tag:theconversation.com,2011:/ca/topics/immunisation-2613/articlesImmunisation – The Conversation2024-03-07T05:30:28Ztag:theconversation.com,2011:article/2250912024-03-07T05:30:28Z2024-03-07T05:30:28ZBabies in WA will soon be immunised against RSV – but not with a vaccine<figure><img src="https://images.theconversation.com/files/580326/original/file-20240307-22-um2200.jpeg?ixlib=rb-1.1.0&rect=142%2C194%2C8471%2C5548&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pediatrician-doctor-examines-newborn-stethoscope-female-2278794293">Dragana Gordic/Shutterstock</a></span></figcaption></figure><p>This week, Western Australia <a href="https://www.wa.gov.au/government/media-statements/Cook-Labor-Government/Western-Australian-children-first-to-access-protection-from-RSV-20240305">announced</a> a state government-funded immunisation program against respiratory syncytial virus (RSV). It’s the first Australian state or territory to do so. </p>
<p>All babies under eight months old and those aged eight to 19 months at increased risk of severe RSV infection will be eligible for the immunisation in WA this year.</p>
<p>RSV can cause serious illness in children, and news headlines have welcomed WA’s impending rollout of “<a href="https://www.dailytelegraph.com.au/lifestyle/health/wa-to-become-the-first-state-offering-rsv-vaccinations-for-babies-in-australia/news-story/ffc9cac0ff8ff9ea98a958ee83ef6de7">vaccinations</a>” against the virus.</p>
<p>But this immunisation differs from other <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">routine childhood vaccines</a>.</p>
<h2>Why is RSV important?</h2>
<p>RSV is the <a href="https://pubmed.ncbi.nlm.nih.gov/35636455/">most common cause</a> of respiratory infection in young children. By the age of two, almost all children show <a href="https://www.nature.com/articles/s41598-021-88524-w">evidence</a> they’ve been exposed to the virus.</p>
<p>Estimates suggest <a href="https://pubmed.ncbi.nlm.nih.gov/35013434/">2-3%</a> of infants are hospitalised with RSV with infection involving the airways and lungs. Infants under three months are at <a href="https://pubmed.ncbi.nlm.nih.gov/32031631/">highest risk</a>. RSV can also have long-lasting effects on children – there’s a well-established link between RSV and subsequent <a href="https://pubmed.ncbi.nlm.nih.gov/31370064/">wheezing illnesses</a> and asthma. </p>
<p>RSV can also be a problem for the <a href="https://theconversation.com/an-rsv-vaccine-has-been-approved-for-people-over-60-but-what-about-young-children-221311">elderly</a> and people with underlying health conditions such as those with weakened immune systems. </p>
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Read more:
<a href="https://theconversation.com/an-rsv-vaccine-has-been-approved-for-people-over-60-but-what-about-young-children-221311">An RSV vaccine has been approved for people over 60. But what about young children?</a>
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<h2>How do we protect children against RSV?</h2>
<p>Antibodies are a key part of the immune system that protect people against many viral infections, including RSV. They’re usually generated in response to infection or a vaccine, and work by attaching to proteins on the surface of RSV, therefore preventing the virus from invading the cells that line the airways and lungs. </p>
<p>The problem in newborn babies (who are at the highest risk of severe RSV infection) is that previous vaccines have not generated sufficient antibodies to provide protection.</p>
<p>So, two strategies have been developed to protect young children against RSV. These strategies are both referred to as <a href="https://immunisationhandbook.health.gov.au/contents/fundamentals-of-immunisation#passive-immunisation">passive immunisation</a>, because children receive protective antibodies from outside the body. This is different to active immunisation where we give a child a vaccine so they can generate their own antibodies.</p>
<figure class="align-center ">
<img alt="A pregnant woman sits on a couch with her daughter, with a laptop on her lap." src="https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580324/original/file-20240307-18-9hxern.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Vaccinating pregnant women is one way to protect babies against RSV.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-black-woman-working-on-laptop-1817195420">Ground Picture/Shutterstock</a></span>
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<h2>Vaccination in pregnancy</h2>
<p>One way to deliver passive immunity to young infants is by vaccinating their mothers during pregnancy. Maternal immunisation has been shown to be effective at protecting infants from other infections, including <a href="https://pubmed.ncbi.nlm.nih.gov/34446538/">influenza, whooping cough</a> (pertussis), <a href="https://www.who.int/initiatives/maternal-and-neonatal-tetanus-elimination-(mnte)/the-strategies">tetanus</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974935/">COVID</a>. </p>
<p>By delivering a single RSV vaccine to pregnant women, antibodies are generated by the mother and transported across the placenta, providing passive immunity and protection to the baby for around the first six months of life. In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2216480">clinical trial</a>, giving an RSV vaccine in late pregnancy reduced RSV in young infants by approximately 70%. But RSV vaccines for pregnant women are <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia">not yet available</a> in Australia.</p>
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Read more:
<a href="https://theconversation.com/rsv-is-everywhere-right-now-what-parents-need-to-know-about-respiratory-syncytial-virus-208855">RSV is everywhere right now. What parents need to know about respiratory syncytial virus</a>
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<h2>What are monoclonal antibodies?</h2>
<p>The other passive immunisation strategy relies on manufactured long-acting antibodies (known as “monoclonal antibodies”), which can be delivered by injection to young children. </p>
<p>This is what will be offered in WA. Nirsevimab (also known as Beyfortus) is a long-acting antibody that Australia’s Therapeutic Goods Administration (TGA) <a href="https://www.tga.gov.au/resources/auspmd/beyfortus">approved</a> in November 2023. </p>
<p>Nirsevimab binds specifically to RSV and remains in the body for several months after injection. In a key <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2110275">clinical trial</a> nirsevimab was shown to reduce RSV infections by about 75% for up to five months. </p>
<p>Several European countries have recently implemented infant programs with nirsevimab and are <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.6.2400046">reporting</a> significantly lower RSV hospitalisation rates in babies. </p>
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<img alt="A baby's leg with a bandaid on it." src="https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580323/original/file-20240307-28-tdjxvt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">For babies, the injection will normally be given in the thigh.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bandaid-on-baby-after-shot-leg-774258127">Allen Mercer/Shutterstock</a></span>
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<p>Antibody therapies in various forms have been used for more than a century for the prevention and treatment of a range of conditions, dating from “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898362/">serotherapy</a>” for tetanus, diphtheria and snake bite in the late 1800s.</p>
<p>Licensed antibody products are rigorously tested in clinical trials and through post-marketing surveillance to ensure their safety. </p>
<p>For <a href="https://pubmed.ncbi.nlm.nih.gov/36634694/">nirsevimab</a> specifically, the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2110275">clinical trial</a> mentioned above included over 1,400 infants. Adverse events were reported at similar rates in the nirsevimab and placebo groups, and no serious adverse events relating to treatment were reported. No significant safety concerns have been identified in the real-world rollout in the northern hemisphere either.</p>
<h2>When does RSV occur?</h2>
<p>RSV <a href="https://pubmed.ncbi.nlm.nih.gov/35083489/">usually takes hold</a> just before the flu season in southern states, and circulates year-round in tropical areas. While influenza almost disappeared during the <a href="https://pubmed.ncbi.nlm.nih.gov/32986804/">COVID</a> pandemic, there were <a href="https://www.nature.com/articles/s41467-022-30485-3">ongoing cases</a> of RSV, albeit with a disruption to the normal seasonal pattern. </p>
<p>Since 2022, RSV has resumed its normal seasonal pattern. The WA government says the immunisations will be available <a href="https://www.wa.gov.au/government/media-statements/Cook-Labor-Government/Western-Australian-children-first-to-access-protection-from-RSV-20240305">from April</a>, which is timely in anticipation of the 2024 season.</p>
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Read more:
<a href="https://theconversation.com/rsv-is-a-common-winter-illness-in-children-why-did-it-see-a-summer-surge-in-australia-this-year-156492">RSV is a common winter illness in children. Why did it see a summer surge in Australia this year?</a>
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<h2>What about other states and territories?</h2>
<p>Free access to an immunisation against RSV should significantly benefit young children and families in WA, keeping children out of hospital this winter. </p>
<p>Whether other states will follow WA’s lead is uncertain at this stage, and we don’t yet know whether nirsevimab will in time become part of the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>, meaning it would be available for free nation-wide. </p>
<p>Ensuring equitable access, particularly for those at greatest risk of severe RSV infection, must be prioritised to ensure maximum benefit for all children and families.</p>
<p>Nirsevimab is likely to be the first of many tools to prevent RSV in children. A maternal RSV vaccine is currently under assessment <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia.">by the TGA</a> and Pharmaceutical Benefits Advisory Committee (PBAC). A vaccine for older Australians, <a href="https://www.tga.gov.au/resources/auspmd/arexvy">Arexvy</a>, is registered and is also being assessed by the <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked#:%7E:text=The%20current%20maternal%20RSV%20vaccine,not%20currently%20available%20in%20Australia">PBAC</a>, with additional vaccines expected to be available in the future. </p>
<p>These developments highlight the future of RSV prevention and also the significant potential for monoclonal antibodies to play a greater role in preventing infections as part of public health programs.</p><img src="https://counter.theconversation.com/content/225091/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Blyth receives funding from the Australian Department of Health and Aged Care, National Health and Medical Research Council and the Perron Trust for RSV-related research. He has previously been a member of the Australian Technical Advisory Group on Immunisation.</span></em></p><p class="fine-print"><em><span>Allen Cheng receives funding from the Australian Department of Health and Aged Care and the National Health and Medical Research Council. He is a member of the Australian Technical Advisory Group on Immunisation.</span></em></p>The RSV shot children in WA will get is a monoclonal antibody. Here’s what that means.Christopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, Telethon Kids Institute, The University of Western AustraliaAllen Cheng, Professor of Infectious Diseases, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173792024-01-09T19:15:56Z2024-01-09T19:15:56ZViruses aren’t always harmful. 6 ways they’re used in health care and pest control<figure><img src="https://images.theconversation.com/files/564112/original/file-20231207-20-amgv6b.jpg?ixlib=rb-1.1.0&rect=33%2C67%2C5573%2C3665&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-nurse-pushing-stretcher-gurney-bed-156022646">Shutterstock</a></span></figcaption></figure><p>We tend to just think of viruses in terms of their damaging impacts on human health and lives. <a href="https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu/">The 1918 flu pandemic</a> killed around 50 million people. <a href="https://www.cdc.gov/smallpox/about/index.html">Smallpox</a> claimed 30% of those who caught it, and survivors were often scarred and blinded. More recently, we’re all too familiar with the health and economic impacts of COVID. </p>
<p>But viruses can also be used to benefit human health, agriculture and the environment. </p>
<p>Viruses are comparatively simple in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150055/">structure</a>, consisting of a piece of genetic material (RNA or DNA) enclosed in a protein coat (the capsid). Some also have an outer envelope. </p>
<p>Viruses get into your cells and use your cell machinery to copy themselves.
Here are six ways we’ve harnessed this for health care and pest control. </p>
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Read more:
<a href="https://theconversation.com/how-do-viruses-get-into-cells-their-infection-tactics-determine-whether-they-can-jump-species-or-set-off-a-pandemic-216139">How do viruses get into cells? Their infection tactics determine whether they can jump species or set off a pandemic</a>
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<h2>1. To correct genes</h2>
<p>Viruses are used in some gene therapies to correct <a href="https://www.mdpi.com/1999-4915/15/3/698#">malfunctioning genes</a>. <a href="https://www.genome.gov/genetics-glossary/Gene">Genes</a> are DNA sequences that code for a particular protein required for cell function. </p>
<p>If we remove viral genetic material from the capsid (protein coat) we can use the space to transport a “cargo” into cells. These modified viruses are called “<a href="https://www.nature.com/articles/s41392-021-00487-6">viral vectors</a>”. </p>
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<img alt="" src="https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564099/original/file-20231207-15-g0knkm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Viruses consist of a piece of RNA or DNA enclosed in a protein coat called the capsid.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Introduction_to_viruses#/media/File:Basic_Scheme_of_Virus_en.svg">DEXi</a></span>
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<p>Viral vectors can <a href="https://www.nature.com/articles/s41392-021-00487-6">deliver a functional gene</a> into someone with a genetic disorder whose own gene is not working properly. </p>
<p>Some <a href="https://www.mdpi.com/1999-4915/15/3/698#">genetic diseases</a> treated this way include haemophilia, sickle cell disease and beta thalassaemia. </p>
<h2>2. Treat cancer</h2>
<p>Viral vectors can be used to treat cancer. </p>
<p>Healthy people have p53, a tumour-suppressor gene. About <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884858/">half</a> of cancers are associated with the loss of p53. </p>
<p>Replacing the damaged p53 gene using a viral vector stops the cancerous cell from replicating and tells it to suicide (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756401/">apoptosis</a>). </p>
<p>Viral vectors can also be used to deliver an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884858/">inactive drug</a> to a tumour, where it is then activated to kill the tumour cell. </p>
<p>This targeted therapy reduces the side effects otherwise seen with cytotoxic (cell-killing) drugs. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Q6qk6Wh6cXU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s how treatment, called gene therapy, works.</span></figcaption>
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<p>We can also use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9888358/">oncolytic</a> (cancer cell-destroying) viruses to treat some types of cancer. </p>
<p>Tumour cells have often lost their antiviral defences. In the case of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884858/">melanoma</a>, a modified herpes simplex virus can kill rapidly dividing melanoma cells while largely leaving non-tumour cells alone. </p>
<h2>3. Create immune responses</h2>
<p>Viral vectors can create a protective immune response to a particular viral antigen. </p>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9317404/">COVID vaccine</a> uses a modified chimp adenovirus (adenoviruses cause the common cold in humans) to transport RNA coding for the SARS-CoV-2 spike protein into human cells. </p>
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Read more:
<a href="https://theconversation.com/how-the-puzzle-of-viral-vector-vaccines-was-solved-leading-to-todays-covid-19-shots-167341">How the puzzle of viral vector vaccines was solved, leading to today’s COVID-19 shots</a>
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<p>The RNA is then used to make spike protein copies, which stimulate our immune cells to replicate and “remember” the spike protein. </p>
<p>Then, when you are exposed to SARS-CoV-2 for real, your immune system can churn out lots of antibodies and virus-killing cells very quickly to prevent or reduce the severity of infection. </p>
<h2>4. Act as vaccines</h2>
<p>Viruses can be modified to act directly as vaccines themselves <a href="https://www.hhs.gov/immunization/basics/types/index.html">in several ways</a>. </p>
<p>We can weaken a virus (for an attenuated virus vaccine) so it doesn’t cause infection in a healthy host but can still replicate to stimulate the immune response. The chickenpox vaccine works like this. </p>
<p>The Salk vaccine for polio uses a whole virus that has been inactivated (so it can’t cause disease). </p>
<p>Others use a small part of the virus such as a capsid protein to stimulate an immune response (subunit vaccines). </p>
<p>An mRNA vaccine packages up viral RNA for a specific protein that will stimulate an immune response. </p>
<h2>5. Kill bacteria</h2>
<p>Viruses can – in limited situations <a href="https://phage.directory/capsid/phage-therapy-regulation-australia">in Australia</a> – be used to treat antibiotic-resistant bacterial infections.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK493185/">Bacteriophages</a> are viruses that kill bacteria. Each type of phage usually infects a particular species of bacteria. </p>
<p>Unlike antibiotics – which often kill “good” bacteria along with the disease-causing ones – phage therapy leaves your normal flora (useful microbes) intact. </p>
<figure class="align-center ">
<img alt="A phage" src="https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564113/original/file-20231207-19-7ruzur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Bacteriophages (red) are viruses that kill bacteria (green).</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteriophages-viruses-that-attack-infect-bacteria-1391256956">Shutterstock</a></span>
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<h2>6. Target plant, fungal or animal pests</h2>
<p>Viruses can be species-specific (infecting one species only) and even cell-specific (infecting one type of cell only). </p>
<p>This occurs because the proteins viruses use to attach to cells have a shape that binds to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083867/#">a specific type of cell receptor</a> or molecule, like a specific key fits a lock. </p>
<p>The virus can enter the cells of all species with this receptor/molecule. For example, <a href="https://www.cdc.gov/rabies/animals/index.html">rabies virus</a> can infect all mammals because we share the right receptor, and mammals have other characteristics that allow infection to occur whereas other non-mammal species don’t. </p>
<p>When the receptor is only found on one cell type, then the virus will infect that cell type, which may only be found in one or a limited number of species. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869238/">Hepatitis B virus</a> successfully infects liver cells primarily in humans and chimps. </p>
<p>We can use that property of specificity to target <a href="https://pubmed.ncbi.nlm.nih.gov/37682594/">invasive plant species</a> (reducing the need for chemical herbicides) and pest insects (reducing the need for chemical insecticides). <a href="https://www.tandfonline.com/doi/full/10.1080/23311932.2023.2254139">Baculoviruses</a>, for example, are used to control caterpillars. </p>
<p>Similarly, <a href="https://www.ncbi.nlm.nih.gov/books/NBK493185/">bacteriophages</a> can be used to control bacterial <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-phyto-021621-114208">tomato and grapevine diseases</a>. </p>
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Read more:
<a href="https://theconversation.com/phage-therapy-could-treat-some-drug-resistant-superbug-infections-but-comes-with-unique-challenges-207025">'Phage therapy' could treat some drug-resistant superbug infections, but comes with unique challenges</a>
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<p>Other viruses reduce plant damage from <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-phyto-021621-114208">fungal pests</a>. </p>
<p><a href="https://csiropedia.csiro.au/myxomatosis-to-control-rabbits/">Myxoma virus and calicivirus</a> reduce rabbit populations and their environmental impacts and improve agricultural production. </p>
<p>Just like humans can be protected against by vaccination, plants can be “<a href="https://www.annualreviews.org/doi/full/10.1146/annurev-phyto-021621-114208">immunised</a>” against a disease-causing virus by being exposed to a milder version.</p><img src="https://counter.theconversation.com/content/217379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Master of Infection Prevention and Control program at Griffith University. </span></em></p>We tend to just think of viruses in terms of their damaging impacts on human health and lives. But viruses can also be used to benefit human health, agriculture and the environment.Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2179152023-11-26T19:20:59Z2023-11-26T19:20:59ZMillions of high-risk Australians aren’t getting vaccinated. A policy reset could save lives<p>Each year, vaccines prevent thousands of deaths and hospitalisations in Australia. </p>
<p>But millions of high-risk older Australians <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">aren’t getting</a> recommended vaccinations against COVID, the flu, pneumococcal disease and shingles. </p>
<p>Some people are more likely to miss out, such as migrant communities and those in rural areas and poorer suburbs. </p>
<p>As our new <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">Grattan report shows</a>, a policy reset to encourage more Australians to get vaccinated could save lives and help ease the pressure on our struggling hospitals.</p>
