinated to a vaccinated population, the rate of death in the vaccinated group is 90% lower than the unvaccinated group. If you are vaccinated, while you are not completely protected from getting COVID-19, if you do contract the virus, you are significantly less likely to get severely ill or die from the disease.

The reduction in outward transmission – giving the disease to other people – is also a very important figure. Vaccinated people are far less likely to pass the disease on to their family or other people in the community. New research shows that COVID-19 vaccination reduces household transmission up to 97%.  Vaccination protects you, and everyone else. This is vital in curbing the number of cases and also in protecting those who cannot be vaccinated like young children, immunocompromised or those with legitimate health exemptions. Reducing transmissibility will be vital in allowing society to re-open – future outbreaks will be smaller and more able to be contained quickly.

However, vaccination is only one part of this equation. Other measures of reducing transmission – wearing masks, social distancing and effective contact tracing will still be required even when we are widely vaccinated.

AstraZeneca Vaccine - Frequently Asked Questions

Will I get a clot or die from this vaccine?

This vaccine has a very rare side effect called TTS (Thrombosis with Thrombocytopenia Syndrome). TTS can cause blood clots in the brain (cerebral venous sinus thrombosis -CVST) or the abdomen (Idiopathic splanchnic thrombosis) which require hospitalisation to treat. The risk of this side effect is very low – 20 in a million (0.002%), with the chance of death from this vaccine being less than 1 in a million (<0.0001%). If you have had TTS before (From a dose of this vaccine or from Heparin), have had a CVST or splanchnic vein thrombosis before, or have Antiphospholipid syndrome (an Autoimmune clotting disease), then you are at higher risk of TTS and cannot have this particular vaccine. 

This vaccine does not increase the risk of other types of blood clots (like DVT or PE). It is safe for people who have a history of these kinds of blood clots, people who are on the contraceptive pill or hormones, or those with clotting disorders like Factor V Leiden. 

Australian doctors have also worked hard to mitigate the impacts of the rare blood clots which has meant that in Australia, the risk of dying from TTS after vaccination is about one in a million in people who have received a first dose, with the risk even lower after a second dose.

AstraZeneca vaccine: risk of death is 1 in a million, but what does that mean? https://www.science.org.au/curious/people-medicine/astrazeneca-vaccine-risk-death-1-million-what-does-mean 

I’m under 60. They said I couldn’t get this vaccine before but now they say I can. Please explain

The risk of TTS (see above) is slightly higher in people under 60 (27 in a million compared to 17 per million in over 60s:  https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/approved-vaccines/astrazeneca 

In Early 2021, when there was almost no local transmission of COVID-19, the risk of TTS from the vaccine in under 60s (despite how rare it was) was higher than the risk of getting COVID-19. The lowest risk option was to recommend people under 60 not get this vaccine.

Things have changed considerably since then – The risk of TTS has not changed, but the risk of getting COVID-19 and dying from it are much higher. As the Astrazeneca vaccine is widely available, the recommendation has now changed – all adults who live in an outbreak setting (i.e. most of Australia right now) are recommended to get whichever vaccine is most readily available to them.

See see below detailed information available on the ATAGI website, including a breakdown of risk calculations by age group and frequently asked questions: 

Weighing up the potential benefits against risk of harm from COVID-19  Vaccine: AstraZeneca: https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_2.pdf

Why did the dose interval change from 12 weeks to 4-8 weeks?

As seen in the table above, most protection comes from the 2nd dose of the vaccine. The 12 week dose interval for this vaccine showed the highest level of effectiveness during its initial trial, so that was the interval that was recommended. The difference between 4, 8 and 12 week dosing intervals is smaller than the difference between single and double dose. In an outbreak, getting the highest effectiveness, as early as possible, is best – so the shorter dose interval is now recommended to achieve widespread community vaccination as early as possible.

Pfizer Vaccine

Does this Vaccine change my DNA?

No.

This vaccine is a new kind of vaccine – an mRNA vaccine. mRNA is produced by your body as a “blueprint” for your body to make proteins. When mRNA has been read, it is quickly broken down by your body. This vaccine contains mRNA that has been made in a lab which contains instructions for your body’s cells to make the spike protein – a part of the novel Coronavirus (but not the whole virus). The spike protein is made by your cells, which then makes antibodies against it. The mRNA is then broken down naturally by your body.