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Read more:
<a href="https://theconversation.com/millions-of-australian-adults-are-unvaccinated-and-its-increasing-disease-risk-for-all-of-us-74991">Millions of Australian adults are unvaccinated and it's increasing disease risk for all of us</a>
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<h2>Adult vaccines reduce the risk of serious illness</h2>
<p>Vaccines slash the risk of <a href="https://www.ncirs.org.au/sites/default/files/2021-03/Influenza-fact-sheet_31%20March%202021_Final.pdf">hospitalisation</a> and serious illness, <a href="https://ncirs.org.au/recent-covid-19-vaccination-highly-effective-against-death-caused-sars-cov-2-infection-older">often by more than half</a>. </p>
<p>COVID has already caused more than <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">3,000 deaths in Australia this year</a>. On average, the flu kills about <a href="https://www.doherty.edu.au/news-events/news/statement-on-the-doherty-institute-modelling">600 people a year</a>, although a bad flu season, like 2017, can mean <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202017%7E2">several thousand deaths</a>. And pneumococcal disease may also kill <a href="https://www.aihw.gov.au/getmedia/49809836-8ead-4da5-81c4-352fa64df75b/aihw-phe-263.pdf?inline=true">hundreds</a> of people a year. Shingles is rarely fatal, but can be extremely painful and cause <a href="https://www.healthdirect.gov.au/shingles#complications">long-term nerve damage</a>. </p>
<p>Even before COVID, vaccine-preventable diseases caused tens of thousands of potentially preventable hospitalisations each year – more than <a href="https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/data">80,000 in 2018</a>.</p>
<p>Vaccines offered in Australia have been tested for safety and efficacy and have been found to be <a href="https://www.health.gov.au/topics/immunisation/about-immunisation/vaccine-safety#:%7E:text=serious%20side%20effects.-,Vaccine%20safety%20monitoring,approved%20for%20use%20in%20Australia.">very safe</a> for people who are <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule">recommended to get them</a>.</p>
<h2>Too many high-risk people are missing out</h2>
<p>Our <a href="https://grattan.edu.au/report/roundabouts-overpasses-carparks-hauling-the-federal-government-back-to-its-proper-role-in-transport-projects">report</a> shows that before winter this year, only 60% of high-risk Australians were vaccinated against the flu. </p>
<p>Only 38% had a COVID vaccination in the last six months. Compared to a year earlier, two million more high-risk people went into winter without a recent COVID vaccination.</p>
<p>Vaccination rates have fallen further since. Just over one-quarter (<a href="https://www.health.gov.au/sites/default/files/2023-11/covid-19-vaccine-rollout-update-10-november-2023.pdf">27%</a>) of people over 75 have been vaccinated in the last six months. That leaves more than 1.3 million without a recent COVID vaccination. </p>
<p>Uptake is also low for other vaccines. Among Australians in their 70s, <a href="https://ncirs.org.au/sites/default/files/2022-12/Coverage%20report%202021%20SUMMARY%20FINAL.pdf">less than half</a> are vaccinated against shingles and only one in five are vaccinated against pneumococcal disease.</p>
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Read more:
<a href="https://theconversation.com/explainer-how-do-you-get-shingles-and-who-should-be-vaccinated-against-it-64436">Explainer: how do you get shingles and who should be vaccinated against it?</a>
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<p>These vaccination rates aren’t just low – they’re also unfair. The likelihood that someone is vaccinated changes depending on where they live, where they were born, what language they speak at home, and how much they earn. </p>
<p>For example, at the start of winter this year, the COVID vaccination rate for high-risk Aboriginal and Torres Strait Islander adults was only 25%. This makes them about one-third less likely to have been vaccinated against COVID in the previous six months, compared to the average high-risk Australian. </p>
<p>For more than 750,000 high-risk adults who do not speak English at home, the COVID vaccination rate is below 20% – about half the level of the average high-risk adult. </p>
<p>Within this group, 250,000 adults aren’t proficient in English. They were 58% less likely to be vaccinated for COVID in the previous six months, compared to the average high-risk person. </p>
<p>High-risk adults who speak English at home have a flu vaccination rate of 62%. But for people from 29 other language groups, who aren’t proficient in English, the rate is less than 31%. These 39,000 people have half the vaccination rate of people who speak English at home. </p>
<p>These vaccination gaps contribute to the differences in people’s health. Australians born overseas don’t just have much lower rates of COVID vaccination, they also have much higher rates of death from COVID.</p>
<p>Where people live also affects vaccination rates. High-risk people living in remote and very remote areas are less likely to be vaccinated, and even within capital cities there are big differences between different areas.</p>
<h2>We need to set ambitious targets</h2>
<p>Australia needs a vaccination reset. A new National Vaccination Agreement between the federal and state governments should include ambitious but achievable targets for adult vaccines. </p>
<p>This can build on the success of targets for childhood and adolescent vaccination, setting targets for overall uptake and for communities that are falling behind. </p>
<p>The federal government should ask the Australian Technical Advisory Group on Immunisation (ATAGI) to advise on vaccination targets for COVID, flu, pneumococcal and shingles for all high-risk older adults. </p>
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<img alt="Nurse gives older man a vaccination." src="https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561243/original/file-20231123-21-vhjtc4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Australia needs to encourage more older adults to get vaccinated.</span>
<span class="attribution"><a class="source" href="https://theconversation.com/drafts/217915/edit#">Shutterstock</a></span>
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<h2>Different solutions for different barriers</h2>
<p>Barriers to vaccination range from the trivial to the profound. A new national vaccination strategy needs to dismantle high and low barriers alike. </p>
<p>First, to increase overall uptake, vaccination should be easier, and easier to understand. </p>
<p>The federal government should introduce vaccination “surges”, especially in the lead-up to winter, as <a href="https://www.who.int/europe/news/item/09-10-2023-vulnerable--vaccinate.-protecting-the-unprotected-from-covid-19-and-influenza">countries in Europe</a> do. </p>
<p>During surges, high-risk people should be able to get vaccinated even if they have had a recent infection or injection. This will make the rules simpler and make vaccination in aged care easier. </p>
<p>Surges should be reinforced with advertising explaining who should get vaccinated and why. High-risk people should get SMS reminders. </p>
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Read more:
<a href="https://theconversation.com/health-check-when-do-adults-need-to-be-immunised-23258">Health Check: when do adults need to be immunised?</a>
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<p>Second, targeted policies are needed for the many people who are happy to use mainstream primary care services, but who don’t get vaccinated – for example, due to <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">language barriers</a>, or living in <a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">aged care</a>. </p>
<p><a href="https://www.health.gov.au/our-work/phn/what-PHNs-are">Primary Health Networks</a> should get funding to coordinate initiatives such as vaccination events in aged care and disability care homes, workforce training to support culturally appropriate care, and provision of interpreters. </p>
<p>Third, tailored programs are needed to reach <a href="https://www.aihw.gov.au/reports/australias-health/health-promotion">people who are not comfortable or able to access mainstream health care</a>, who have the most complex barriers to vaccination – for example, distrust of the health system or poverty.</p>
<p>These communities are all very different, so one-size-fits-all programs don’t work. The pandemic showed that vaccination programs can succeed when they are designed and delivered with the communities they are trying to reach. Examples are “<a href="https://pubmed.ncbi.nlm.nih.gov/36366401/">community champions</a>” who challenge misinformation, or health services organising vaccination events where communities work, gather or <a href="https://www.theguardian.com/australia-news/2021/aug/11/hundreds-queue-for-hours-and-some-camp-overnight-at-pop-up-vaccine-clinic-in-sydneys-lakemba">worship</a>.</p>
<p>These programs should get ongoing funding, but also be accountable for achieving results. </p>
<p>Adult vaccines are the missing piece in Australia’s whole-of-life vaccination strategy. For the health and safety of the most vulnerable members of our community, we need to close the vaccination gap. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?</a>
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<img src="https://counter.theconversation.com/content/217915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p><p class="fine-print"><em><span>Ingrid Burfurd's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p>Millions of high-risk older Australians aren’t getting recommended vaccinations against COVID, the flu, pneumococcal disease and shingles.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteIngrid Burfurd, Senior Associate, Health Program, Grattan Institute, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2040272023-06-01T20:00:40Z2023-06-01T20:00:40ZI need a flu shot and a COVID booster. Can I get them at the same time?<figure><img src="https://images.theconversation.com/files/529244/original/file-20230531-23-t3j8la.jpg?ixlib=rb-1.1.0&rect=55%2C66%2C7293%2C4836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/uN8TV9Pw2ik">CDC/Unsplash</a></span></figcaption></figure><p>Cases of influenza (the flu) and COVID are set to rise over winter, with many Australians looking to protect themselves from both of these respiratory viruses. </p>
<p>For most adults, if it has been <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/clinical-recommendations#timing-of-administration-of-other-vaccines-including-influenza-vaccine">six months</a> since you had COVID or your last vaccination, you’re likely eligible to book in your next dose. </p>
<p>Meanwhile, the flu vaccine is <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">recommended</a> for everyone over the age of six months.</p>
<p>But can you get both at once? Yes, you can get your flu vaccine and COVID booster safely at the same time, saving you a trip to the GP, nurse or pharmacy. </p>
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<strong>
Read more:
<a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">Haven't had COVID or a vaccine dose in the past six months? Consider getting a booster</a>
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<h2>Why has the advice changed?</h2>
<p>When COVID vaccines were first rolled out, a gap was recommended between COVID and flu vaccines. This is because we didn’t have adequate data of the individual and long-term effects of the new COVID vaccines.</p>
<p>After examining the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">latest available evidence</a> on safety and efficacy, the World Health Organization updated its <a href="https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-vaccines-SAGE_recommendation-coadministration-influenza-vaccines">interim guidelines</a>. It suggests getting an influenza vaccine and any dose of any approved COVID vaccine at the same time is a practical option.</p>
<p>However, until more data becomes available, the WHO advises <a href="https://www.who.int/news/item/14-10-2022-influenza-in-the-northern-hemisphere-is-back">using different arms</a> for vaccination. This is to prevent the ingredients of the vaccines mixing and to limit the initial immune response to a different group of lymph nodes. </p>
<p>The <a href="https://www.coronavirus.vic.gov.au/sites/default/files/2022-05/Appendix34_Guidance_on_co-administration.pdf">Australian Technical Advisory Group on Immunisation</a> updated its vaccination guidelines in <a href="https://www.health.gov.au/sites/default/files/documents/2022/02/atagi-advice-on-seasonal-influenza-vaccines-in-2022.pdf">March 2022</a>, advising that influenza and COVID vaccines can be <a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">administered on the same day</a>. </p>
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<img alt="Clinician vaccinates man" src="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529255/original/file-20230531-25-3psb0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s practical to get both at once.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-black-female-doctor-prepares-1897028242">Shutterstock</a></span>
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<h2>What happens when you get two shots at once?</h2>
<p>Getting multiple vaccinations at once isn’t new. Childhood vaccinations are routinely and safely administered at the same time.</p>
<p>For COVID and flu vaccines, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952219/">randomised controlled trials</a> show no significant difference in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746457/">immune responses</a> of the people who had both vaccines at once compared to those who had them on different days. </p>
<p>Participants who had both vaccines at once reported the same types of side effects from the body’s inflammatory response to vaccination (injection-site pain, redness, swelling at the injection site) as well as general symptoms associated with both COVID and flu vaccines, such as fever, muscle pain and a headache. </p>
<p>These minor side-effects were of similar intensity and duration to those who had either vaccine administered alone. </p>
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<img alt="Person sick with COVID or the flu sits in the dark" src="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529256/original/file-20230531-23-cereaj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Side effects are similar when you have the vaccines individually or at once.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/d_mzrEx6ytY">Annie Sprat/Unsplash</a></span>
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<p>Getting both COVID and flu vaccines is also more cost-effective, the uptake is higher when people don’t have to make multiple trips, and it saves health practitioners’ time. </p>
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Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
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<h2>What about the viruses? Can you get COVID and the flu at the same time?</h2>
<p>Although simultaneous infections with two different viruses are common, SARS-CoV-2 has been infecting humans for a relatively short time. We therefore have limited data on how influenza strains and SARS-CoV-2 interact with the host at the same time, and if there is any interaction between the viruses. </p>
<p>However, one <a href="https://pubmed.ncbi.nlm.nih.gov/33942104/">large study in England</a> reported that people positive for influenza had lower odds of also testing positive for SARS-CoV-2. This was attributed to possible <a href="https://pubmed.ncbi.nlm.nih.gov/36134660/">cross-reactive immunity</a> between viruses. </p>
<p>It did, however, find people infected with both viruses at the same time had worse outcomes and were twice as likely to die as those who were only infected with SARS-CoV-2. </p>
<p>Some experimental evidence <a href="https://pubmed.ncbi.nlm.nih.gov/33603116/">suggested</a> prior infection with type A influenza virus promotes SARS-CoV-2 entry and infectiousness. This could be due to a unique feature of the influenza A virus which allows COVID to take hold more easily. </p>
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<strong>
Read more:
<a href="https://theconversation.com/flu-covid-and-flurona-what-we-can-and-cant-expect-this-winter-177826">Flu, COVID and flurona: what we can and can’t expect this winter</a>
</strong>
</em>
</p>
<hr>
<h2>Where can I get vaccinated and how much will it cost?</h2>
<p><a href="https://www.health.gov.au/sites/default/files/2023-03/2023-influenza-vaccination-program-advice-for-vaccination-providers.pdf">Influenza</a> and <a href="https://www.health.gov.au/our-work/covid-19-vaccines/who-can-get-vaccinated">COVID</a> vaccines are available at GP clinics and pharmacies. </p>
<p>Australians aged five years and over are eligible for a free COVID vaccination. The flu vaccine is free for people at higher risk of complications, including:</p>
<ul>
<li>pregnant women</li>
<li>people six months and older with selected chronic conditions</li>
<li>Aboriginal and Torres Strait Islander people. </li>
</ul>
<p>For the rest of the population, the flu vaccine costs around A$20-30. Some practitioners also charge a consultation fee. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1540220689273192449"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">I'm over 65 and worried about the flu. Which vaccine should I have?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cases of the flu and COVID are set to rise over winter, with many people looking to get vaccinated against both viruses.Vasso Apostolopoulos, Professor of Immunology and Pro Vice-Chancellor, Research Partnerships, Victoria UniversityMaja Husaric, Senior Lecturer; MD, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034062023-05-16T20:09:39Z2023-05-16T20:09:39ZShould I get a flu vaccine this year? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/525558/original/file-20230511-27-mu2hpj.jpg?ixlib=rb-1.1.0&rect=53%2C152%2C5937%2C3835&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-holding-her-head-4064177/">Pexels/Marcus Aurelius</a></span></figcaption></figure><p>After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. </p>
<p>So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. </p>
<p>Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. </p>
<p>Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-flu-cases-already-100-times-higher-than-last-year-heres-what-we-really-know-about-the-2023-flu-season-201559">Are flu cases already 100 times higher than last year? Here's what we really know about the 2023 flu season</a>
</strong>
</em>
</p>
<hr>
<h2>What are the different types of flu?</h2>
<p>There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N).</p>
<p>Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">HA is the yellow spike, while the NA is the green oval.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></span>
</figcaption>
</figure>
<p>Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. </p>
<p>Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. </p>
<p>The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flu-or-covid-you-can-now-test-for-both-at-home-with-a-single-swab-heres-what-you-need-to-know-204119">Flu or COVID? You can now test for both at home with a single swab. Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What strains does this year’s flu shot protect against?</h2>
<p>Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes:</p>
<ul>
<li><p>an A/Sydney/5/2021 (H1N1)pdm09-like virus</p></li>
<li><p>an A/Darwin/9/2021 (H3N2)-like virus</p></li>
<li><p>a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </p></li>
<li><p>a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.</p></li>
</ul>
<p>The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype).</p>
<p>This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. </p>
<p>Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage).</p>
<figure class="align-center ">
<img alt="People on a beach in Darwin" src="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525563/original/file-20230511-25-qhnxgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This year’s flu vaccine protects against a strain isolated in Darwin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunset-over-mindil-beach-darwin-northern-494537734">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Who should get a flu shot?</h2>
<p>Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year.</p>
<p><a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes:</p>
<ul>
<li><p>Aboriginal and Torres Strait Islander people aged six months and over</p></li>
<li><p>children aged six months to five years</p></li>
<li><p>pregnant women at any stage of pregnancy</p></li>
<li><p>people aged 65 years or over</p></li>
<li><p>people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-flu-shot-if-im-pregnant-96408">Should I get the flu shot if I'm pregnant?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I get it?</h2>
<p>You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. </p>
<p>While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. </p>
<p>If you aren’t eligible for a free vaccine, it usually costs around A$20-$30.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates woman" src="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525561/original/file-20230511-19-k7iqhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some people can get the shot for free, while others pay $20 to $30.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-african-american-woman-getting-flu-1906058728">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Are there different options?</h2>
<p>For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program.</p>
<p>A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. </p>
<p>People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. </p>
<p>The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. </p>
<h2>How well do they work?</h2>
<p>The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>What are the side effects?</h2>
<p>You can’t get the flu from the vaccine as there’s no live virus in it. </p>
<p>When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>.</p>
<p>Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. </p>
<h2>When’s the best time to get your flu shot?</h2>
<p>The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. </p>
<p>The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country.</p>
<p>Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.</p><img src="https://counter.theconversation.com/content/203406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Griffin has been a Medical Advisory Board Member including for AstraZeneca, GSK, MSD, Moderna, Biocelect/Novavax, Seqirus and Pfizer and has received speaker honoraria including from Seqirus, Novartis, Gilead, Sanofi, MSD and Janssen.
Paul Griffin is also a Director and Scientific Advisory Board Member of the Immunisation Coalition. </span></em></p>As people flock back to offices and pack public transport, we’re seeing more cases of the flu than in recent years. The flu shot isn’t perfect but it cuts your chance of being hospitalised.Paul Griffin, Associate Professor, Infectious Diseases and Microbiology, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037632023-04-18T03:28:33Z2023-04-18T03:28:33ZWhen did you have your last tetanus vaccine? A booster dose may save your life<figure><img src="https://images.theconversation.com/files/521445/original/file-20230418-18-3hqftn.jpg?ixlib=rb-1.1.0&rect=327%2C35%2C7482%2C5199&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid-vaccine-plaster-doctor-patient-consulting-2211549193">Shutterstock</a></span></figcaption></figure><p>NSW Health <a href="https://twitter.com/NSWHealth/status/1646283387496443906">recently reported</a> three cases of tetanus and the tragic death of a woman in her 80s – the first tetanus fatality in the state in 30 years. </p>
<p>Tetanus is a rare but potentially fatal disease. Thankfully, it’s preventable – being up to date with tetanus vaccination is your best protection.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1646359040266731520"}"></div></p>
<h2>What is tetanus and how do you get it?</h2>
<p>The bacteria that causes tetanus is called <em>Clostridium tetani</em>. Spores can enter your body usually following a skin wound, puncture or injury. </p>
<p>Tetanus cannot be transmitted from person to person. </p>
<p>The spores are ubiquitous, found in soil, dust and animal waste. They can <a href="https://www.elsevierhealth.com.au/plotkins-vaccines-9780323357616.html">persist</a> in the environment for months to years, and are remarkably hardy – they’re even resistant to boiling and a number of disinfectants. </p>
<figure class="align-center ">
<img alt="Person gardens in soil with their bare hands" src="https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The bacteria that causes tetanus can remain in soil for years.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/q13Zq1Jufks">Sandie Clarke/Unsplash</a></span>
</figcaption>
</figure>
<p>Once in a wound, the bacteria can grow and produce a toxin. It is the toxin that acts on your nervous system to cause muscle rigidity and painful spasms. </p>
<h2>What are the symptoms?</h2>
<p>One <a href="https://www.uptodate.com/contents/tetanus">classic symptom</a> of tetanus is “lockjaw”, where the muscles around your mouth go into spasms. This makes it difficult to eat and speak but patients maintain full consciousness or awareness. The muscle contractions and spasms are intensely painful and can be triggered by loud noises, physical contact or even light.</p>
<p>Patents with tetanus are commonly treated in an intensive care unit and require cleaning of the wound, antibiotics and injections of anti-toxin, known as human tetanus immunoglobulin, as well as a vaccine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/at-least-five-reasons-you-should-wear-gardening-gloves-89451">(At least) five reasons you should wear gardening gloves</a>
</strong>
</em>
</p>
<hr>
<p>In severe cases, spasms of muscles surrounding your airways and lungs, alongside high and low blood pressure and heart rhythm abnormalities can lead to death. </p>
<p>Despite the best treatment, about <a href="https://link.springer.com/article/10.17269/s41997-022-00732-7#:%7E:text=From%201995%20to%202019%2C%20a,range%3A%2043%E2%80%9393">2</a>-<a href="https://www.gov.uk/government/publications/tetanus-in-england-annual-reports/tetanus-in-england-2021#:%7E:text=tetanus%20is%20a%20severe%2C%20potentially,per%20year%20over%20previous%20years">10</a>% of patients die. </p>
<h2>How does the vaccine work?</h2>
<p>In Australia, tetanus is rare because of high vaccination coverage, with around <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/summary_of_national_surveillance_data_on_vaccine_preventable_diseases_in_australia_2016_2018_final_report.pdf">14 cases</a> reported to health authorities a year.</p>
<p>Tetanus can occur at any age, but is more common in older adults who have never been vaccinated or were vaccinated more than ten years ago. </p>
<p>The vaccine is very effective in preventing tetanus. Tetanus vaccination stimulates the production of antibodies, also known as antitoxin. This means vaccination doesn’t stop <em>Clostridium tetani</em> growing in contaminated wounds. Rather, it protects against the effects of the toxin.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates child" src="https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccination protects you from the effects of the toxin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-doctor-putting-medical-plaster-girl-1921268393">Shutterstock</a></span>
</figcaption>
</figure>
<h2>When do we need a tetanus shot?</h2>
<p>Tetanus vaccination has been available in Australia since <a href="https://www.health.vic.gov.au/immunisation/vaccine-history-timeline">1925</a>. It’s currently on the National Immunisation Program (NIP) as an initial five-dose schedule for infants and children until five years of age, administered as a combined diphtheria-tetanus-acellular pertussis (DTPa) vaccine. </p>
<p><a href="https://doi.org/10.33321/cdi.2022.46.60">Most children</a> (97%) in Australia complete this primary immunisation schedule. </p>
<p>The <a href="https://www.who.int/publications/i/item/WHO-WER9206">level of antitoxin needed</a> for protection from tetanus is 0.1-0.2 international units (IU) per millilitre (mL). This level is <a href="https://pubmed.ncbi.nlm.nih.gov/16822597/">reached</a> following a fifth dose, at age four to six years. </p>
<p>But by middle age, <a href="https://pubmed.ncbi.nlm.nih.gov/30318003/">about 20%</a> of Australians have low or undetectable levels of antitoxin. This places them at risk of contracting tetanus after a wound or injury. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-up-to-date-with-your-vaccinations-116510">Health Check: are you up to date with your vaccinations?</a>
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<p>A single dose of tetanus vaccine produces protective levels of antitoxin in these people. This is why a booster dose of tetanus vaccine is <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/tetanus">recommended</a> for the following people if their last dose was more than ten years ago: </p>
<ul>
<li><p>adults at 50 years of age</p></li>
<li><p>adults aged 65 years or over</p></li>
<li><p>travellers, of any age, to countries where it may be difficult to access timely health services if you sustain a tetanus-prone wound (any wound other than a clean, minor cut).</p></li>
</ul>
<p>If you have a tetanus-prone wound and there is any doubt about your tetanus immunisation status, you should receive tetanus immunoglobulin as soon as possible. You should also receive a tetanus vaccine. </p>
<p>If you’re overseas, it could be hard and expensive to get access to both tetanus immunoglobulin and tetanus vaccine.</p>
<h2>How do I check my vaccination status?</h2>
<p>If you’re over 14 years of age, you can check your vaccine history:</p>
<ul>
<li><p>online, by setting up a myGov account and accessing your Medicare online account through the Express Plus Medicare mobile app</p></li>
<li><p>by calling the <a href="https://www.servicesaustralia.gov.au/australian-immunisation-register">Australian Immunisation Register</a> on 1800 653 809</p></li>
<li><p>by asking your doctor or immunisation provider to <a href="https://www.health.gov.au/topics/immunisation/getting-vaccinated/check-immunisation-history">print a copy</a> of your immunisation records. </p></li>
</ul>
<p>If it has been more than ten years since your last dose, ask your GP about getting a booster. It could save your life.</p><img src="https://counter.theconversation.com/content/203763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood has previously received funding from the NHMRC for a Career Development Fellowship.</span></em></p><p class="fine-print"><em><span>Helen Quinn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tetanus is a rare but potentially fatal disease. Being up to date with tetanus vaccination is your best protection.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyHelen Quinn, Senior Research Fellow, National Centre for Immunisation Research and Surveillance & Senior Lecturer, Children’s Hospital Westmead Clinical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905652022-09-21T13:11:00Z2022-09-21T13:11:00ZCOVID pandemic created immunisation gaps in Africa. Over half a million children are at risk<figure><img src="https://images.theconversation.com/files/485537/original/file-20220920-18-c12wfn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Routine immunisation has resulted in diseases like measles being drastically reduced.</span> <span class="attribution"><span class="source">Laszlo Mates/shutterstock</span></span></figcaption></figure><p>The COVID pandemic exposed the fault lines in health systems and national routine immunisation programmes around the world. </p>
<p>A <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">recent</a> World Health Organization (WHO) report showed that the pandemic fuelled the largest sustained decline in childhood vaccine coverage rates. </p>
<p>These declines threaten to undo the exceptional efforts made in preventing and controlling the devastating burden of vaccine preventable diseases globally. Routine immunisation has prevented <a href="https://ourworldindata.org/vaccination#global-decline-in-vaccine-preventable-diseases">two to three million deaths</a> yearly. Of the lives saved, <a href="https://www.afro.who.int/health-topics/immunization#:%7E:text=Immunization%20currently%20prevents%20over%204,every%20year%20because%20of%20vaccines.">800,000</a> were in the Africa region. Routine immunisation has led to a drastic reduction in diseases like neonatal tetanus and measles. And bacterial meningitis (type A) and polio have virtually been eliminated across the continent. </p>
<p>The repercussions of the pandemic on routine immunisation programmes in the African region are yet to be fully realised. What we do know so far is that the pandemic has resulted in substantial disruptions to national routine immunisation programmes. As a result, the continent is seeing an increased number of outbreaks of vaccine preventable diseases. </p>
<p>African countries had nearly eliminated the deadly form of meningitis type A. But a four-month-long meningitis outbreak was reported in the <a href="https://www.afro.who.int/news/meningitis-outbreak-democratic-republic-congo-declared-over#:%7E:text=Meningitis%20outbreak%20in%20Democratic%20Republic%20of%20the%20Congo%20declared%20over,-24%20December%202021&text=Brazzaville%2FKinshasa%20%E2%80%93%20The%20Democratic%20Republic,and%20205%20deaths%20were%20recorded.">Democratic Republic of Congo</a> in 2021. It accounted for 2,665 cases, claiming 205 lives. This resurgence has been <a href="https://www.voanews.com/a/covid-threatening-resurgence-of-deadly-meningitis-in-africa/6736714.html?s=09">linked</a> with the suspension of meningitis vaccination campaigns at the height of the COVID pandemic. In February 2022, <a href="https://www.afro.who.int/news/malawi-declares-polio-outbreak">Malawi</a> reported its first wild case of poliovirus type 1 in 30 years. A second case followed in <a href="https://www.afro.who.int/countries/mozambique/news/mozambique-confirms-wild-poliovirus-case">Mozambique</a> three months later. The outbreaks sparked <a href="https://doi.org/10.1016/s1473-3099(22)00269-9">mass polio vaccination campaigns</a> across southern Africa. </p>
<p>UNICEF and the WHO have <a href="https://www.who.int/news/item/27-04-2022-unicef-and-who-warn-of--perfect-storm--of-conditions-for-measles-outbreaks--affecting-children">warned</a> of the heightened risk for measles outbreaks, given widening immunisation gaps. </p>
<p>Currently, Zimbabwe is contending with a devastating measles outbreak. Within five months, there have been <a href="https://twitter.com/MoHCCZim/status/1567416772512415744?s=20&t=JslCu5Tki9SCpNLaJXclwg">6,551 confirmed measles cases</a> and <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/zimbabwe-measles-outbreak-death-toll-rises-685-health-ministry-2022-09-03/">704 related deaths</a>. </p>
<p>These emerging outbreaks are a matter of great concern. They call for urgent and sustained public health interventions. Unless these are put in place, the compounding effects of the pandemic could derail regional progress towards the global <a href="https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030">immunisation targets</a> that secure the health and wellbeing of infants and children.</p>
<p>The resurgence of deadly vaccine preventable diseases underscores the importance of maintaining high vaccination coverage rates. Children everywhere must have access to all the recommended lifesaving vaccines they need. The disruptions observed during the COVID pandemic also highlight the importance of establishing resilient health systems. Systems must be able to withstand acute and prolonged shocks while delivering essential health services like immunisation programmes. </p>
<h2>Immunisation before COVID</h2>
<p>It is important to contextualise the performance of routine immunisation programmes within the African region. Even before the pandemic, the African region was already contending with a precarious situation. </p>
<p>For one, an <a href="https://www.afro.who.int/publications/investment-case-vaccine-preventable-diseases-surveillance-african-region-2020-2030">estimated</a> 30.7 million children under five continue to suffer from vaccine preventable diseases. These include rotavirus diarrhoea, pneumonia, pertussis and measles. Of these children, more than 520,000 die each year because of poor access to essential immunisation services. </p>
<p>The continent’s health systems have to manage on average <a href="https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates">150 cases of disease outbreaks and other public health emergencies</a> every year. These range from armed conflicts to climate-related disasters (including flooding, drought, and famine) and disease outbreaks. National routine immunisation programmes have had to function in this context. </p>
<h2>The pandemic widened immunisation gaps</h2>
<p>On the continent the pandemic has substantially disrupted national routine immunisation programmes. In many countries health systems were forced to divert limited resources to combat the pandemic. This often left immunisation services vulnerable. </p>
<p>At the height of the pandemic, <a href="https://doi.org/10.1016/S2214-109X(21)00512-X">several countries reported</a> having to suspend vaccination services. There were disruptions to vaccine supply chains which led to stockouts. The number of people taking up immunisation services declined due to restrictions on public gathering. Many people also feared being exposed to the virus at health facilities. </p>
<p>A good measure of the COVID-related disruptions to immunisation programmes is the coverage of the three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine. The <a href="https://www.who.int/data/gho/data/indicators/indicator-details/GHO/diphtheria-tetanus-toxoid-and-pertussis-(dtp3)-immunization-coverage-among-1-year-olds-(-)">WHO</a> uses the coverage of DTP3 to monitor access to immunisation services and measure the performance of broader health systems. </p>
<p>The <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">WHO report</a> shows that the COVID-19 pandemic contributed to a general decline in DTP3 coverage globally – irrespective of economic power or income level. </p>
<p>In Africa, national immunisation programmes in several countries maintained optimal performance, achieving <a href="https://immunizationdata.who.int/index.html">DTP3 coverage rates above 90%</a>. These included Algeria, Botswana, Burkina Faso, Burundi, Ghana, Kenya, Malawi, Mauritius, Namibia, Sierra Leone, Uganda and Zambia. </p>
<p>Of concern, however, are the 29 countries that recorded coverage of less than 90%, creating substantial immunisation gaps.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485610/original/file-20220920-3689-nsysvx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">DTP vaccine coverage in many African countries was below the WHO’s 90% threshold.</span>
<span class="attribution"><span class="source">Data Source: WHO, https://immunizationdata.who.int/index.html</span></span>
</figcaption>
</figure>
<p>The increased misinformation and disinformation during the pandemic also led to some decline in public trust and confidence in immunisation services. This has significantly affected vaccine demand. </p>
<h2>Charting a way forward</h2>
<p>The pandemic provides useful lessons on the importance of continuously strengthening health systems and “crisis-proofing” national routine immunisation programmes. </p>
<p>COVID-19 has been a catalyst for renewed political interest in immunisation programmes. But this must be followed up with regional solidarity to re-prioritise routine immunisation in the national and regional public health agendas. </p>
<p>National governments will have the responsibility to secure and sustain donor funding while increasing domestic financial commitments that will fill the funding gaps for national immunisation programmes. This is in line with the <a href="https://www.afro.who.int/health-topics/immunization/the-addis-declaration-immunization">declarations they have endorsed</a>. </p>
<p>But most importantly, there’s a need to intensify demand for vaccines and immunisation programmes. This is critical to build back public confidence and trust in vaccines and immunisation services in a post-COVID world.</p><img src="https://counter.theconversation.com/content/190565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edina Amponsah-Dacosta does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The pandemic has disrupted national immunisation programmes. As a result, the African continent is seeing more outbreaks of vaccine preventable diseases.Edina Amponsah-Dacosta, Postdoctoral Research Fellow, Vaccines for Africa Initiative, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1881572022-08-09T18:52:00Z2022-08-09T18:52:00ZNZ children face a ‘perfect storm’ of dangerous diseases as immunisation rates fall<figure><img src="https://images.theconversation.com/files/478217/original/file-20220809-18-orxjcu.jpg?ixlib=rb-1.1.0&rect=15%2C15%2C5226%2C3473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Routine childhood immunisations have dropped so dramatically globally during the COVID-19 pandemic that the World Health Organization and <a href="https://www.unicef.org/press-releases/WUENIC2022release">UNICEF</a> are raising the alarm. </p>
<p>Internationally, <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">25 million children</a> in 2021 alone have missed out on life-saving vaccinations. This is the <a href="https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades">largest sustained drop</a> in childhood immunisation in a generation. </p>
<p>In Aotearoa New Zealand, we are seeing a similarly concerning trend. The decline in childhood immunisation resulting in low overall coverage is now putting our tamariki (children) at real risk of preventable disease, especially with national borders open again.</p>
<p>The country is not alone in suffering collateral damage to normal childhood immunisation programmes due to the COVID-19 pandemic. But while the decline may be worrying, all is not lost. </p>
<h2>Risk of disease outbreaks</h2>
<p>Immunisation coverage at six months of age <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data">has fallen</a> in New Zealand from a high of around 80% in early 2020 to 67% by June 2022, and as low as 45% for Māori. </p>
<p>This is important because immunisation coverage at six months is used as a marker for timely receipt of lifesaving <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/new-zealand-immunisation-schedule">government-funded vaccines</a>, including for whooping cough (pertussis), diphtheria, polio, pneumococcal disease and rotavirus.</p>
<p>For example, <a href="https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/whooping-cough">whooping cough</a> (pertussis), a particularly serious illness for babies, is a very real concern. Aotearoa has seen a <a href="https://surv.esr.cri.nz/PDF_surveillance/PertussisRpt/2019/PertussisReportMay2019.pdf">pertussis resurgence</a> every three to four years, meaning we are due an increase in cases at a time when we also have low vaccine coverage.</p>
<p>Additionally, these declines in immunisation coverage and subsequent risk of infection are especially important to consider now, as international travel picks up.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=572&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=572&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=572&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=719&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=719&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478239/original/file-20220809-16-8awc3f.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=719&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">NZ Ministry of Health</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>The return of ‘old’ diseases</h2>
<p>Polio, a viral disease that can cause paralysis, disappeared from Aotearoa thanks to immunisation, with the Western Pacific region declared <a href="https://www.scielosp.org/pdf/bwho/2000.v78n12/1375-1375/en">polio free</a> in 2000. As some parts of the world have yet to eradicate it, however, we still vaccinate children against polio. </p>
<p>A <a href="https://www.statnews.com/2022/07/29/u-s-polio-case-tied-to-viruses-detected-in-u-k-israel-suggesting-silent-spread">recent case</a> in an unvaccinated young man in New York shows how the virus can travel and re-emerge – even in developed, polio-free countries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diphtheria-is-back-in-australia-heres-why-and-how-vaccines-can-prevent-its-spread-186348">Diphtheria is back in Australia, here's why – and how vaccines can prevent its spread</a>
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<p>Likewise, <a href="https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/diphtheria">diphtheria</a> is a rare but serious disease that causes breathing problems and can also lead to nerve paralysis and heart failure, with 5% to 10% of people with the disease dying. </p>
<p>Until widespread immunisation after the 1940s, diphtheria was a common cause of childhood death, and we haven’t seen it in Aotearoa for decades. But diphtheria has recently been detected in Australia in two unvaccinated children. </p>
<p>With New Zealand’s <a href="https://covid19.govt.nz/international-travel/who-can-enter-new-zealand/">borders fully open</a> since July 31, we run the risk of both these “old” diseases being imported and causing problems for our under-immunised tamariki and their whānau.</p>
<h2>A perfect measles storm</h2>
<p>The significant measles outbreak of 2019 serves as a warning. More than 2,000 <a href="https://www.health.govt.nz/system/files/documents/pages/health-report-measles-review-2020.pdf">people were infected and 700 hospitalised</a>, with the largest case numbers in Auckland.</p>
<p>Fiji, Tonga and Samoa also saw outbreaks, with Samoa <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30053-0/fulltext">particularly devastated</a> by more than 5,000 cases and more than 80 deaths, mostly in young children. </p>
<p>The severity of this outbreak <a href="https://www.health.govt.nz/system/files/documents/pages/health-report-measles-review-2020.pdf">could have been prevented</a> because the combined measles, mumps and rubella (MMR) vaccine is highly effective. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-most-challenging-phase-of-the-omicron-outbreak-is-yet-to-come-but-new-zealand-may-be-better-prepared-than-other-countries-175819">The most challenging phase of the Omicron outbreak is yet to come, but New Zealand may be better prepared than other countries</a>
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<p>But childhood coverage of MMR was not high enough at the time (nor has it been historically), leaving a <a href="https://journal.nzma.org.nz/journal-articles/a-measles-epidemic-in-new-zealand-why-did-this-occur-and-how-can-we-prevent-it-occurring-again">known immunity gap</a> of susceptible teens and young adults. </p>
<p>Significant efforts have since been made to <a href="https://www.health.govt.nz/your-health/healthy-living/immunisation/measles-vaccination">close this gap</a> in MMR coverage, although these have been dwarfed by the COVID-19 vaccination campaign. </p>
<p>The upshot is a potential perfect storm for another measles outbreak, with low MMR coverage worldwide and locally. Measles could “walk” through New Zealand airports and meet under-immunised tamariki and rangatahi (youth). </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1415658657925066755"}"></div></p>
<h2>Prevention as cure</h2>
<p>There is some good news, however. This year we’ve seen the introduction of new initiatives to help manage surges of winter ills, including the government funding influenza vaccines for children aged three to 12. </p>
<p>This is welcome, as influenza crosses our border every year (with the <a href="https://doi.org/10.1038/s41467-021-21157-9">exception of 2020</a> when COVID-19 public health measures, including quarantine and mask wearing, were in force). Because children are often <a href="https://www.influenza.org.nz/children/influenza-disease-vaccination-and-children">considered super-spreaders</a>, vaccination of children can reduce influenza-like illness and related costs in both tamariki and their whānau. </p>
<p>But the message from World Health Organization Director-General Tedros Adhanom Ghebreyesus remains urgent:</p>
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<p>Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhoea. </p>
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<p>In Aotearoa New Zealand, the COVID-19 vaccination experience has also shown how Māori and Pacific community health providers can help reach high vaccination targets – especially when combined with good outreach services, increasing vaccination providers beyond GP clinics, and building the vaccination workforce.</p>
<p>But right now the statistics paint a concerning picture. Low childhood immunisation coverage puts tamariki at risk of <em>many</em> preventable and serious diseases and adds a major burden to the <a href="https://theconversation.com/resurgent-covid-19-flu-and-other-viruses-are-pushing-new-zealands-health-system-to-the-limit-and-now-winter-is-coming-183536">already strained healthcare system</a>. </p>