Will I get Myopericarditis from this vaccine?

Myopericarditis, inflammation of the heart muscle or its lining is a rare side effect of mRNA vaccines (Pfizer and moderna vaccines). The overall risk of this side effect is 27 per 1 million. It is more common in young men after the second dose of the vaccine, with the highest prevalence in young men aged 16-17 after the (72 per million doses).

Myopericarditis is a known complication of COVID-19, and occurs at much higher rates in people who are infected with Covid-19, 110 per million cases. The risk of this side effect from the vaccine is significantly lower than getting it from the virus itself.

More detailed information available here - 

Guidance on Myocarditis  and Pericarditis after mRNA COVID-19 Vaccines 

https://www.health.gov.au/sites/default/files/documents/2021/09/covid-19-vaccination-guidance-on-myocarditis-and-pericarditis-after-mrna-covid-19-vaccines_0.pdf )

COVID-19 vaccine FAQs relating to mRNA vaccines - Melbourne Vaccine Center from Murdoch Children’s Research Institute 

https://mvec.mcri.edu.au/references/covid-19-vaccine-faqs-mrna-vaccines/ 

Here is my stepwise approach to discussing vaccination with my patients

Routinely ask about their vaccination status, which vaccine/how many doses and the vaccine status of their household members

I do this for a few reasons – This forms part of a Covid-19 risk-assessment that should be done on all patients, as well as to screen for possible vaccine side-effects as a cause of their presentation. It is also important to initiate the conversation around vaccination with all patients 

If they are not vaccinated, ask if they are planning to get vaccinated and when

This is an opportunity to recommend vaccination as early as possible. I have encountered many patients who are waiting up to 3 months to get vaccinated with the Pfizer vaccine when AstraZeneca is available immediately for them.

If they are vaccine hesitant or anti-vaccine, ask them what there concerns are and offer to discuss them in detail

We’ve discussed a few factors that contribute to vaccine hesitancy. Understanding why your patient feels hesitant will allow you to directly address their specific concerns.

The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal

https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643 

Health workers are among the COVID vaccine hesitant. Here’s how we can support them safely

https://theconversation.com/health-workers-are-among-the-covid-vaccine-hesitant-heres-how-we-can-support-them-safely-168838 

Address misconceptions and allow the patient to ask questions

There are many myths and misconceptions surrounding vaccination – many of which have unfortunately become relatively mainstream during this pandemic. While some are flat-out ridiculous (5G chips courtesy of Bill Gates come to mind), others may seem more palatable or plausible to the layperson. I’ve compiled a list of common myths about vaccination that you may encounter and how to deal with them:

Vaccines cause autism

This is perhaps the most harmful and pervasive myth around vaccines. This claim originated from a 1997 study by Andre Wakefield which linked the MMR vaccine to developing Autism. The paper has been completely discredited due to a number of factors – poor quality evidence and study design, academic misconduct, falsification of data and non-disclosure of financial conflicts of interest. Several subsequent studies have convincingly debunked this claim, but it remains a staple of harmful anti-vaccination rhetoric. 

The vaccines were developed too quickly and weren’t trialled widely enough

While the development of these vaccines was indeed the fastest in history, this has not come at the cost of proper approval and testing. This was built off the back of 200 years of vaccine technology, as well as decades of study in developing vaccines for other coronaviruses including SARS and MERS. The Synthetic mRNA technology used in the Pfizer and Moderna vaccines has been used for the development of cancer therapies over the last decade and was adapted for these vaccines.  All vaccines underwent standard processes of ethics approval and staged clinical trials during their development. The speed of development was due to them being highly prioritised and streamlined through the usual months or years-long waits for ethical approval and subject recruitment. 

There have been over 6.3 billion doses of COVID-19 vaccines administered to date, with the WHO and international and national health regulatory bodies closely monitoring for adverse effects. The rollout of this vaccine has been an unprecedented triumph of modern medical science.