<p>Prevention must be our top priority. It is better than the best cure, and will protect the health system from overload so it is available for those who need urgent care.</p><img src="https://counter.theconversation.com/content/188157/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Howe receives funding from the Health Research Council. While not the principal investigator she has been involved in research projects funded by GSK and was the first KPS Research Fellow. She works with the Immunisation Advisory Centre as their Research and Policy Analyst.</span></em></p><p class="fine-print"><em><span>Emma Best is as a member of anti-infectives Subcommittee of PHARMAC and holds research grants Health and Research Council. She works as a medical advisor for the Immunisation Advisory Centre </span></em></p><p class="fine-print"><em><span>Dr. Matthew Hobbs receives funding from the New Zealand Health Research Council, Cure Kids/A Better Start National Science Challenge and IStar. He was also previously funded as a researcher by the New Zealand Ministry of Health. </span></em></p>The risk of serious disease outbreaks among NZ children is now very real. Some childhood immunisation rates have dropped from about 80% in early 2020 to 67% by June 2022, and as low as 45% for Māori.Anna Howe, Research Fellow, University of Auckland, Waipapa Taumata RauEmma Best, Senior Lecturer, Department of Child and Youth Health, University of Auckland, Waipapa Taumata RauMatthew Hobbs, Senior Lecturer (Above the Bar) in Public Health and Co-Director of the GeoHealth Laboratory, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847122022-06-23T15:21:43Z2022-06-23T15:21:43ZFive ways the pandemic has affected routine medical care<figure><img src="https://images.theconversation.com/files/470332/original/file-20220622-3398-wbyi4r.jpg?ixlib=rb-1.1.0&rect=13%2C0%2C8661%2C5020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-specialist-discussing-female-patient-his-695918428">Jacob Lund/Shutterstock</a></span></figcaption></figure><p>Since the beginning of the pandemic, COVID has infected at least <a href="https://coronavirus.data.gov.uk/details/cases">a third of the UK population</a> and is estimated to have factored in the deaths of <a href="https://coronavirus.data.gov.uk/details/deaths">almost 200,000 people</a> in the UK. But critically, COVID has also had a devastating impact on our healthcare systems. While this was expected, new evidence is beginning to reveal the scope of the issue – in particular the effects for people living with long-term health conditions.</p>
<p>Here are five ways the pandemic has affected access to routine medical care. </p>
<h2>1. Heart disease</h2>
<p>A <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac227/6594507?login=true">2022 review</a> looked at evidence on the impact of the pandemic on heart disease and care, covering 158 studies across 49 countries.</p>
<p>Across all types of heart disease and all countries studied, there were fewer hospitalisations, treatments and healthcare appointments than before the pandemic. This might seem like a good thing, but actually it means that people delayed seeking medical attention when suffering from heart conditions. Indeed, this review found that the people who made it to hospital were more unwell than patients hospitalised with heart conditions before the pandemic.</p>
<p>The impact was the most severe in low and middle-income countries, where deaths from heart disease in hospital increased. </p>
<h2>2. Diabetes</h2>
<p>Diabetes care and services have been disrupted throughout the pandemic, from new diagnoses to critical screening and treatment programmes. A <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00131-0/fulltext">study</a> published in May 2022 reveals that in England, death rates (excluding deaths caused by COVID) were higher among people with diabetes in 2021 compared with previous years. A recent analysis has linked this to disruptions in routine care caused by the pandemic. </p>
<p>People from the most deprived groups have had poorer outcomes compared with those from more advantaged groups. This plays out globally, too – people with access to sophisticated diabetes technology such as continuous blood glucose monitors appear to have had <a href="https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/dom.14771?campaign=wolacceptedarticle">relatively stable</a> blood sugar levels during the pandemic. But others have experienced serious declines in health and wellbeing, due in part to issues accessing <a href="https://theconversation.com/fewer-diabetes-patients-are-picking-up-their-insulin-prescriptions-another-way-the-pandemic-has-delayed-health-care-for-many-171364">insulin</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/people-whove-had-covid-appear-more-likely-to-develop-diabetes-heres-why-that-might-be-180211">People who've had COVID appear more likely to develop diabetes – here's why that might be</a>
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<h2>3. Immunisation services</h2>
<p>Another <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00512-X/fulltext">recent report</a> brought together data from 170 countries and territories and showed that, compared to pre-pandemic, administration of vaccines for common childhood illnesses declined. Vaccine supply and demand were interrupted, and fewer healthcare professionals were available to deliver vaccines.</p>
<p>People may have also been hesitant to go and get their vaccinations because of fears around contracting COVID. Reductions spanned the different areas the researchers studied, but tended to be largest in lower and middle-income regions.</p>
<p>This introduces the possibility of future vaccine-preventable disease outbreaks, as we saw <a href="https://theconversation.com/how-the-drcs-ebola-crisis-has-led-to-children-dying-from-measles-119946">following disruptions</a> caused by Ebola in parts of Africa. A <a href="https://www.sciencedirect.com/science/article/pii/S2214109X20303089">risk-benefit analysis</a> looking at re-opening vaccination clinics during the pandemic in African countries found that for every death from COVID acquired at the clinic, 84 deaths from vaccine-preventable diseases could be avoided.</p>
<h2>4. Cancer diagnosis and care</h2>
<p>2022 <a href="https://www.cancerresearchuk.org/sites/default/files/cancerpathwaykeystats_jan22.pdf">data</a> from Cancer Research UK shows that cancer care provision declined across all areas. In the first year of the pandemic, one million fewer screening invitations were sent, 380,000 fewer people saw a specialist after an urgent suspected cancer referral, ten times more people were waiting six weeks or more for cancer tests, and almost 45,000 fewer people started cancer treatment. </p>
<p>This isn’t because fewer people had cancer. Cancers were less likely to be picked up, and once picked up, less likely to be promptly treated. By November 2021, cancer waiting time standards in the UK were missed by wider margins than ever before. Significant efforts are underway to rectify this, but there’s still a long way to go. Such disruptions to cancer care have been observed <a href="https://ascopubs.org/doi/full/10.1200/GO.20.00639">across the world</a>.</p>
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<img alt="A doctor gives a child, sitting on his mother's lap, a high five after receiving a vaccination." src="https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470523/original/file-20220623-51579-v1imfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The COVID pandemic has seen fewer routine vaccinations administered.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-child-giving-each-other-high-2003065016">Jacob Lund/Shutterstock</a></span>
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<h2>5. Waiting lists</h2>
<p>Treatment backlogs – of people who should be receiving treatment, but haven’t yet – existed before the pandemic, but the pandemic made them much worse. A <a href="https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2022/02/C1466-delivery-plan-for-tackling-the-covid-19-backlog-of-elective-care.pdf">February 2022 report</a> from the NHS in England showed that 6 million people were on the waiting list for <a href="https://www.nuffieldtrust.org.uk/news-item/elective-care">elective care</a> (care planned in advance, as opposed to emergency care), compared to 4.4 million prior to the pandemic. </p>
<p>This is, of course, not unique to England. In Finland, for example, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253875">elective surgery waiting times</a> have increased by one-third since before the pandemic, even though the rate of elective surgeries increased by one-fifth after lockdown restrictions were lifted.</p>
<p>Delayed treatments, including surgeries, can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834494/">increase preventable deaths</a> and <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00001-1/fulltext">harm wellbeing</a>. Delays in <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hex.13241">receiving healthcare</a> are associated with anxiety, depression and poor quality of life among patients and caregivers.</p>
<h2>What next?</h2>
<p>It will be years until we can say for sure what the impacts of all of these disruptions will be. There is little doubt that they will be devastating on individual, national and global levels. There is also little doubt that some people will be much more affected than others – including those already living with long-term conditions, people from less advantaged backgrounds, and those living in areas with less equitable healthcare systems. </p>
<p>In our third year of the pandemic, prioritisation – of treatments, patients and services – continues to be both complex and necessary, and robust funding and support of healthcare services and staff are more critical than ever. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-nhs-is-having-its-worst-winter-ever-and-the-reasons-run-much-deeper-than-covid-174741">The NHS is having its worst winter ever – and the reasons run much deeper than COVID</a>
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<p>On an individual level, if you’re due for a check-up or vaccine, do your best to ensure you receive it. If you have a worrying symptom, don’t let concerns of contracting COVID stop you from getting it checked out. </p>
<p>On a societal level, we’d do well to remember that the risks from COVID disruptions have not been equally distributed. When we make plans to address and recover from these disruptions, we need to acknowledge that <a href="https://www.goodthingsfoundation.org/insights/digital-exclusion-and-health-inequalities/">digital advances</a> won’t be a solution for all groups, and direct more resources to the people and areas who need them most.</p><img src="https://counter.theconversation.com/content/184712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hartmann-Boyce receives or has received funding from the National Institute for Health and Care Research, the British Heart Foundation, Cancer Research UK, the University of Oxford, and the World Health Organization.</span></em></p>Emerging evidence shows the COVID pandemic has seen fewer people receiving routine medical care across many areas. Here’s what we know about the impact that’s having – and could have down the track.Jamie Hartmann-Boyce, Associate Professor and Director of Evidence-Based Healthcare DPhil Programme, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1775442022-02-23T06:10:48Z2022-02-23T06:10:48ZThe Moderna vaccine is now available for 6 to 11 year olds. Here’s what parents need to know<figure><img src="https://images.theconversation.com/files/447986/original/file-20220223-23-1kqd7qq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-doctor-putting-medical-plaster-girl-1921268393">Shutterstock</a></span></figcaption></figure><p>Australian children aged six to 11 years old will be able to get the Moderna COVID vaccine at pharmacies, GP clinics and vaccination hubs <a href="https://www.abc.net.au/news/2022-02-23/moderna-vaccine-approved-children-six-older/100853112">from tomorrow</a>. </p>
<p>This follows the Therapeutic Goods Administration’s <a href="https://www.tga.gov.au/covid-19-vaccine-spikevax-elasomeran">provisional approval</a> and today’s <a href="https://www.health.gov.au/news/atagi-recommendations-on-the-use-of-spikevax-moderna-covid-19-vaccine-in-children-aged-6-to-11-years">ATAGI</a> (Australian Technical Advisory Group on Immunisation) recommendation for the Moderna vaccine, called Spikevax, to be made available to this age group. </p>
<p>Australia is <a href="https://www1.racgp.org.au/newsgp/clinical/atagi-releases-moderna-guidance-for-children-aged">one of the first countries</a> to approve the use of the Moderna vaccine for children under 12 years old.</p>
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Read more:
<a href="https://theconversation.com/what-is-the-moderna-covid-vaccine-does-it-work-and-is-it-safe-160859">What is the Moderna COVID vaccine? Does it work, and is it safe?</a>
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<p>Until now, the Pfizer vaccine was the only option available for five to 11 year olds.</p>
<p>Moderna eligibility starts at six, so the Pfizer vaccine is still the only COVID vaccine option for kids aged five. </p>
<p>No COVID vaccines are currently available for under-fives and with trials still under way, they’re likely <a href="https://www.afr.com/politics/federal/vaccination-approval-for-under-5s-expected-well-after-easter-20220223-p59yzl">some months away</a>.</p>
<h2>What’s the dose and interval?</h2>
<p>The Moderna vaccine is given at a lower dosage of 0.25ml (50 micrograms) for children under 12 years old. </p>
<p>(Adults are given 0.5ml for their first and second doses, and 0.25ml for a booster.) </p>
<p>Two doses are recommended for five to 11 year olds, with an eight-week interval. </p>
<p>This can be shortened to four weeks for children at risk of severe COVID and in special circumstances such as travelling overseas. </p>
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<img alt="Boy in a masks works at a computer." src="https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448009/original/file-20220223-15-15pb37m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Most children who have the Moderna vaccine will have their doses eight weeks apart.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-wearing-face-mask-learning-home-1676485906">Shutterstock</a></span>
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<h2>How effective is it?</h2>
<p>The Moderna vaccine was trialled in a <a href="https://trials.modernatx.com/study/?id=mRNA-1273-P204">clinical trial called KidCOVE</a>. This trial involved 4,753 children aged six to 11 years and was designed to look at safety and immune responses. </p>
<p>The trial results have not been formally published and only appear in a <a href="https://www.businesswire.com/news/home/20211025005471/en">press release</a>. However, a full clinical dossier will have been submitted to the TGA for its consideration in granting a provisional approval. </p>
<p>The KidCOVE trial found children developed an equivalent level of antibodies to that seen in young adults aged 18 to 25 years. Nearly all participants made antibodies (99.3%) after vaccination. </p>
<p>These results (as detailed in the press release) demonstrate a strong immune response in this group of children one month after the second dose.</p>
<h2>Is it safe?</h2>
<p>The KidCOVE trial also monitored safety. The Spikevax Moderna vaccine was generally well tolerated, with side effects consistent with those in adolescents and adults. </p>
<p>The most common adverse events were fatigue, headache, fever, and injection site pain. </p>
<p>As often occurs in clinical trials, children in the KidCOVE trial will be followed for 12 months after their second injection to assess long-term protection and safety. </p>
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<h2>Should my child get Pfizer or Moderna?</h2>
<p>There is no direct head-to-head comparison available to tell us which vaccine is more effective in the real-world setting in children age six to 11 years. </p>
<p>Both vaccines were shown to be efficacious, but the overall number of cases available for evaluation in both trials was small. </p>
<p>Side effects reported after the Moderna vaccine were mild to moderate and quickly resolved, as did those those reported in the Pfizer trial of five to 11 year olds.</p>
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<strong>
Read more:
<a href="https://theconversation.com/safety-side-effects-allergies-and-doses-the-covid-19-pfizer-vaccine-for-5-11-year-olds-explained-173323">Safety, side effects, allergies and doses. The COVID-19 Pfizer vaccine for 5-11 year olds explained</a>
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<p>But while there is no direct comparison of side effects in a single trial, the available evidence suggests mild to moderate side effects are <a href="https://www.health.gov.au/news/atagi-recommendations-on-the-use-of-spikevax-moderna-covid-19-vaccine-in-children-aged-6-to-11-years">more commonly reported</a> after Moderna. This includes pain at the injection site, swelling and tenderness of lymph nodes in the armpit, fever, headache and nausea.</p>
<p>This may be due to the difference in the amount of antigen content (the substance that produces the immune response) between vaccines. Pfizer contains 10 micrograms, while Moderna contains 50 micrograms.</p>
<h2>What about rare complications?</h2>
<p>Moderna didn’t report any cases of myocarditis or pericarditis (inflammation of the heart muscle or the tissue surrounding the heart) in its clinical trial of 4,700 children. However it’s important to note the sample size of the trial was not large enough to rule out any risk.</p>
<p>Australia’s vaccine monitoring body, AusVaxSafety, has closely <a href="https://ausvaxsafety.org.au/covid-19-vaccines/child-participants">monitored the safety</a> of the Pfizer vaccine in children aged five to 11 years. It found side effects have generally been mild, with pain, swelling, and redness at the vaccination site the most common. </p>
<p>AusVaxSafety and our other surveillance systems will also monitor Moderna vaccine safety in children as it’s rolled out in the coming months, and will closely watch for serious adverse events, including myocarditis and pericarditis. </p>
<p><a href="https://www.theguardian.com/australia-news/datablog/ng-interactive/2022/feb/21/covid-19-vaccine-rollout-australia-vaccination-rate-progress-how-many-people-vaccinated-percent-tracker-australian-states-number-total-daily-live-data-stats-updates-news-schedule-tracking-chart-percentage-new-cases-today">Just under half</a> of Australian primary school-age children have received their first COVID vaccine dose, after becoming eligible on January 10. Parents of children now have another vaccine to consider as we look to protect our community from COVID. Hopefully adding another vaccine choice helps to boost these rates. </p>
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<strong>
Read more:
<a href="https://theconversation.com/is-your-child-frightened-of-needles-heres-how-to-prepare-them-for-their-covid-vaccine-170791">Is your child frightened of needles? Here's how to prepare them for their COVID vaccine</a>
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<img src="https://counter.theconversation.com/content/177544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood received funding from the NHMRC for a Career Development Fellowship from 2018 to 2021. He holds a Churchill Fellowship awarded in 2019. </span></em></p>Parents can now choose Moderna to vaccinate their children against COVID. So how effective is it, and how does it compare with Pfizer?Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733232021-12-09T22:29:53Z2021-12-09T22:29:53ZSafety, side effects, allergies and doses. The COVID-19 Pfizer vaccine for 5-11 year olds explained<figure><img src="https://images.theconversation.com/files/436314/original/file-20211208-137612-19ufg0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mixed-asian-young-girl-showing-her-2013119786">Shutterstock</a></span></figcaption></figure><p>Australian children aged 5-11 will start to receive the Pfizer COVID-19 vaccine <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/tga-provisionally-approves-pfizer-covid-19-vaccine-for-5-to-11-year-olds">from January 10</a>, after it cleared the final regulatory step and was recommended for use in this age group by the <a href="https://www.health.gov.au/resources/publications/atagi-recommendations-on-pfizer-covid-19-vaccine-use-in-children-aged-5-to-11-years">Australian Technical Advisory Group on Immunisation</a> (ATAGI).</p>
<p>ATAGI recommends children aged 5-11 receive two 10 microgram doses (which is one-third of the over-12s dose), eight weeks apart.</p>
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Read more:
<a href="https://theconversation.com/covid-vaccines-for-5-to-11-year-olds-are-inching-closer-heres-what-we-know-so-far-169732">COVID vaccines for 5 to 11 year olds are inching closer. Here's what we know so far</a>
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<h2>What does the trial data say about safety and efficacy?</h2>
<p>The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116298">Pfizer vaccine trial</a> included 2,268 children aged 5-11. Of these children, 1,517 were given two doses of 10 microgram vaccine three weeks apart, and 751 who were given a placebo. The results found the vaccine was safe and had good efficacy. </p>
<p>Children given the vaccine had similar antibody levels after the second dose to older adolescents and young adults (aged 16-25). This indicates their immune system was able to recognise the lower amount of vaccine mRNA – the vital ingredient in the Pfizer vaccine – and still produce a good amount of antibody to protect against the virus. </p>
<p>There were no serious reactions in this trial, however the sample size wasn’t large enough to detect rare adverse events. </p>
<figure class="align-center ">
<img alt="Boy smiles and cuddles his mother after being vaccinated." src="https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436316/original/file-20211208-23-18ubofu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most common side effect is a sore arm.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-boy-mom-getting-vaccine-shot-2000430659">Shutterstock</a></span>
</figcaption>
</figure>
<p>The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116298">most common side effects</a> occurred in the first two to three days and included:</p>
<ul>
<li>painful arm (around 70% at any time in the first week after vaccination but usually in the first few days) </li>
<li>headache (around 25%) </li>
<li>tiredness (around 35%).</li>
</ul>
<p>The vaccine was around 90% effective at preventing confirmed COVID-19 infection, with three COVID cases in the vaccine group and 16 in the placebo group.</p>
<p>Based on this data, the Therapeutic Goods Administration (TGA) <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/tga-provisionally-approves-pfizer-covid-19-vaccine-for-5-to-11-year-olds">provisionally approved the vaccine</a> for use in 5-11 year-old Australians on Sunday, following United States’ Food and Drug Administration (FDA) approval at the <a href="https://www.fda.gov/media/153447/download">end of October</a>. </p>
<h2>How safe and effective has it been overseas?</h2>
<p>Australia has around <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/tga-provisionally-approves-pfizer-covid-19-vaccine-for-5-to-11-year-olds">2.3 million</a> children aged 5-11. So we can look to the real-world experience of the Pfizer vaccine in the US to see what we can expect. </p>
<p>More than <a href="https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-Demographics-in-the-United-St/km4m-vcsb">5 million US children aged 5-11</a> have had one dose and more than 2 million have had a second dose. </p>
<figure class="align-center ">
<img alt="Two children in masks wait by a door." src="https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436315/original/file-20211208-68670-18bege4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The US has administered more than 2 million second doses to 5-11 year olds.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/RYABMCLP7aM">Kelly Sikkema/Unsplash</a></span>
</figcaption>
</figure>
<p>One potential concern authorities are watching out for is the risk of heart inflammation, called myocarditis. This is a rare side effect after the second dose in young males aged 12-17, with an <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-02-12-2021">estimated risk</a> of around ten cases per 100,000. </p>
<p>No cases of myocarditis, or the related condition pericarditis, were reported in the clinical trial of 5-11 year olds.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-benefits-of-a-covid-vaccine-far-outweigh-the-small-risk-of-treatable-heart-inflammation-163970">The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation</a>
</strong>
</em>
</p>
<hr>
<p>No data is yet available on the real world effectiveness of the vaccine to protect against hospitalisation or infection in children aged 5-11, however this will emerge.</p>
<h2>Why an 8 week interval?</h2>
<p>The US, European Union, Canada and Israel have approved Pfizer for younger children. The US has gone with a three week interval between doses, while <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/pfizer-biontech-10-mcg-children-5-11-years-age.html">Canada recommends</a> eight weeks. </p>
<p>There are <a href="https://www.health.gov.au/sites/default/files/documents/2021/12/atagi-recommendations-on-pfizer-covid-19-vaccine-use-in-children-aged-5-to-11-years.docx">two reasons</a> for a wider interval. The first is a <a href="https://www.medrxiv.org/content/medrxiv/early/2021/10/26/2021.10.26.21265397.full.pdf">potentially better immune response</a>. Studies in adults <a href="https://www.medrxiv.org/content/10.1101/2021.07.26.21261140v1">have shown</a> a larger gap between doses has resulted in a higher antibody immune response and better vaccine effectiveness, although this has not been shown yet for children under 12. </p>
<p>The second is a possible lower risk of <a href="https://www.medrxiv.org/content/10.1101/2021.12.02.21267156v1">developing myocarditis</a>. In a Canadian study, young adults aged 18-24 had lower rates of myocarditis when the interval between dose one and two was greater than eight weeks compared to those with an interval of less than 30 days between doses. </p>
<p>While similar data for children under 12 is not yet available, a recommendation for a wider interval allows us to continue to monitor real-world international experience of the risk of myocarditis. </p>
<h2>Who should be first in line to get the vaccine?</h2>
<p>Some children with underlying medical conditions are more likely to get sicker with COVID. This <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780706">includes</a> those with obesity, diabetes, neurological diseases, heart and lung conditions. These children should be among the first to get the vaccine next January.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/it-might-be-uncomfortable-to-talk-about-but-obesity-puts-children-at-risk-of-severe-covid-171116">It might be uncomfortable to talk about. But obesity puts children at risk of severe COVID</a>
</strong>
</em>
</p>
<hr>
<h2>If my child is about to turn 12, should I wait?</h2>
<p>There is no major difference in the immune systems of an 11 and 12 year old. </p>
<p>The age cut-off was chosen based on the ages of the children in the vaccine trials. These age groupings were most likely designed to match the ages children are when they attend primary and high school. </p>
<p>If your 11 year old is about to turn 12, they should get the dose at 11 and not wait. </p>
<figure class="align-center ">
<img alt="Boy in a mask sits in a classroom." src="https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436317/original/file-20211208-159504-1o39w15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your child should get the dose recommended for their age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-schoolboy-writing-notebook-during-class-2018661608">Shutterstock</a></span>
</figcaption>
</figure>
<p>If they had the 10 microgram dose and turn 12 before their second dose is due, ATAGI says they may get a 30 microgram second dose when they are 12.</p>
<h2>How will the vaccine be administered?</h2>
<p>The lower (10 microgram) child’s dose has been packaged in orange-top vials so it doesn’t get confused with the purple- or grey-top (30 microgram) dose vial used for adults. </p>
<p>The vaccine will be given in the child’s upper arm, and you and child will need to wait for at least 15 minutes after vaccination in case of a reaction. </p>
<p>The vaccine will be available through general practices, Aboriginal Health Services, community pharmacies and state and territory clinics. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-your-child-frightened-of-needles-heres-how-to-prepare-them-for-their-covid-vaccine-170791">Is your child frightened of needles? Here's how to prepare them for their COVID vaccine</a>
</strong>
</em>
</p>
<hr>
<p>Your child <a href="https://www.health.gov.au/sites/default/files/documents/2021/12/atagi-recommendations-on-pfizer-covid-19-vaccine-use-in-children-aged-5-to-11-years.docx">can get other vaccines at the same time</a>, if they’re due, but there is very limited data on the side effects when both a COVID and non-COVID vaccine are given at the same time. </p>
<p>If your child has had COVID-19 disease in the past they should still get vaccinated but it is important to make sure they have completely recovered before getting a vaccine. You can wait up to six months after natural infection before getting the vaccine. If in doubt talk with your GP.</p>
<h2>Can my child with allergies still get the vaccine?</h2>
<p>Children who have had an allergic reaction to a substance called PEG (<a href="https://mvec.mcri.edu.au/references/covid-19-vaccines-and-allergy/">polyethylene glycol</a>) – which is a commonly used ingredient of other medications, hand sanitisers, cosmetics and bathroom products – should talk to their GP before getting the vaccine.</p>
<p>If your child has an allergic reaction after the first dose, talk to your GP before getting dose two. </p>
<p>Children who are allergic to foods such as nuts, milk or eggs, or those who have asthma or hay fever, can <a href="https://ncirs.org.au/covid-19/covid-19-vaccines-frequently-asked-questions">safely receive</a> the Pfizer vaccine. </p>
<h2>When will kids under 5 be vaccinated?</h2>
<p>Results from clinical trials in children under five years old are <a href="https://www.theatlantic.com/science/archive/2021/09/pfizer-ceo-vaccine-young-children-2-4/620236/">expected soon</a>.</p>
<p>A lower dose of 3 micrograms of the Pfizer vaccine is being trialled in <a href="https://clinicaltrials.gov/ct2/show/NCT04816643?term=Pfizer+children+under+2+years&cond=COVID-19&draw=2&rank=2">children aged six months to two years</a>. </p>
<p>Moderna is also <a href="https://trials.modernatx.com/study/?id=mRNA-1273-P204">trialling lower doses of its vaccine</a> in children under five. </p>
<p>Vaccinating 5-11 year-old Australian children is is an important next step in our ability to protect both ourselves and the community against COVID-19. The safety of the vaccines will be closely monitored as we roll them out in January and aim to give first doses before children go back to school.</p><img src="https://counter.theconversation.com/content/173323/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship. He holds a Churchill Fellowship</span></em></p>The Pfizer COVID-19 vaccine will be available for children aged 5-11 from January 10, after it cleared the final regulatory step. Here’s what you need to know.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1707912021-12-04T23:25:41Z2021-12-04T23:25:41ZIs your child frightened of needles? Here’s how to prepare them for their COVID vaccine<figure><img src="https://images.theconversation.com/files/433869/original/file-20211125-15-199cuvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccinating-child-174165788">Shutterstock</a></span></figcaption></figure><p>Your child’s experience of needles in their early years may <a href="https://pubmed.ncbi.nlm.nih.gov/7636457/">impact how they feel</a> about and react to subsequent vaccinations. So it’s important to reduce the chance of a negative experience. </p>
<p>But what can parents do to help prepare their child for the COVID-19 Pfizer vaccine or other injections?</p>
<h2>Fear or phobia?</h2>
<p>Most children <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.13818">are fearful of needles</a>. But for some children, this fear is more serious and can be defined as a needle phobia. </p>
<p>Needle phobia is a very scary and distressing response to the presence of or reaction to a needle, for example, to take blood or have an injection. The anxiety and fear are out of proportion to the threat, and people will avoid needles as much as possible. </p>
<p>In severe cases, the level of anxiety caused by just the sight of a needle may result in feelings of dizziness, nausea, increased sweatiness, loss of consciousness, and fainting.</p>
<p>Almost <a href="https://journals.sagepub.com/doi/full/10.1177/2377960818759442">one in five</a> children (19%) aged 4-6 have a needle phobia, and this decreases to one in nine (11%) by age 10-11. Among adults, <a href="https://journals.sagepub.com/doi/full/10.1177/2377960818759442">about 3.5-10%</a> have a needle phobia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needle-phobia-could-be-the-cause-of-10-of-covid-vaccine-hesitancy-in-the-uk-new-research-162678">Needle phobia could be the cause of 10% of COVID vaccine hesitancy in the UK – new research</a>
</strong>
</em>
</p>
<hr>
<p>Working as a nurse, I still remember Emma, a five-year old girl, who was petrified of needles. I recall her little face, the anger and fear, the tears and screams just at the sight of a needle. </p>
<p>Her <a href="https://www.routledge.com/Clinical-Applications-of-the-Therapeutic-Powers-of-Play-Case-Studies-in/Prendiville-Parson/p/book/9780367341091">increasing fear</a> was due to previous blood tests, injections, and other medical procedures. And it didn’t get any easier until she got some professional play therapy help. </p>
<h2>Reducing the chance of a negative experience</h2>
<p>When booking vaccination appointments, consider asking the nurse to set aside extra time to prepare. </p>
<p>When children come for a vaccination, most nurses anticipate the child may be concerned and nervous, or very frightened of an injection. </p>
<p>Nurses may help by asking the child to tense and relax their muscles to prevent fainting. They may suggest taking a deep breath, holding it and breathing out slowly. They may also ask the child to wiggle their toes to provide some distraction. </p>
<figure class="align-center ">
<img alt="Worried girl sits on her mother's lap, looking at a tablet." src="https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433881/original/file-20211125-17-tlqa1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distraction can help take the child’s mind off it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-girl-her-mother-wearing-protective-1858030414">Shutterstock</a></span>
</figcaption>
</figure>
<p>If the child is obviously distressed – for example, screaming, kicking and saying they don’t want it – parents can postpone the needle so the child has an opportunity to develop some coping strategies. This could potentially prevent a needle phobia from developing. </p>
<p>Parents are the best advocates for their child and know how to support them during their immunisations. </p>
<h2>How can you prepare your child?</h2>
<p>The first step is to consider when to give your child information about the vaccine. For children under five years, a shorter time frame works better; for example, the same day. </p>
<p>For children five to six years, you might tell them up a day or two before; and for those seven years, up to a week before. </p>
<figure class="align-center ">
<img alt="Little boy plays with stuffed toys wearing face masks." src="https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433880/original/file-20211125-25-1rtdt0x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Think about timing, based on your child’s age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-plays-roleplaying-games-baby-bay-2046114410">Shutterstock</a></span>
</figcaption>
</figure>
<p>But if your child has a needle phobia, they may need significant help in a safe environment to play out their thoughts and feelings, and learn some stress management strategies. </p>
<h2>Getting help from therapists</h2>
<p>Qualified play therapists, child life therapists and child psychologists can help. After building a trusting relationship with the therapist, medical play therapy sessions involve role-playing scenarios to desensitise the child to medical equipment. </p>
<p>This often starts with toy medical equipment and moves towards more authentic medical equipment. </p>
<p>The therapist provides information to the child by showing them how things work. The child may then develop mastery by injecting their doll or teddy, while the therapist provides cues for coping strategies and resiliency. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fear-of-needles-could-be-a-hurdle-to-covid-19-vaccination-but-here-are-ways-to-overcome-it-139029">Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it</a>
</strong>
</em>
</p>
<hr>
<p>Some children need one or two sessions, but those with a needle phobia may require up to ten sessions or more. </p>
<p>Therapists can also teach parents skills to support their child during a needle or other medical procedure. </p>
<h2>Using play therapy techniques at home</h2>
<p>Introduce some pretend medical equipment toys to your child’s playtime and notice if they’re curious or avoid them.</p>
<p>If they’re curious and seek more information, show and tell them about their upcoming vaccine and why they need it. You might say, for instance, it will help to stop them, and lots of other people, from getting the coronavirus, including their grandparents. </p>
<p>Children are aware from media and school that COVID has forced people to stay at home because it made many people sick, and they couldn’t breathe properly. You might explain that protection from the vaccine will help them stay at kinder or school and see their friends.</p>
<figure class="align-center ">
<img alt="Child practices vaccinating a doll." src="https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433879/original/file-20211125-17-hr39iw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">See how your child responds to medical toys.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-child-makes-injection-wooden-syringe-1994012915">Shutterstock</a></span>
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</figure>
<p>For the child who avoids playing with the medical toys, distraction techniques may help. Consider introducing a new toy or object that can hold the child’s attention immediately before and during the injection. This might be sensory fidget toys, I-spy books, digital games or apps.</p>
<h2>What tools do play therapists use?</h2>
<p>For Emma, after developing a therapeutic play relationship, I introduced and practised the <a href="https://www.youtube.com/watch?v=cyApK8Z_SQQ">Magic Glove Technique</a>. For children with good imaginations, they can learn to relax and pretend they have a <a href="https://doi.org/10.1111/j.1460-9592.2012.03860.x">magic invisible glove</a> that makes their arm – and themselves – feel calm and relaxed. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/cyApK8Z_SQQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Leora Kuttner practising the magic glove technique.</span></figcaption>
</figure>
<p>For other children, I have used <a href="https://www.buzzy4shots.com.au/">Buzzy</a>, a mechanical vibrating device that looks like a bee, developed by American physician and pain researcher Amy Baxter. It has a cold pack and the vibration <a href="https://www.buzzy4shots.com.au/pages/buzzy-research-clinical-trials">inhibits the sensation of pain</a>.</p>
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Read more:
<a href="https://theconversation.com/needles-are-nothing-to-fear-5-steps-to-make-vaccinations-easier-on-your-kids-153639">Needles are nothing to fear: 5 steps to make vaccinations easier on your kids</a>
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<p>If your child has a negative experience during their vaccination, and you’d like to access professional help, ask your GP for suggestions of local <a href="https://appta.org.au/">play therapists</a> or <a href="http://childlife.org.au/">child life therapists</a> or child psychologists in your area.</p><img src="https://counter.theconversation.com/content/170791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Judi Parson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australia’s regulator has approved the Pfizer COVID vaccine for 5-11 year olds, with the rollout expected to start on January 10. Here’s how to prepare your child if they’re fearful of needles.Judi Parson, Senior Lecturer, Child Play Therapy, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1689472021-10-06T14:18:09Z2021-10-06T14:18:09ZCombating COVID-19 anti-vaxxers: lessons from political philosophy<figure><img src="https://images.theconversation.com/files/424223/original/file-20211001-22-1otz9lz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Challenging the scepticism and resistance in the public response to the COVID-19 vaccine is deeply important to the state of public health. This is a critical conversation because people are protesting the COVID-19 vaccines not just in South Africa, but globally too. </p>
<p>As a teacher of political philosophy, I think it’s important to dispel the notion that the call to vaccinate is an infringement on acceptable liberal freedoms. </p>
<p>Based on a significant number of years of studying, reading and teaching the works of the world’s most important philosophies, I am of the view that the anti-vaxxer position that being “forced to take the vaccine is an infringement on their liberal rights” is a misinformed stance. </p>
<p>Through a liberal lens that looks at <a href="https://www.open.edu/openlearn/history-the-arts/culture/philosophy/two-concepts-freedom/content-section-3.3">positive freedom</a> versus <a href="https://plato.stanford.edu/entries/liberty-positive-negative/">negative freedom</a>, I want to show how taking the vaccine essentially creates positive (or nett) freedom. Anti-vaxxers against the COVID-19 vaccine may be considered selfish by demanding freedom in an absolute sense. Negative freedom supports the idea that there should be no restrictions or boundaries on any free activity. This can become incredibly problematic when it comes to public health.</p>
<p>For example, think of restricting where people can smoke. These are in place to ensure that the majority of people (non-smokers) are protected from the risks associated with passive smoke inhalation.</p>
<p>In a similar vein, anti-vaxxers should perhaps be reprimanded and regulated for not willingly taking the COVID-19 vaccine. The ethical focus is to promote universal immunisation and positive freedom for everyone in society.</p>
<p>The liberal philosophies that we might use to challenge the “anti-vaxxer’s freedom to choose” position are <a href="https://philpapers.org/rec/BENITT">Jeremy Bentham’s (1789) Utilitarianism</a>, <a href="https://plato.stanford.edu/entries/mill-moral-political/">JS Mill’s (1859) Harm Principle</a> and <a href="https://www.jstor.org/stable/3877074">Isiah Berlin’s (1969) reflections on Positive Freedom</a>. </p>
<p>This trajectory of liberal thought over the last 200 years is pivotal to the development of the liberal democratic freedoms we experience today. Let’s unpack the theories a little more.</p>
<h2>What the philosophers have to say</h2>
<p>Let me start by addressing the philosophical dilemma of the anti-vaxxer’s “freedom to choose”.</p>
<p>The need to maintain individual freedoms is the most important mandate of the modern liberal state. </p>
<p>Today’s liberal democratic understanding of freedom (with acceptable restraint) was an idea first conceived over 200 years ago. In political philosophy, Jeremy Bentham’s (1789) Utilitarianism suggests that policies should be created to provide the greatest amount of felicity (or happiness) for the largest portion of society. </p>
<p>This forms the crux of the conversation surrounding COVID-19 vaccinations. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">South Africa's immunisation record risks being dented by anti-vaccination views</a>
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<p>Presently, it is understood that for the sake of public health and the “common good”, all citizens should take one of the certified COVID-19 vaccinations. The reason for this is that it will create a greater nett freedom for everyone in that given society. </p>
<p>The alternative is absolute and unrestrained freedom not to vaccinate, which puts pressure on our common freedoms and could prolong lockdown measures.</p>
<p>Continuing this theme on a positive application of freedom, J.S. Mill (1859) provides us with a sophisticated ethical proposition, the <a href="https://www.cambridge.org/core/journals/utilitas/article/john-stuart-mills-harm-principle-and-free-speech-expanding-the-notion-of-harm/F1D77D5D5F9A4B8AA3BAD4058A9708B4">Harm Principle</a>. This principle suggests simply that we should be free to pursue our individual will, as long as it does not cause harm to someone else. </p>
<p>Whereas it may be an indirect influence, this principle nestles neatly into the ethical position held by many laws and policies passed in liberal democratic societies.</p>
<p>Many countries, including South Africa, have used it in public smoking legislation for instance, by regulating smokers to confined areas in public so that they do not bring harm to non-smokers.</p>
<p>This leads us to ask the same questions about the freedom of movement of unvaccinated people in public. It is unquestionable that someone who refuses the COVID-19 vaccine could effectively bring harm to their broader community. The science is clear on this, crowded hospitals all over South Africa are reporting that almost all COVID-19 related hospitalisations are presently coming from the unvaccinated portion of society. This creates a further detriment to the implementation of positive freedom in society.</p>
<p><a href="https://plato.stanford.edu/entries/berlin/">Isaiah Berlin</a>’s (1969) thoughts on positive freedom best diagnoses the dilemma of the anti-vaxxer, as it allows us to ponder their desire for the unrestrained “freedom to choose”. </p>
<p>Absolute and unrestrained freedom is also known by theorists as negative freedom. While negative freedom may sound enticing, it could be severely detrimental to society and communities if applied strictly. It is acceptable in a progressive society that we accept limitations on our freedom, so as not to infringe on the freedoms of others. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/compulsory-covid-19-vaccination-in-nigeria-why-its-illegal-and-a-bad-idea-167396">Compulsory COVID-19 vaccination in Nigeria? Why it's illegal, and a bad idea</a>
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<p>It is important then to convey that the verifiable science on vaccines should not be politicised further.</p>
<p>There is also a link to be made between the African communitarian philosophy of <a href="https://theconversation.com/what-archbishop-tutus-ubuntu-credo-teaches-the-world-about-justice-and-harmony-84730">Ubuntu</a> (Humaneness) and positive freedom. Ubuntu remains somewhat of a clichéd call to civic nationalism and the fostering of a mutual help society in a fractured South Africa. </p>
<p>However, the isiZulu phrase, <em>Umuntu ngumuntu ngabantu</em>, (I am, because we are) proves an important building block in society. “I am because we are” simply implies that: I am part of my community, where the good I do reflects back onto the society. This can be incredibly significant in the face of vaccine scepticism and anti-vaccination ideas. </p>
<p>South Africans in particular should heed the call of Ubuntu to mobilise toward vaccination, as it advocates for the “common good” and encourages communitarian benefits for broader society. This in turn promotes positive freedom.</p>
<h2>What it adds up to</h2>
<p>There are many debates to be had in an evolving society where freedom of speech and choice will take centre stage. But, in my view, the COVID-19 vaccination shouldn’t be one of them. Armed with ideas such as utilitarianism and the harm principle, the application of positive freedom might see many liberal democracies eventually prohibit the anti-vaxxer’s spread of misinformation and protests against vaccination.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-covid-19-vaccines-should-be-mandatory-in-south-africa-165682">Why COVID-19 vaccines should be mandatory in South Africa</a>
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<p>It is imperative that citizens are made to understand that this is a matter of public health, the science is verifiable, and that 99.9% of the global medical community backs the rollout of the COVID-19 vaccine. </p>
<p>Hence, getting vaccinated is for the “common good” of society and promotes the more desirable aspects of positive freedom.</p>
<h2>There is no time to delay</h2>
<p>South Africa is a tinderbox for COVID-19 outbreaks and potential virus mutation. Embracing positive freedom’s emphasis on utility and minimising harm, while emphasising the communitarian benefits of vaccinating, provides a clear imperative for action. </p>
<p>The country needs to vaccinate as quickly as possible so that its people can return to some semblance of normal life. A life where all can freely pursue their goals, remaining mindful that freedom without reasonable restraint will inevitably bring harm to others.</p><img src="https://counter.theconversation.com/content/168947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giovanni Poggi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many countries, including South Africa, use regulations to control smoking in public so that they do not harm non-smokers. Likewise, getting vaccinated is for the common good of society.Giovanni Poggi, Lecturer in Political Science, Nelson Mandela UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1651922021-07-29T05:52:46Z2021-07-29T05:52:46ZShould pregnant women have a COVID vaccine? The evidence says it’s safe and effective<figure><img src="https://images.theconversation.com/files/413653/original/file-20210729-23-1dmwp3q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-asian-woman-medical-mask-1752875924">Shutterstock</a></span></figcaption></figure><p>Having a baby brings enough stress and uncertainty without having to deal with a pandemic. Added to that is the difficult <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy-covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregna_0.pdf">decision to have a recently developed vaccine</a> or not.</p>
<p>Last week, pregnant women of all ages were added to Australia’s <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/priority-groups-for-covid-19-vaccination-program-phase-1b_1.pdf">priority phase 1b</a> of the COVID vaccine rollout. Pregnant women are <a href="https://www.abc.net.au/news/2021-07-23/pregnant-women-eligible-pfizer-covid-vaccine/100318792">now eligible</a> for Pfizer. </p>
<p>But some are unclear if they should get vaccinated. Our survey (still ongoing) of 519 women who had a baby 12 months ago asked their <a href="https://www.facebook.com/birthinthetimeofcovid">intention to be vaccinated</a>. We found 62% said they would, 12% wouldn’t and 26% were unsure, mainly due to fears over safety during pregnancy and breastfeeding.</p>
<p>Increasingly, international evidence supports the safety of COVID vaccines for pregnant women and demonstrates it is effective at preventing severe disease. Here’s what it says so far.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/generation-covid-pregnancy-birth-and-postnatal-life-in-the-pandemic-160644">Generation COVID: pregnancy, birth and postnatal life in the pandemic</a>
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</em>
</p>
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<h2>What does the new advice say?</h2>
<p>The peak medical body for Australian obstetricians and gynaecologists recently updated its advice in a <a href="https://www.health.gov.au/news/joint-statement-between-ranzcog-and-atagi-about-covid-19-vaccination-for-pregnant-women">joint statement</a> with the Australian Technical Advisory Group on Immunisation <a href="https://www.health.gov.au/committees-and-groups/australian-technical-advisory-group-on-immunisation-atagi">(ATAGI)</a>, the government’s vaccine advisory group. </p>
<p>The two groups recommend:</p>
<blockquote>
<p>pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy […] because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.</p>
</blockquote>
<p>There are also other benefits. During pregnancy, antibodies that pass through the <a href="https://pubmed.ncbi.nlm.nih.gov/33983379/">umbilical cord</a> may offer protection to the baby. We don’t know how long this protection lasts.</p>
<p>The statement also recommends breastfeeding women should get vaccinated. Evidence suggests <a href="https://www.ajog.org/article/S0002-9378(21)00187-3/fulltext">antibodies</a> pass to the baby through <a href="https://www.ajog.org/article/S0002-9378(21)00187-3/fulltext">breastmilk</a> and may protect the baby.</p>
<h2>Why the change?</h2>
<p>The main reason the advice has changed is new data from recently published studies. </p>
<p>A study from the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2104983">United States</a> of 827 pregnant women who had mRNA vaccines such as Pfizer, mostly in their third trimester, found no safety concerns. </p>
<p>The rates of miscarriage (12.6%), stillbirth (one baby), preterm birth (9.4%) small babies (3.2%) and abnormalities in the baby (2.2%) were similar to what would be expected in an unvaccinated group of women. </p>
<p>This study is still under way and includes nearly 4,000 pregnant women in total, many of whom were yet to give birth when this paper was published. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-the-covid-19-vaccine-while-pregnant-or-breastfeeding-experts-explain-the-safety-evidence-and-clinical-trials-164144">Should I get the COVID-19 vaccine while pregnant or breastfeeding? Experts explain the safety, evidence and clinical trials</a>
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<p>In July, a paper <a href="https://jamanetwork.com/journals/jama/fullarticle/2782047?fbclid=IwAR2QQauMrXVfRd9CTcFuUhDuKc2jWzk8M0GYeNMYZvXwPoaD7Y7TkdSBrgg">from Israel</a> looked at 7,530 pregnant women who were vaccinated and 7,530 unvaccinated pregnant women.