For further info please read: 

Why should I trust the coronavirus vaccine when it was developed so fast? A doctor answers that and other reader questions: https://theconversation.com/why-should-i-trust-the-coronavirus-vaccine-when-it-was-developed-so-fast-a-doctor-answers-that-and-other-reader-questions-152429 

Rigorous testing procedures and scientific evaluation of Covid-19 vaccines: https://mvec.mcri.edu.au/references/vaccine-development-and-safety/ 

The powerful technology behind the Pfizer and Moderna vaccines: https://www.pbs.org/newshour/health/the-powerful-technology-behind-the-pfizer-and-moderna-vaccines 

We don’t know the long-term effects of these vaccines

I concede this is true – our oldest data on vaccine side effects is less than 2 years old. However, vaccine technology used in these vaccines is over 200 years old. 

Side effects for vaccinations usually appear within days or weeks of vaccination. When side effects were deemed unsafe, such as with the 2010 influenza vaccination in young children, the vaccine was discontinued. However, with Covid-19 the safety monitoring systems are more robust which enables us to detect such serious side-effects in the general population after clinical trials much sooner. For example, check out the weekly safety reports from the the therapeutic goods administration: https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report 

Of the dozens of routine vaccines available for other diseases, none of them have shown any dramatic or unexpected long-term health effects. COVID-19 presents a real threat to life and long-term health. The potential consequences of contracting COVID-19 while unvaccinated are real. There is no absolute zero risk option – all vaccines have side effects, these vaccines have some rare side effects. But in a world where COVID-19 is here to stay, rolling the dice and getting COVID-19 represents a much higher risk. 

For further information please see: 

How do we know the COVID vaccine won’t have long-term side-effects?

https://theconversation.com/how-do-we-know-the-covid-vaccine-wont-have-long-term-side-effects-155714 

New COVID-19 vaccine warnings don’t mean it’s unsafe – they mean the system to report side effects is working

https://theconversation.com/new-covid-19-vaccine-warnings-dont-mean-its-unsafe-they-mean-the-system-to-report-side-effects-is-working-164455 

We’re gathering data on COVID vaccine side effects in real time. Here’s what you can expect

https://theconversation.com/were-gathering-data-on-covid-vaccine-side-effects-in-real-time-heres-what-you-can-expect-158945 

I don’t get sick/I’m healthy. I don’t need the vaccine

Modern society has benefited from widespread vaccination to prevent infectious diseases. Even if you were unvaccinated as a child, vaccination is so ubiquitous that you were protected by herd immunity. This is an unprecedented new infectious disease, with no established immunity within the population. This is not a simple cold or flu. Being young and healthy will not prevent you from getting COVID-19 or passing it on to vulnerable people.

The vaccine is part of a system of control/new world order etc.

These fixed false beliefs are difficult to shake – extreme anti-vaxxers/COVID-19 deniers can be difficult to deal with. They have subscribed to a set of falsehoods where a common ground cannot be found. The distrust of authority creates a self-fulfilling prophecy – health advice is fake and designed to make/keep you sick, and things that are recommended against (i.e.Ivermectin/Hydroxychloroquine) are the things that really work. Getting into an argument with these people is unlikely to change their minds. Just let them know that you recommend getting vaccinated, you care about their health and are there to guide them to make informed health decisions, and that you’re not forcing them to do it. Importantly, you may need to stand your ground with these people - providing an inappropriate vaccine or mask exemption or prescribing treatments that are not recommended is not going to happen.

Offer support and resources. Encourage further discussion 

There are many reasons people may be hesitant about vaccination - brushing these aside, dismissing their feelings and telling them to get vaccinated anyway will not help this hesitancy. Let them know that you care about their health and wellbeing, validate their concerns and use these as an opportunity to educate.  It is essential that patients feel empowered and motivated to follow-through with their decision to get vaccinated. ATAGI and the Department of Health have numerous patient information packages regarding COVID-19 vaccination which you can provide for them to read up on. 

If you are seeing them in an ED/ward context, encourage them to book an appointment with their GP to discuss other questions they have. We are there to guide and support people to make informed health decisions and providing as much information as possible from multiple sources is vital.

I hope this piece has informed and invigorated you to engage with your patients on the issue of Covid-19 vaccination. Widespread vaccination is our way out of this pandemic, and it takes the hard work and dedication of all of us, healthcare workers and members of the community to protect each other.