Rates of COVID were higher among unvaccinated pregnant women (202) than vaccinated pregnant women (118).</p>
<p>Of the pregnant women who were vaccinated, 68 reported possible vaccine-related side effects, such as headache, body aches, pain at the injection site, but none were severe or prolonged or different to non-pregnant people. There was no difference in any other pregnancy outcomes. </p>
<figure class="align-center ">
<img alt="Pregnant woman in a mask rolls up her sleeve to be vaccinated." src="https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413669/original/file-20210729-13-4fcndy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The research so far hasn’t detected any safety concerns.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-giving-covid-19-coronavirus-vaccine-1961087548">Shutterstock</a></span>
</figcaption>
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<h2>What about clinical trials?</h2>
<p>The studies above looked at what was happening in <a href="https://crcaustralia.com/media-releases/real-world-data/">real world data</a>, rather than testing the vaccine in trials, where people don’t know if they got the vaccine or a placebo (disguised as a vaccine).</p>
<p>Pregnant women are often excluded from vaccine trials. This is because vaccinating pregnant women has the potential to affect both mother and baby, and testing medications on them rightly makes us nervous. </p>
<p>But while <a href="https://www.sciencedirect.com/science/article/pii/S0890623821000800">animal studies</a> of COVID vaccines show no fertility or pregnancy effects, we need more than mouse models to test safety and efficacy in humans. Calls are therefore <a href="https://www.derby.ac.uk/blog/protecting-or-harming-the-exclusion-of-pregnant-women-from-the-covid-19-vaccine-trials/">growing</a> for pregnant women to be involved in trials. </p>
<p><a href="https://www.globenewswire.com/news-release/2021/02/18/2178392/0/en/Pfizer-and-BioNTech-Commence-Global-Clinical-Trial-to-Evaluate-COVID-19-Vaccine-in-Pregnant-Women.html">One such trial of Pfizer</a> involving pregnant women is currently under way but only started in February this year so data won’t be available yet. </p>
<h2>Real world data from the UK and US</h2>
<p>In the UK, the professional bodies for midwives, <a href="https://www.rcog.org.uk/en/news/covid-unlocking-will-create-perfect-storm-for-pregnant-women-say-maternity-colleges/">obstetricians and gynaecologists</a> have expressed concern about the effect easing restrictions will have on pregnant women. </p>
<p>Around <a href="https://www.bbc.com/news/health-57840159">58% of pregnant women in the UK</a> have declined the vaccine. The main reason for declining is <a href="https://www.rcog.org.uk/en/news/covid-unlocking-will-create-perfect-storm-for-pregnant-women-say-maternity-colleges/">waiting for more evidence</a> to reassure them it’s safe for their baby.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pregnant-women-at-increased-risk-of-severe-covid-new-study-156813">Pregnant women at increased risk of severe COVID – new study</a>
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<p>One in ten pregnant women <a href="https://www.rcog.org.uk/en/news/covid-unlocking-will-create-perfect-storm-for-pregnant-women-say-maternity-colleges/">admitted to hospital with COVID symptoms</a> in the UK go to intensive care. These women are more likely to have a baby born early (preterm), develop high blood pressure, need a caesarean during labour and become very ill, particularly after 28 weeks.</p>
<p>More than 100 pregnant women <a href="https://www.rcog.org.uk/en/news/covid-unlocking-will-create-perfect-storm-for-pregnant-women-say-maternity-colleges/">have been admitted</a> to hospital in the UK in the past couple of weeks with COVID; none had received both doses of the vaccine and five had one dose. </p>
<figure class="align-center ">
<img alt="Hospital trolley in a corridor." src="https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=428&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=428&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413672/original/file-20210729-23-19od5bb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=428&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unvaccinated pregnant women are more likely to be admitted to hospital than those who have been immunised.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/empty-hospital-hallway-611606933">Shutterstock</a></span>
</figcaption>
</figure>
<p>Meanwhile in the US, <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafepregnancyregistry.html">more than 130,000 pregnant women</a> have received a COVID vaccine to date, and the data so far is reassuring. Side effects such as getting a sore arm or headache or feeling tired are common but don’t appear to affect the pregnancy.</p>
<h2>What else do pregnant women need to know?</h2>
<p>The Pfizer vaccine is recommended in Australia for pregnant women and doesn’t contain live coronavirus or additional ingredients harmful to pregnant women. </p>
<p>It’s now one of three vaccines offered in pregnancy, along with the whooping cough (pertussis) and influenza vaccines. </p>
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Read more:
<a href="https://theconversation.com/vaccines-to-expect-when-youre-expecting-and-why-50587">Vaccines to expect when you're expecting, and why</a>
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<p>Pregnant women are <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/">higher risk of becoming very unwell</a> with COVID-19 if they:</p>
<ul>
<li>have underlying medical issues such as high blood pressure, diabetes, asthma, heart disease, immune problems</li>
<li>are overweight</li>
<li>are over 35 years of age</li>
<li>in their final trimester. </li>
</ul>
<p>So getting vaccinated before 28 weeks will offer protection for mother and baby in the riskiest time. </p>
<p>If you are pregnant, keep in mind no vaccine is 100% effective, so it’s important to continue social distancing, wearing masks when needed, and keeping up good hand hygiene.</p>
<p>The decision to get vaccinated as a pregnant woman is not an easy one. The decision should be the woman’s and that decision <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy-covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregna_0.pdf">should be informed</a> and free of pressure or misinformation.</p><img src="https://counter.theconversation.com/content/165192/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The international evidence so far shows COVID vaccines are safe for pregnant women and effective at preventing severe disease.Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647332021-07-21T15:02:24Z2021-07-21T15:02:24ZVaccine hesitancy has risen in Ghana: a closer look at who’s worried<figure><img src="https://images.theconversation.com/files/411994/original/file-20210719-15-1c2rixg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine confidence is essential if the pandemic is to be brought under control</span> <span class="attribution"><span class="source">Wikimedia Commons</span></span></figcaption></figure><p>The COVID-19 pandemic <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---13-july-2021">continues apace</a>, with high- and lower-income settings struggling to contain outbreaks. The vaccine rollout is relatively speedy in some countries such as the UK. However, vaccine demand is much greater than supply. This, combined with the hoarding of surplus doses from high-income countries, means that the continent of Africa is left with very few doses to protect its countries’ populations.</p>
<p>As of 13 July 2021, <a href="https://ourworldindata.org/covid-vaccinations">Our World in Data</a> report that only 2.95% of the African population had received one dose of a COVID-19 vaccine. In <a href="https://ourworldindata.org/coronavirus/country/ghana">Ghana</a>, this figure is just 2.8%.</p>
<p>West Africa has handled the pandemic response <a href="https://gh.bmj.com/content/6/5/e004762">relatively well thus far</a>, with lessons learned from the 2014/15 Ebola outbreak. However, with the highly transmissible Delta variant <a href="https://twitter.com/DSD_GHS/status/1407472131022151685">now known to be present</a> in Ghana, the vaccine rollout is arguably more important than ever. The Ghanaian population has very little immunity to this novel coronavirus, and is thus almost entirely susceptible to infection. It is essential that people accept vaccines when doses arrive in the country. </p>
<p>As we know from existing <a href="https://www.who.int/polio-transition/documents-resources/best-practices-microplanning-entire-population.pdf?ua=1">international guidance</a>, vaccine acceptance requires time, laborious engagement, planning and monitoring to be successful. In 2019, before the pandemic, the World Health Organisation <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">described vaccine hesitancy</a> as one of the top ten greatest threats to global health. </p>
<p>Much of the existing literature and knowledge focuses on the richer countries, but the scenarios faced in Ghana may be very different. Previous research <a href="https://royalsocietypublishing.org/doi/10.1098/rsos.201199">has suggested</a> there are differences in types of misinformation across countries and continents.</p>
<p>Also, a false sense of confidence may emerge because Ghana has a long history of <a href="https://www.gavi.org/delivering/ghana">successful mass vaccination campaigns</a>, for example pneumococcal and rotavirus vaccines. COVID-19 is different in that it is driven by a novel emerging pathogen, and the knowledge base is rapidly evolving. The general public know the impact on quality of life of existing vaccine-preventable diseases like polio. But the strength of Ghana’s infrastructure and health workforce is up against widespread misinformation about this novel pathogen. </p>
<p>Our multi-disciplinary team from Ghana, Togo and the UK has conducted <a href="https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851">surveys</a> in Ghana repeatedly over time. We focused on COVID-19 and assessed trends between August 2020 and June 2021, key drivers of willingness to vaccinate, and vaccine hesitancy. </p>
<h2>The key findings</h2>
<p>The first survey was conducted in August 2020 before any COVID-19 vaccines had been approved. The second round was in March 2021 at a time when the Oxford AstraZeneca vaccines had arrived in the country. Hesitancy significantly decreased between those two time points – from 36.8% to 17.2%. </p>
<p>Our new <a href="https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851">report</a> includes findings from the latest survey, which took place in June 2021, and includes 1,295 Ghanaian respondents. We saw a significant decrease in willingness, and therefore an increase in hesitancy – from 17.2% to 28.5%. Within this 28.5% subgroup, 15.1% reported that they were undecided, and 13.4% indicated they would not accept the vaccine if offered. Both of these proportions had increased since the previous survey in March.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=213&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=213&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=213&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=268&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=268&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411886/original/file-20210719-23-1f9cp4p.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=268&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Percentage of Ghanaian willingness to receive vaccine.</span>
<span class="attribution"><span class="source">Author</span></span>
</figcaption>
</figure>
<p>Around one-third of respondents had read stories (for example on <a href="https://edition.cnn.com/2021/04/08/health/astrazeneca-covid-vaccine-blood-clots-explainer-cmd-gbr-intl/index.html">CNN</a>) about the indecision surrounding the Oxford AstraZeneca vaccine in Europe and North America on social media. Worryingly, a high proportion of respondents suggested that these stories made them feel concerned about accepting a COVID-19 vaccine in the future. COVID-19 will always be a global problem that requires international collaborations and solutions. Thus, the actions of a few countries can easily have an impact beyond their borders, and this may be what we are witnessing here with observed hesitancy in Ghana. </p>
<p>We found the groups more likely to be hesitant were women, Christians, opposition party supporters and people with higher education. </p>
<p>Research in higher-income settings often shows that <a href="https://www.mdpi.com/2076-393X/9/6/593">more years of education</a> correlates with stronger vaccine confidence. But in other research covering African nations, there is a <a href="https://afrobarometer.org/sites/default/files/publications/Dispatches/ad432-covid-19_vaccine_hesitancy_high_trust_low_in_west_africa-afrobarometer-8march21.pdf">mixed set of findings</a> regarding education status. It may be that younger urban populations are more likely to be educated and also have access to the internet, and thus be exposed to a mixture of good and bad information about vaccines. There may also be different voting patterns in younger education groups that affect level of trust in government messaging. </p>
<p>In Togo, we <a href="https://figshare.com/articles/journal_contribution/Examining_determinants_of_COVID-19_vaccine_hesitancy_in_Togo/14805765">carried out</a> one survey in January 2021. Hesitancy was higher than in Ghana – at 32.3%. The two main reasons provided were that the vaccines were dangerous (stated by 90% of the hesitant respondents) and that they did not trust the current government (40% of the hesitant respondents). </p>
<p>Considering the results across Ghana and Togo, there is a clear need for strong health promotion ahead of any future arrivals of vaccine doses. It is difficult to push good public health messages through the noise of uncertainty, misinformation, and outright conspiracy theories. For maximum impact, the information must come from trusted sources, and this may differ depending upon the receiving demographic. </p>
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<strong>
Read more:
<a href="https://theconversation.com/low-trust-in-authorities-affects-vaccine-uptake-evidence-from-22-african-countries-161045">Low trust in authorities affects vaccine uptake: evidence from 22 African countries</a>
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<h2>Approaches to health messaging</h2>
<p>Our results show that, generally, the Ghana health service is a <a href="https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851">highly trusted source</a>. Many respondents obtain their vaccine-related information directly or indirectly via social media – particularly Facebook. Therefore, Ghana health service messaging via electronic platforms such as Facebook and Whatsapp can potentially be effective, but the use of multiple methods and sources will be vital. </p>
<p>Our research required use of the internet and access to a device. Thus, there will be an additional need to assess vaccine confidence in rural and hard-to-reach areas where access to information will be different to urban areas. </p>
<p>Vaccine confidence is essential if the pandemic is to be brought under control. Vaccinating a population is the end point, and there must be proactive approaches to health promotion and community preparedness. The Ghana health service may be the best organisation to take the lead on this, but the government, opposition political parties and employers can all contribute positive messaging ahead of the next delivery of COVID-19 vaccines.</p><img src="https://counter.theconversation.com/content/164733/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Head has received funding from the Bill & Melinda Gates Foundation and the UK Department for International Development. The project cited in this article was funded by the University of Southampton Strategic Development Fund. </span></em></p><p class="fine-print"><em><span>Ken Brackstone has received funding from the Impact Acceleration Account (IAA), University of Southampton.</span></em></p><p class="fine-print"><em><span>Laud Boateng has received funding from the UK Department for International Development.</span></em></p>Vaccinating a population requires a proactive approach to health promotion and community preparedness.Michael Head, Senior Research Fellow in Global Health, University of SouthamptonKen Brackstone, Research Fellow in Health Psychology, University of SouthamptonLaud Boateng, Post Doctoral Researcher, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1621102021-07-06T15:00:16Z2021-07-06T15:00:16ZWhy Africa’s push to make vaccines should look further than COVID-19<figure><img src="https://images.theconversation.com/files/405100/original/file-20210608-130350-1ba9vr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South African President Cyril Ramaphosa, Deputy president David Mabuza, Health Minister Dr Zweli Mkhize visiting the Aspen Pharmacare sterile manufacturing facility. </span> <span class="attribution"><span class="source">Lulama Zenzile/Die Burger/Gallo Images via Getty Images</span></span></figcaption></figure><p>It’s unlikely that vaccine manufacturing will offer Africa a quick fix for COVID-19. Countries on the continent are grappling with a diverse array of challenges. These include vaccine hesitancy, supply bottlenecks and a lack of operational funding and human resources to administer jabs. </p>
<p>Still, the political will to boost local manufacturing of vaccines is rising across the globe, including in Africa – and has never been this high.</p>
<p>The reason is simple. COVID-19 has shown that regions and countries take care of their own people first when crises hit. Africa wants to be able to do the same. To do so, the continent must seize new opportunities to fast-track the development of vaccine manufacturing capacity and to boost regulatory processes.</p>
<p>In 2020, about 40 African countries participated in a World Health Organisation (WHO) <a href="https://www.who.int/director-general/speeches/detail/director-general-s-opening-remarks-for-panel-is-africa-ready-to-finance-its-own-vaccine">training marathon</a> to build manufacturing capacity.
All 54 countries on the continent also supported Ethiopia’s recently passed resolution to the <a href="https://healthpolicy-watch.news/us-backs-trips-waiver-to-strip-vaccines-of-patent-protection-as-wha-pushes-local-vaccine-capacity/">74th World Health Assembly</a>, focused on strengthening local production of medicine and health technology. At the recent <a href="https://www.g20.org/the-global-health-summit-ended-with-the-signing-of-the-rome-declaration.html">G20 Global Health Summit</a>, the European Commission also announced a new initiative on manufacturing in Africa, backed by €1 billion. </p>
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Read more:
<a href="https://theconversation.com/trips-waiver-us-support-is-a-major-step-but-no-guarantee-of-covid-19-vaccine-equity-160638">TRIPS waiver: US support is a major step but no guarantee of COVID-19 vaccine equity</a>
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<p>That’s critical because manufacturing vaccine doesn’t come cheap. Success will depend heavily on support – in cash and in kind – from developed countries. It takes hundreds of millions of dollars to produce a <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30346-2/fulltext">new vaccine</a>. </p>
<p>There is hope for relaxation of <a href="https://theconversation.com/trips-waiver-us-support-is-a-major-step-but-no-guarantee-of-covid-19-vaccine-equity-160638">intellectual property rights</a>. These are necessary to open the way to local manufacturing of existing vaccines. </p>
<p>But the production process for new vaccines can take as long as five to 10 years. The typical vaccine roadmap begins with exploratory research, followed by pre-clinical and clinical safety and efficacy testing on animals and humans – and regulatory reviews and approvals for licensing. Only then can the manufacturing process begin.</p>
<p>This requires a significant body of skills. Local expertise in areas such as research and development, regulatory expertise and quality assurance must be strengthened too. </p>
<h2>Local manufacturing</h2>
<p>It will take several more years before countries are fully prepared to manufacture new vaccines to the scale of contributing significantly to global output. Therefore, governments should adopt a longer-term view that prioritises the most urgent health challenges in the region. This vision must be about manufacturing vaccine generally, rather than COVID-19 vaccines specifically.</p>
<p>Africa has <a href="https://www.nature.com/articles/d41586-021-01048-1">54 countries</a> and 1.2 billion people, but produces only 1% of all the vaccines it administers. The continent also faces a heavy burden of disease. Over <a href="https://www.who.int/news-room/fact-sheets/detail/malaria#:%7E:text=Disease%20burden&text=cases%20in%202018.-,The%20estimated%20number%20of%20malaria%20deaths%20stood%20at%20409%20000,all%20malaria%20cases%20and%20deaths">90%</a> of the world’s malaria deaths and <a href="https://www.afro.who.int/health-topics/hivaids">70%</a> of all people living with HIV are in Africa.</p>
<p>So far, the continent has only a few producers of vaccines. Statutes signed between the government of Senegal and the Institut Pasteur in <a href="https://www.avmi-africa.org/manufacturers/#1490181278853-496b3000-e3fc">2009</a> allowed the country to manufacture yellow fever vaccines. There are <a href="https://www.avmi-africa.org/manufacturers/#1490181277540-254a2bb0-9973">six other vaccine manufacturing institutes</a>. One is <a href="https://www.vacsera.com/">VACSERA </a>in Egypt, the oldest vaccine manufacturer in Africa. Egypt is slated to complete the production of <a href="https://egyptindependent.com/egypt-to-produce-40-million-doses-of-sinovac-vaccine-in-2021/">40 million</a> doses of China’s Sinovac COVID-19 vaccine domestically by the end of 2021. In South Africa, the pharmaceutical company<a href="https://www.aspenpharma.com/"> Aspen</a> will be manufacturing doses of the <a href="https://www.reuters.com/article/uk-health-coronavirus-safrica-johnson-jo-idUSKBN2BO5IA">Johnson & Johnson</a> COVID-19 vaccine under licence.</p>
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<strong>
Read more:
<a href="https://theconversation.com/vaccine-production-in-south-africa-how-an-industry-in-its-infancy-can-be-developed-153204">Vaccine production in South Africa: how an industry in its infancy can be developed</a>
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<p>Most local companies engage only in packaging and labelling, and occasionally fill-and-finish steps. But it’s noteworthy that there are about <a href="https://www.afro.who.int/news/what-africas-vaccine-production-capacity">80 sterile injectables facilities</a> on the continent. These produce a broad range of fill-and-finish sterile solutions and emulsions including anaesthetics, eye drops and multi-drug resistant tuberculosis vaccines. Significant financial commitment would be required to transform them into fully integrated manufacturing facilities. But these operations have built solid track records with partners and suppliers that will benefit expansion plans.</p>
<h2>Integrating policies</h2>
<p>Africa’s segmented markets, and often small economies, are at odds with the fact that vaccines are mostly produced in large quantities to keep prices down. They require large markets for sustainability. Regulatory bodies that meet international standards are also lacking, presenting a further hurdle.</p>
<p>Integrating national and regional policies and strategies would in effect increase the size of the overall market. All countries could then benefit, regardless of the size of their economy.</p>
<p>More integration will drive agreement on the manufacturing of products in high demand in Africa. It will also expand market access, and help avoid costly duplication. But most importantly, it will help ensure sustainability because most African countries’ markets are too small to support their own manufacturing. </p>
<p>African countries must make better use of regional economic integration platforms such as the <a href="https://www.ecowas.int/">Economic Community of West African States</a>, the <a href="https://www.comesa.int/">Common Market for Eastern and Southern Africa</a>, and the new <a href="https://au.int/en/cfta">African Continental Free Trade Agreement</a>, all of which offer great opportunities. </p>
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<strong>
Read more:
<a href="https://theconversation.com/africas-free-trade-area-offers-great-promise-but-only-if-risks-are-managed-with-resolve-161535">Africa's free trade area offers great promise. But only if risks are managed with resolve</a>
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<p>The <a href="https://www.un.org/africarenewal/magazine/november-december-2020/afcfta-africa-readying-free-trade-come-january-2021">African Continental Free Trade Area</a>, for example, aims to reduce all trade costs – it will eliminate 90% of tariffs – and enable Africa to integrate further into global supply chains. Cutting red tape and simplifying customs procedures will bring significant income gains. </p>
<p>Strong regulatory capacity and oversight is another building block for vaccine production and product safety. Countries must strengthen their regulatory systems to ensure that all medical products are of the highest quality, and that local manufacturers maintain international standards. This is why it’s critical for member states to urgently ratify the treaty to support the creation of the <a href="https://au.int/en/pressreleases/20200205/african-medicine-agency-ama-treaty">African Medicines Agency</a>. To date, <a href="https://au.int/en/pressreleases/20210507/republic-guinea-deposits-instrument-ratification-african-medicines-agency-ama">seven</a> of the required 15 African Union member states have ratified the treaty.</p>
<p>The World Health Organisation, where I am the regional advisor for vaccine research and regulation in the Africa region, works with member states and partners towards local vaccine manufacture.</p>
<p>In Ethiopia, for example, we are working closely with the Ministry of Health. We’re conducting a feasibility study in respect of the potential for high-standard manufacturing of vaccines. We’re also developing cost estimates for a road map to success.</p>
<p>Ethiopia, home to the second biggest population on the continent, had to pay a hefty US$707 million to procure routine vaccines between 2016 to 2020. That’s an enormous financial burden and sends a very clear message about the urgency for local manufacturing.</p>
<h2>Looking forward</h2>
<p>Africa is facing <a href="https://www.dw.com/en/coronavirus-digest-who-says-africa-urgently-needs-20-million-vaccine-doses/a-57695529">delays in accessing life-saving vaccines</a> for COVID-19. The continent may experience similar delays in the future. The continent faces significant and enduring <a href="https://www.hsph.harvard.edu/news/features/africa-cdc-head-is-driving-a-new-public-health-agenda-on-the-continent/#:%7E:text=March%2012%2C%202020%20%E2%80%93%20Africa%20faces,growing%20burden%20of%20chronic%20diseases">public health threats</a>, including measles, rotavirus, yellow fever and Ebola.</p>
<p>To manage these public health threats, Africa needs its own capacity for vaccine development and production so that it can immunise for childhood diseases and help control outbreaks of highly infectious diseases – including COVID-19.</p><img src="https://counter.theconversation.com/content/162110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bartholomew Dicky Akanmori is Regional Adviser for Vaccine Research and Regulation in the WHO Regional Office for Africa. </span></em></p>Vaccine manufacturing doesn’t come cheap. It depends heavily on support from developed countries. It also requires much more than relaxing intellectual property rights and a desire for vaccine equity.Bartholomew Dicky Akanmori, Professor Emeritus of Immunology, University of GhanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1610452021-05-20T15:08:24Z2021-05-20T15:08:24ZLow trust in authorities affects vaccine uptake: evidence from 22 African countries<figure><img src="https://images.theconversation.com/files/401683/original/file-20210519-21-9c0dnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker administers an injection to a child below the age of one year during a routine immunisation at a health center in Kampala, Uganda.</span> <span class="attribution"><span class="source">Xinhua/Nicholas Kajoba via Getty Images</span></span></figcaption></figure><p>In a time when the world is focusing on <a href="https://theconversation.com/africa/covid-19">COVID-19 vaccines</a>, the World Health Organisation (WHO) has highlighted the importance of routine immunisations for diseases such as measles, tetanus and polio. </p>
<p>Although immunisation saves millions of lives each year, progress in vaccine <a href="https://doi.org/10.1038/s41586-019-1656-7">coverage</a> remains highly uneven, both between and within countries. Despite considerable progress over the past two decades, the situation is particularly worrying in Africa. <a href="https://www.who.int/publications/m/item/progress-and-challenges-with-achievinguniversal-immunization-coverage">Nearly half</a> of the world’s unvaccinated and under-vaccinated children live in this region.</p>
<p>Even where vaccines are available, one barrier to progress is vaccine hesitancy: the reluctance or refusal to vaccinate. In 2019, the WHO listed vaccine hesitancy among the <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">top ten threats to global health</a>. <a href="https://www.who.int/news-room/events/detail/2021/04/24/default-calendar/world-immunization-week-2021">Building trust in vaccination</a> is a key aspect of this year’s WHO immunisation campaign. </p>
<p>Vaccine hesitancy is not new. Mistrust in authorities has been <a href="https://pubmed.ncbi.nlm.nih.gov/29617183/">shown</a> to negatively affect vaccine uptake in high and upper middle income countries such as Russia, the US, France and Croatia. But there is less research quantifying vaccine hesitancy in lower income countries.</p>
<p>Our latest <a href="http://dx.doi.org/10.1136/bmjgh-2020-004595">research</a> shows that child vaccination rates in African countries are lower in areas where the local population displays high levels of mistrust in local authorities. </p>
<p>Finding ways to improve vaccination uptake may help countries to reach the Sustainable Development Goals target of reducing under 5 mortality to no more than 25 per 1,000 live births by 2030. Currently, <a href="https://apps.who.int/iris/handle/10665/332070">two-thirds</a> of the 53 countries that are not on course to meet this goal are located in Africa.</p>
<h2>Linking vaccination uptake and trust in authorities</h2>
<p>We looked at the status of vaccinations for more than 160,000 children across 22 African countries, and matched it with information on the levels of trust people had in local and national authorities. </p>
<p>Information on vaccination status was obtained from the <a href="https://dhsprogram.com">Demographic and Health Surveys</a>. Information on institutional trust comes from the <a href="https://afrobarometer.org">Afrobarometer surveys</a>. We measured the degree of trust at the highest subnational region within each country. We calculated the share of the population that said they had no trust at all in the president, parliament, electoral system, courts or local government. </p>
<p>Various socio-economic characteristics at the individual, household and regional level may affect the affordability and accessibility of vaccination services, and hence vaccine uptake. In our statistical analysis we isolated the effect of institutional mistrust from these variables. To do so, we compared households with similar socio-economic characteristics, in the same area, with similar access to healthcare facilities. </p>
<p>We found that higher mistrust was associated with lower vaccination uptake.</p>
<p>When mistrust in local government increased by 10 percentage points, children living in that region were 11% more likely not to receive any of the eight basic vaccines. These were the BCG vaccine (to protect against tuberculosis); three doses of the combined diphtheria, pertussis, and tetanus vaccine; three doses of the polio vaccine; and a dose of measles-containing vaccine. And these children were 3.4% less likely to receive all eight of the basic vaccines.</p>
<p>Our study is the first comprehensive attempt to quantify the role of institutional mistrust on vaccine uptake in Africa. But our findings are in line with qualitative case studies from many African countries. These include the <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30063-5/fulltext">Democratic Republic of Congo</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953616306256">Liberia</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/17441692.2019.1680724?journalCode=rgph20">Nigeria</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27265459/">South Sudan</a>. </p>
<p>The most famous case of vaccine hesitancy on the continent is the boycott of the polio vaccination campaign in the early 2000s in <a href="https://global.oup.com/academic/product/stuck-9780190077242?cc=be&lang=en&">Nigeria</a>. It led to the outbreak of a disease that had nearly been eradicated. </p>
<p>The importance of institutional mistrust was also highlighted during the Ebola outbreak in West Africa in 2014. For instance, in Liberia, communities rejected health workers and did not follow the health recommendations. Such resistance was not explained by people’s understanding of Ebola symptoms or transmission. Respondents rather <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953616306256">indicated</a> that they could not trust the capacity and integrity of the government institutions to protect them.</p>
<h2>Policy implications</h2>
<p>There is an urgent need to recognise the importance of mistrust in vaccination campaigns. <a href="https://www.nature.com/articles/s41586-019-1656-7">Research</a> has shown that immunisation is one of the most cost-effective public health interventions. The World Health Organisation <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">estimates</a> that vaccination prevents 2-3 million deaths each year. </p>
<p>In a world where the global rollout of vaccines is considered crucial in bringing the COVID-19 pandemic to an end, boosting immunisation seems more relevant than ever. The pandemic has caused the cancellation of supplementary measles immunisation campaigns and puts the delivery of critical routine immunisation services at <a href="https://science.sciencemag.org/content/369/6501/261">risk</a>. </p>
<p>An obvious implication of our findings is that the benefits of vaccines should be communicated better. Myths and misunderstandings must be addressed. But raising awareness is unlikely to be enough unless people trust those providing the information and delivering vaccination services. </p>
<p>It takes considerable effort to build trust. Building trust usually starts by recognising people’s concerns and then providing reliable information from credible sources, using terms that are not confusing or too technical. </p>
<p>To guide policy, it is important to identify where mistrust comes from and engage with communities and trusted leaders. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776099/">example</a> is the so-called <a href="https://coregroup.org/our-work/programs/core-group-polio-project/">CORE</a> projects that managed to address vaccine hesitancy in North East Nigeria. They created trusted spaces for community dialogue in a challenging environment. </p>
<p>Our study calls for scaling up and adapting such initiatives to protect the 2.6 million children under 5 who are <a href="https://doi.org/10.1080/21645515.2018.1522921">estimated</a> to be at risk of dying from vaccine-preventable diseases by 2030.</p><img src="https://counter.theconversation.com/content/161045/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nik Stoop acknowledges financial support from Research Foundation Flanders through a post-doctoral scholarship (nr.: 12W8320N).</span></em></p><p class="fine-print"><em><span>Jean-Francois Maystadt and Kalle Hirvonen do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even where vaccines are available, one barrier to progress is vaccine hesitancy: the reluctance or refusal to vaccinate.Jean-Francois Maystadt, Professor, Lancaster UniversityKalle Hirvonen, Senior Research Fellow, International Food Policy Research Institute (IFPRI) Nik Stoop, Post-doctoral researcher, University of AntwerpLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1554532021-02-18T03:15:39Z2021-02-18T03:15:39ZHow the Pfizer COVID vaccine gets from the freezer into your arm<figure><img src="https://images.theconversation.com/files/384901/original/file-20210218-17-1rif73i.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/buenos-aires-argentina-november-27-pfizer-1865003029">from www.shutterstock.com</a></span></figcaption></figure><p><a href="https://www.theguardian.com/australia-news/2021/feb/15/australias-covid-vaccine-rollout-to-begin-next-monday-as-first-pfizer-shipment-arrives">From Monday</a>, people at high risk of COVID-19 will be lining up to receive the Pfizer vaccine, marking the start of Australia’s long-awaited COVID vaccination program.</p>
<p>We’ve heard about the need to store the vaccine <a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">frozen at about -70°C</a> — a temperature well below freezing and unusually cold, <a href="https://www.antarctica.gov.au/about-antarctica/weather-and-climate/weather/">even for Antarctica</a>. The vaccine also comes in a multi-dose vial, meaning the vaccine will have to be diluted then individual doses taken from the vial. </p>
<p>These two aspects make the Pfizer vaccine rollout one of the most complex vaccine programs ever delivered. So all nurses and doctors set to give the Pfizer vaccine in Australia need to have gone through <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/covid-19-vaccination-training-program">special</a> <a href="https://www.covid19vaccinationtraining.org.au">training</a> in how to store, handle and administer the vaccine.</p>
<p>If you’re one of the high-risk groups set to receive the Pfizer vaccine from next week — because of your occupation or you are in aged- or disability care — here’s what goes on behind the scenes to get the vaccine from the freezer into your arm.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=956&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=956&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=956&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1201&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1201&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1201&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>Once the vaccine leaves the freezer, the clock starts ticking</h2>
<p>Once the vaccine is removed from the “deep freezer” there is no turning back; we <a href="https://www.abc.net.au/news/2021-02-08/australia-tries-to-avoid-covid19-pfizer-vaccine-losses/13130808">don’t want to waste</a> any of these precious vaccine doses.</p>
<p>As you would expect, the vaccine needs to be thawed before it can be injected. Once this happens, it cannot be re-frozen; it must be used.</p>
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Read more:
<a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">How mRNA vaccines from Pfizer and Moderna work, why they're a breakthrough and why they need to be kept so cold</a>
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<p>The thawing process <a href="https://www.tga.gov.au/sites/default/files/auspar-bnt162b2-mrna-210125-pi.pdf">has rules</a>. Frozen vials are transferred from the freezer to a fridge set at 2-8°C to thaw. A pack of 195 vials, containing about 975 doses, may take three hours. But it can sit in the fridge for up to five days, if needed. To speed things up, it is possible to thaw the frozen vials for 30 minutes at temperatures up to 30°C. But then, the vaccine needs to be used within two hours.</p>
<p>Either way, people must be lined up ready to be vaccinated to avoid wastage.</p>
<p>Once thawed, the vaccine needs to be mixed gently. So the vaccinator needs to turn each vial up and down (invert it) ten times. They cannot <a href="https://www.youtube.com/watch?v=czlIrRDFAPs">shake the vial</a> as the vaccine is fragile.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1337587741941501952"}"></div></p>
<h2>Then each vial is split into individual doses</h2>
<p>One of the challenges with the Pfizer vaccine is that it comes in multi-dose vials, containing enough vaccine for five or six doses.</p>
<p>Nearly all current vaccines in our national immunisation program are single-use. Many come already prepackaged in the needle and syringe. So for many vaccinators,
“drawing up” and giving a vaccine from a multi-dose vial will be new. This too has rules.</p>
<p>The vaccinator first needs to clean the top of the vial with an antiseptic swab. This is important to ensure the vials remain free from contamination.</p>
<p>Then the vaccinator injects a set amount of sterile saline into the vial, through the top, to dilute the vaccine. Care must be taken not to introduce contaminants during this part of the process.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse giving vaccine to elderly person" src="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Vaccinators have several steps to go through before giving the Pfizer vaccine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-nurse-doing-vaccine-injection-senior-1852449988">www.shutterstock.com</a></span>
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<p>The vial then needs to be turned up and down ten times to make sure the saline mixes with the vaccine. Again, the clock is ticking. Once the vaccinator injects the saline into the vial and mixes it, the vaccine must be used within six hours. After that, any unused vaccine must be discarded.</p>
<p>The vaccinator must then take a new needle and syringe, clean the top of the vial again and “draw” up 0.3 millilitres of vaccine from the vial. This is a new volume for our vaccinators to get used to as most vaccines given as part of our current immunisation program are 0.5 millilitres.</p>
<p>Once the 0.3 millilitres is in the syringe, it is ready to be injected into the upper arm.</p>
<p>The vaccinator must use a new needle and syringe to “draw” up the next dose. This is repeated until five or six doses have been removed from the vial. </p>
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<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-covid-vaccine-while-im-pregnant-or-breastfeeding-is-it-safe-for-me-and-my-baby-153309">Should I get a COVID vaccine while I'm pregnant or breastfeeding? Is it safe for me and my baby?</a>
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<h2>Ready, set, go</h2>
<p>Next, the injection itself. In most cases, the person will be sitting down and have their upper arm exposed so the vaccinator can see the deltoid muscle. This is the large fleshy part of muscle on the outer edge of your upper arm. </p>
<p>There is usually no need to clean the upper arm unless it is visibly dirty. The needle is then inserted at 90⁰ to the arm and the vaccine injected slowly over a few seconds. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/not-sure-about-the-pfizer-vaccine-now-its-been-approved-in-australia-you-can-scratch-these-4-concerns-straight-off-your-list-153719">Not sure about the Pfizer vaccine, now it's been approved in Australia? You can scratch these 4 concerns straight off your list</a>
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<h2>That’s not all</h2>
<p>Once you have been given the vaccine you will be <a href="https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-preparing-for-covid-19-vaccination_2.pdf">asked to stay</a> in the clinic for at least 15 minutes to make sure you don’t have any reactions. In some cases, especially if there’s a history of severe allergic reactions, people will be asked to wait for 30 minutes. </p>
<p>Your vaccine details will be added to the <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register">Australian Immunisation Register</a>. This is <a href="https://theconversation.com/the-covid-vaccine-is-here-when-and-to-whom-will-we-need-to-prove-weve-had-it-155122">now mandatory</a>. That’s because it is very important we know exactly which vaccine you were given and will be checked when you return for the second dose, 21 days later. </p>
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Read more:
<a href="https://theconversation.com/the-covid-vaccine-is-here-when-and-to-whom-will-we-need-to-prove-weve-had-it-155122">The COVID vaccine is here. When and to whom will we need to prove we've had it?</a>
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<img src="https://counter.theconversation.com/content/155453/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship </span></em></p>The clock starts ticking once the vaccine leaves the freezer. Here’s what to expect.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1550752021-02-14T09:11:51Z2021-02-14T09:11:51ZGhana faces hurdles to achieve targets set for COVID-19 vaccine rollout<figure><img src="https://images.theconversation.com/files/383537/original/file-20210210-19-4e8mmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">African countries are relying on approved vaccines to stem a rise in cases</span> <span class="attribution"><span class="source">Lisa Ferdinando/Wikimedia Commons</span></span></figcaption></figure><p>Ghana, like many of its counterparts on the continent, is contending with the fallout from the rapid spread of SARS-CoV-2 variants. Of particular concern is the B.1.1.7 variant first identified in the UK. It is estimated to be up to <a href="https://www.reuters.com/article/health-coronavirus-britain-variant-detai-idUSL8N2IZ0H7">70% more infectious</a> and <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/959426/Variant_of_Concern_VOC_202012_01_Technical_Briefing_5.pdf">65% more lethal</a> than the ancestral strain. </p>
<p>Scientists at the West African Centre for Cell Biology of Infectious Pathogens <a href="https://twitter.com/gordon_awandare/status/1357681706975789056">have confirmed</a> that B.1.1.7 is now the dominant variant in Ghana based on nationwide genomic surveillance. And that it is responsible for 88% of cases in the capital city.</p>
<p>The ongoing surge in new infections, hospital admissions and deaths has refocused public attention on a situation that the Ghana Medical Association <a href="https://citinewsroom.com/2021/01/ghanas-current-covid-19-situation-dire-and-alarming-gma/">describes as “dire”</a>. Intensive care units are operating at the limits of their staff and space constraints. And more young people appear to be developing severe forms of the illness.</p>
<p>This means that the rollout of COVID-19 vaccines in Ghana cannot come quickly enough. But what is the country’s COVID-19 vaccination strategy? And how well advanced are plans to execute it?</p>
<h2>Potential pitfalls</h2>
<p>At least 60% of Ghana’s 31 million residents will need to be vaccinated for the population <a href="https://www.reuters.com/article/us-health-coronavirus-immunity-analysis/analysis-can-first-covid-19-vaccines-bring-herd-immunity-experts-have-doubts-idUSKBN27Y124">to attain herd immunity</a>. The <a href="https://presidency.gov.gh/index.php/briefing-room/speeches/1859-update-no-23-measures-taken-to-combat-spread-of-coronavirus">goal of the president, Nana Akufo Addo,</a> is that every Ghanaian will be vaccinated. But a timeline for this remains elusive as no plan has been made public.</p>
<p>The president has <a href="https://presidency.gov.gh/index.php/briefing-room/speeches/1859-update-no-23-measures-taken-to-combat-spread-of-coronavirus">promised</a> to procure and administer 17.6 million COVID-19 vaccine doses in the first half of 2021 as part of an initial push. But there is uncertainty even around this target. </p>
<p>Firstly, how the country will secure this number of doses is not yet clear. </p>
<p>Secondly, there are questions around how the doses will be stored and distributed, as well as the capacity of the country’s existing cold chain infrastructure. </p>
<p>And there will be a final major hurdle to clear – convincing many sceptical Ghanaians that the vaccines on offer are <a href="https://www.modernghana.com/news/1060496/no-need-to-fear-covid-19-vaccines-dacosta-aboagy.html">safe and effective</a>.</p>
<h2>Constraining factors</h2>
<p>A number of external factors are hampering Ghana’s efforts to secure the doses it needs to reach its mid-year target. </p>
<p>Unlike developed nations, countries like Ghana have limited bargaining power to negotiate directly with manufacturers. As a result, it is principally relying on two multilateral initiatives to procure COVID-19 vaccines – the <a href="https://www.who.int/docs/default-source/coronaviruse/act-accelerator/covax/covax-interim-distribution-forecast.pdf?sfvrsn=7889475d_5">COVAX facility </a> and the African Vaccine Acquisition Task Team. Combined, they have secured 1.27 billion vaccine doses for African nations. </p>
<p><a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX</a> is a global initiative co-led by the World Health Organisation, Gavi and the Coalition for Epidemic Preparedness Innovations. It aims to develop, manufacture and distribute COVID-19 vaccines to all nations on a fair and equitable basis. It operates as a <a href="https://www.gavi.org/vaccineswork/gavi-covax-amc-explained">funding mechanism</a> that uses the collective purchasing power of participating nations to obtain competitive prices. </p>
<p>Nevertheless, participating low- and middle-income countries will only receive enough vaccines to cover up to 20% of their populations.</p>
<p>Ghana expects to take delivery of up to 968,000 doses of the Oxford-AstraZeneca vaccine by the end of March 2021 as part of an initial batch from COVAX. These first doses have been earmarked for the nation’s healthcare <a href="https://ghanahealthservice.org/downloads/Facts+Figures_2018.pdf">workforce</a> of about 108,000. </p>
<p>COVAX aims to deliver the remainder of this initial tranche of 2.4 million doses by June 2021. This should be enough to protect about 1.2 million Ghanaians with the two-jab Oxford-AstraZeneca vaccine. But reaching the president’s target will require about four times that amount.</p>
<p>This means that Ghana will have to lean heavily on vaccine supplies from the African Vaccine Acquisition Task Team – an <a href="https://www.un.org/africarenewal/magazine/february-2021/covid-19-african-countries-scramble-vaccines">initiative</a> being driven by the African Union. It aims to bridge the gap between the 20% population coverage promised by COVAX to participating African countries and the 60% coverage they need to attain herd immunity. </p>
<p>The African Export-Import Bank and the World Bank are <a href="https://edition.cnn.com/2021/01/14/africa/vaccine-africa-intl/index.html">supporting</a> the strategy with about $7 billion in cash advancements to vaccine manufacturers on behalf of AU member states. The African Vaccine Acquisition Task Team has so far <a href="https://www.un.org/africarenewal/magazine/february-2021/covid-19-african-countries-scramble-vaccines">secured</a> 270 million doses of the Pfizer, Oxford-AstraZeneca and Johnson & Johnson vaccines. Deliveries are scheduled to begin later this month.</p>
<p>In early February the director of the Africa Centers for Disease Control <a href="https://www.reuters.com/article/uk-health-coronavirus-africa-idUSKBN2A418P">announced</a> that 16 African nations had applied to the task team for vaccine supplies totalling 114 million doses. While the final allocations are yet to be published, Zambia, Kenya and Nigeria are <a href="https://allianceforscience.cornell.edu/blog/2021/01/zambia-to-receive-8-7-million-doses-of-covid-19-vaccines-under-au-initiative/">set to receive</a> 42.7 million. </p>
<p>It is not yet known if Ghana is one of the remaining 13, nor how many doses it intends to order from the African Vaccine Acquisition Task Team.</p>
<p>Ghana’s Presidential Advisor on Health, Anthony Nsiah-Asare, <a href="https://www.facebook.com/223759804310337/videos/709851329729052">recently</a> hinted that the country was also procuring vaccines through bilateral deals with some of its development partners. But these supplies are likely to be a negligible fraction of the 15.2 million additional doses required to meet the June target. </p>
<p>This means that Ghana’s supplies from the African Union initiative is likely to determine the nation’s ability to reach its mid-year goal of 17.6 million doses.</p>
<h2>The groundwork</h2>
<p>Ghana’s COVID-19 vaccination drive will face other challenges that ought to be addressed urgently. </p>
<p>One is a storage and distribution plan that prioritises speed and minimises waste. Public health authorities have <a href="https://www.modernghana.com/news/1060775/covid-19-vaccine-rollout-to-rely-on-ghs-infrastruc.html">assured</a> Ghanaians that a comprehensive plan exists – it has not yet been made public – to make use of the country’s existing cold chain infrastructure for vaccine distribution.</p>
<p>This infrastructure supports Ghana’s enviable record in immunisation coverage that has helped reduce infant mortality and the incidence of vaccine-preventable diseases such as measles. In 2019, immunisation <a href="https://www.who.int/immunization/monitoring_surveillance/data/gha.pdf">coverage</a> for essential vaccines was in excess of 90%. Ghana has not <a href="https://www.unicef.org/ghana/immunization#:%7E:text=In%20Ghana%2C%20the%20Expanded%20Programme,such%20as%20measles%20and%20poliomyelitis.">recorded</a> a single death from measles since 2003. In addition, it was certified as having <a href="https://www.unicef.org/media/media_60763.html#:%7E:text=ACCRA%2C%20Ghana%2C%2021%20November%202011,disease%20since%202000%20to%2021.">eliminated</a> maternal and neonatal tetanus in 2011.</p>
<p>But there are gaps. Ghana’s current cold storage facilities lack the capacity to house vaccines like those manufactured by Pfizer and Moderna because of the arctic temperatures required to store them. Both use a technology known as mRNA.</p>
<p>This limits the COVID-19 vaccine options available to Ghana. It also matters because these vaccines can be adapted to target new SARS-CoV-2 variants relatively quickly compared with other vaccine technologies. Having access to them could therefore determine how fast nations are able to respond to the emergence of new variants.</p>
<p>Ghana faces a potentially bigger stumbling block: <a href="https://www.myjoyonline.com/playback-pm-express-probes-into-ghanas-preparedness-for-covid-19-vaccine-the-fears-and-the-how/">public scepticism</a> about COVID-19 vaccines. </p>
<p>Anxieties and uncertainties about their safety underlies considerable hesitancy in Ghana towards the COVID-19 vaccines. The proliferation of fake news and misinformation on social media and in certain quarters of the popular press are fanning those embers. </p>
<p>To meet this challenge public health authorities will have to be laser-focused on identifying and addressing both legitimate apprehensions and conspiracy theories. They will also have to be proactive in monitoring digital platforms because of the dynamic and viral nature of vaccine misinformation. </p>
<p>It will also be important to measure progress towards public acceptance of the vaccines. One route would be to conduct a series of public surveys to assess the evolving landscape of knowledge and attitudes. This would enable the government to identify specific misinformation that allows for more focused communication about vaccine safety and efficacy. </p>
<p>Much of that will also depend on media coverage. It is therefore crucial to engage the media on its role in combating misinformation</p><img src="https://counter.theconversation.com/content/155075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nana Kofi Quakyi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ghana’s mid-year target of procuring and administering 17.6 million COVID-19 vaccine doses may be constrained by global supply, cold chain capacity, and vaccine hesitancy.Nana Kofi Quakyi, Research Fellow, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1536392021-01-27T18:53:46Z2021-01-27T18:53:46ZNeedles are nothing to fear: 5 steps to make vaccinations easier on your kids<figure><img src="https://images.theconversation.com/files/380791/original/file-20210127-23-1fku5ev.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4500%2C2984&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The COVID vaccine rollout has placed the issue of vaccination firmly in the spotlight. A successful rollout will depend on a variety of factors, one of which is vaccine acceptance. One potential hurdle to vaccine acceptance is needle fear. </p>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S0264410X1200686X?via%3Dihub">a study</a> that surveyed parents and children in Canada, 24% of parents and 63% of children reported a fear of needles. About one in 12 children and adults alike said they didn’t get all the vaccinations they needed because of their phobia.</p>
<p>Needle phobia generally begins from <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/the-epidemiology-of-blood-injection-injury-phobia/44B2603FC1218AF52BC8F5256A853837">around age five</a>, and can last through to adulthood. It can be a barrier to health-care access and treatment.</p>
<p>So it’s important to establish positive attitudes towards needle procedures, particularly vaccination, early in life.</p>
<h2>An opportunity</h2>
<p>Although there’s no one specific reason why people develop needle phobia, people who are anxious and fearful of needles <a href="https://journals.lww.com/clinicalpain/Fulltext/2015/10001/Far_From__Just_a_Poke___Common_Painful_Needle.3.aspx">can often relate their concerns</a> back to one poorly-managed needle experience as a child. A bad experience may result from feelings of powerlessness due to being under-informed or being “tricked” into a vaccination. </p>
<p>In Australia, the <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule">National Immunisation Program Schedule</a> includes vaccinations during the first 18 months, again at age four, and then in adolescence. </p>
<p>While it’s important to use a respectful approach at all ages, the four-year-old vaccinations present a particularly valuable opportunity for parents to help children feel comfortable with needle procedures.</p>
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Read more:
<a href="https://theconversation.com/everyone-can-be-an-effective-advocate-for-vaccination-heres-how-111828">Everyone can be an effective advocate for vaccination: here's how</a>
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<p>The guide below offers a strategy to help make vaccination a positive experience for your child. It’s based on what’s called the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241764">respectful approach to child-centred health care</a>. This focuses on the parent and health-care provider developing a cooperative relationship with the child, rather than using authority or incentives. </p>
<p>The aim is to help the child feel in control and reduce anxiety around needle procedures.</p>
<figure class="align-center ">
<img alt="The author's son having his four-year-old vaccinations. He's sitting on his father's knee and receiving it in his thigh." src="https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380369/original/file-20210125-19-1wlvbyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The author’s son is pictured having his four-year-old vaccinations.</span>
<span class="attribution"><span class="source">Therese O'Sullivan</span>, <span class="license">Author provided</span></span>
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<h2>Five steps</h2>
<p><strong>1. Prepare</strong></p>
<p>A few weeks beforehand, briefly <a href="http://peacefulparentsconfidentkids.com/2015/04/taking-the-dread-out-of-4-year-old-needles/">introduce the topic</a> of vaccinations and why they’re important. </p>
<p>Expect some resistance. This is normal — there’s no need to argue, just acknowledge your child’s feelings. Let them know adults don’t particularly like getting vaccinations either!</p>
<p>About a week out, mention again that they’ll be having a vaccination, and give some details, such as where they will be going. Another reminder the day before is helpful.</p>
<p><strong>2. Be honest and transparent</strong></p>
<p>It’s important to check if your child has any questions each time you discuss vaccination with them. Answer as honestly as possible. Yes, it will hurt. But not for long — most of the pain will be gone by the time 30 seconds is up, perhaps as long as it takes to run around the house or say the alphabet.</p>
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Read more:
<a href="https://theconversation.com/children-may-need-to-be-vaccinated-against-covid-19-too-heres-what-we-need-to-consider-146404">Children may need to be vaccinated against COVID-19 too. Here's what we need to consider</a>
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<p><strong>3. Give choices</strong></p>
<p>Help children feel like they are actively part of the process by giving choices where possible. For example, can they have a choice of day, or morning or afternoon? </p>
<p>Check with your health-care provider in advance whether children can choose the location of the injection – normally the vaccines <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118997/">are administered</a> on the outside of the thigh, or the upper arm.</p>
<p>In the lead up, the child might like to prod themselves with a toothpick to see the difference between how each site feels. They may also have a preference for the left or right side. </p>
<p>Sometimes it helps to yell out when you feel pain. Kids may find this fun if you give them free rein to call out anything they want (even “rude” words) when the injection goes in. Just let your health-care provider know in advance so they’re not taken by surprise.</p>
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<img alt="A little girl receives an injection in her arm." src="https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380792/original/file-20210127-17-1lorwar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Let your child watch the injection, if they want to.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p><strong>4. Avoid bribes and distractions</strong></p>
<p>Offering a bribe can give the child the impression there’s something terrible about the procedure. As the parent, be confident (or pretend to be confident if you have needle fear yourself). Pain-related beliefs and behaviours <a href="https://pubmed.ncbi.nlm.nih.gov/21111682/">can be learnt through observing others</a>, and children are very perceptive. </p>
<p>You can always do a fun activity or have a treat afterwards, but make this a surprise at the end rather than a bribe before the vaccination.</p>
<p>Distractions are common, but can leave the child wondering why they were distracted. “What was going on that was so bad I wasn’t allowed to look at it?”, they might wonder. When children feel they have been deceived, this may erode trust.</p>
<p>Some children may like to watch so they know what’s happening — give them the option. Interestingly, in one study, adults who chose to watch the needle being inserted into their arm <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.526">reported less pain</a> compared with those who chose to look away.</p>
<p><strong>5. Use mindful parenting</strong></p>
<p>Think of vaccinations as an opportunity to be 100% present, one-on-one with your child. Put aside any multitasking for the morning or afternoon of the vaccination. If you can, take the time off work, turn off your phone, and arrange for any other siblings to be looked after.</p>
<p>Observe your child, aim to listen with your full attention, be compassionate and aware of how you and your child are feeling. All of these things <a href="https://link.springer.com/article/10.1007/s10567-009-0046-3">can improve the quality of parent–child relationships</a> and are important for helping children through potentially anxious times.</p>
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<strong>
Read more:
<a href="https://theconversation.com/fear-of-needles-could-be-a-hurdle-to-covid-19-vaccination-but-here-are-ways-to-overcome-it-139029">Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it</a>
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<img src="https://counter.theconversation.com/content/153639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Therese O'Sullivan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s no secret many kids (and adults) don’t like needles. But where needle phobia can be a barrier to vaccine acceptance, it’s important to set your children up not to fear injections. Here’s how.Therese O'Sullivan, Associate Professor, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1535492021-01-21T13:33:53Z2021-01-21T13:33:53ZSouth Africa’s immunisation record risks being dented by anti-vaccination views<figure><img src="https://images.theconversation.com/files/379912/original/file-20210121-19-12dyogd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine hesitancy is a growing public health problem. </span> <span class="attribution"><span class="source">Sharon Seretlo/Gallo Images via Getty Images</span></span></figcaption></figure><p>Vaccination has eradicated smallpox, nearly eradicated polio, and led to major reductions of serious infectious diseases. These include diphtheria, whooping cough, tetanus, and measles.</p>
<p>Yet concerns about vaccination – or what’s known as <a href="https://www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf?ua=1">vaccine hesitancy</a> – persist. This isn’t new: people have delayed being vaccinated, or point blank refused, since the first vaccines came off the production line. </p>
<p>In 2019, the World Health Organisation identified <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">vaccine hesitancy</a> as one of the ten greatest threats to global health.</p>
<p>This is understandable. Vaccine hesitancy poses significant risks for those refusing to be vaccinated as well as the wider community. For example, delays and refusals of vaccination make communities unable to reach thresholds of coverage necessary for herd immunity. This happens when a large percentage of the inhabitants of an area is vaccinated against a disease, making the spread of the disease from person to person unlikely. As a result, the whole community becomes protected, not just those who were vaccinated. </p>
<p>Herd immunity thresholds vary with each disease. For example, herd immunity against measles requires about 95% of the population to be vaccinated. For COVID-19, data to calculate an accurate herd immunity threshold is limited, but it is currently estimated to be about 67%. </p>
<p>When herd immunity thresholds are not met, the risk of infection increases among susceptible individuals, leading to <a href="https://www.thinkglobalhealth.org/article/vaccine-hesitancy-escalating-danger-africa">outbreaks of vaccine-preventable diseases</a>. </p>
<p>Vaccine hesitancy has resulted in multiple vaccine-preventable disease outbreaks. These include the measles epidemics in Europe and North America between <a href="https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fglobalhealth%2Fmeasles%2Fglobalmeaslesoutbreaks.htm">2018 and 2020</a>. The polio vaccine boycott in Nigeria in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831725/">2003–2004</a> is another striking example.</p>
<p>Research on vaccine hesitancy in South Africa is still limited. But growing evidence <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-578">suggests</a> that <a href="http://www.samj.org.za/index.php/samj/article/view/12516">it is</a> becoming a <a href="https://pubmed.ncbi.nlm.nih.gov/31521412/">problem</a>. </p>
<p>South Africa has made important advances in a number of its immunisation programmes over the past <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279621/">20 years</a>. The danger is that it could begin to fall behind if people increasingly question vaccines, seek alternatives, or decide to <a href="http://www.samj.org.za/index.php/samj/article/view/9654">postpone or reject vaccination</a> – even when vaccination services are available and accessible. </p>
<p>Scientists and policy makers need to know the scale of the problem so that tailored and targeted strategies can be developed to address it.</p>
<h2>A growing trend</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31831547/">In 2019</a>, more than half of vaccinators in selected healthcare facilities in Cape Town reported having encountered vaccine hesitant individuals at some point in their careers. </p>
<p>There were a number of reasons for the reluctance to receive childhood vaccinations. These included the fear of side effects, religious beliefs, and the need for natural immunity. </p>
<p>The healthcare workers said that the internet and social media were significant contributors to vaccine <a href="https://pubmed.ncbi.nlm.nih.gov/31831547/">hesitancy among caregivers</a>. </p>
<p>These findings were backed up by another <a href="https://pubmed.ncbi.nlm.nih.gov/31521412/">study</a> we did in 2019 in which we identified multiple misconceptions, conspiracy theories, and concerns expressed on Facebook about human papillomavirus (HPV) vaccination. HPV vaccination helps prevent cervical cancer and other HPV-associated diseases. At the moment, HPV vaccination is offered free of charge to grade 5 girls over the age of 9 years in public sector schools in South Africa. </p>
<p>Research stretching back over decades shows that there is a trend of a growing tide of misinformation and disinformation about vaccination on the internet. For example, there’s <a href="http://www.samj.org.za/index.php/samj/article/view/9654">evidence</a> that there was an increase in the numbers of anti-vaccination webpages in South Africa between 2011 and 2013. Advertisements appeared on more than half of the web pages. And two-thirds of these were sponsored by or linked to organisations with financial interests in discrediting vaccines. <a href="http://www.samj.org.za/index.php/samj/article/view/9654">Most web pages</a> (93%) claimed that vaccines were not safe. Nearly 80% of the anti-vaccination claims originated from the United States of America. </p>
<p>In a more recent <a href="https://gh.bmj.com/content/5/10/e004206">study</a>, we analysed a wide range of social media posts and found a significant relationship between foreign disinformation campaigns on social media and declining vaccination coverage. The study also shows a significant relationship between organisation on social media and public doubts regarding the safety of vaccines.</p>
<h2>Lots to be done</h2>
<p>Measuring the scale of the problem accurately isn’t easy. Most methods of doing this have been developed for <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2018.1460987">high-income countries</a>. These might not be appropriate for countries like South Africa. </p>
<p>In 2017, the vaccine implementation research portfolio at the <a href="https://southafrica.cochrane.org/our-work/vaccine-implementation-research">South African Medical Research Council</a> set about developing a vaccine hesitancy instrument. We wanted to develop a tool that would measure vaccine hesitancy in a <a href="https://www.fondation-merieux.org/wp-content/uploads/2017/11/vaccine-acceptance-2018-charles-wiysonge.pdf">South African</a> context. We have refined the instrument and started field-testing among healthcare workers in Cape Town. After this, field-testing will be expanded to other population groups and areas in the country. </p>
<p>It’s still early days but this tool is a key step towards measuring and addressing vaccine hesitancy in the country.</p>
<p>There is, however, a silver lining. There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838535/">evidence</a> that vaccination decisions of most caregivers are influenced by advice given by their healthcare workers. Most caregivers consider healthcare workers as knowledgeable about the science behind vaccination and the benefits and risks of vaccination. </p>
<p>Nevertheless, vaccine hesitancy poses a serious threat to health efforts, particularly during a pandemic. It is pervasive, misinformed and <a href="https://pubmed.ncbi.nlm.nih.gov/30451037/">contagious</a>. Only a collective effort between parents, paediatricians, family doctors, public health officials, governments, the technology sector, and civil society will allow misinformation to be dispelled and confidence in vaccination to be enhanced.</p><img src="https://counter.theconversation.com/content/153549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccine hesitancy has resulted in multiple vaccine-preventable disease outbreaks. Research on vaccine hesitancy in South Africa is limited. But growing evidence suggests that it’s becoming a problem.Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilSara Cooper, Senior Scientist in Cochrane South Africa at the South African Medical Research Council (SAMRC) and Honorary researcher in the Division of Social & Behavioural Sciences in the School of Public Health, UCT, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1478992020-11-15T18:52:39Z2020-11-15T18:52:39ZCOVID-19 vaccines could go to children first to protect the elderly<figure><img src="https://images.theconversation.com/files/366001/original/file-20201028-13-yffqre.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C998%2C657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-holds-injection-vaccination-child-437593207">Shutterstock</a></span></figcaption></figure><p><em>Several COVID-19 vaccines are in late-stage clinical trials. So discussion is turning to who should receive these vaccines first, should they be approved for use. Today, we discuss two options. One is to <a href="https://theconversation.com/why-we-should-prioritise-older-people-when-we-get-a-covid-vaccine-148432">prioritise the elderly</a>. This article looks at the benefits of vaccinating children first.</em></p>
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<p>The World Health Organisation <a href="https://apps.who.int/iris/bitstream/handle/10665/334299/WHO-2019-nCoV-SAGE_Framework-Allocation_and_prioritization-2020.1-engpdf?sequence=1&isAllowed=y">is</a> <a href="https://www.who.int/publications/m/item/who-sage-roadmap-for-prioritizing-uses-of-covid-19-vaccines-in-the-context-of-limited-supply">discussing</a> how best to allocate and prioritise COVID-19 vaccines when they arrive.</p>
<p>It is focusing on the immediate crisis. To reduce deaths quickly when there are extremely limited vaccine doses available, <a href="https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-25-september-2020/jcvi-updated-interim-advice-on-priority-groups-for-covid-19-vaccination">vaccinating older</a>, more vulnerable people is expected to be the best option, even if the vaccine is relatively poor at protecting them. That is because the elderly are so <a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">much more likely</a> to die from the disease. </p>
<p>But as we produce more vaccines, the goal will be returning to normality where we can freely mix without increased risk. If vaccines are not very effective in older adults, we will need many more people to be vaccinated, including children. One possible strategy is <a href="https://academic.oup.com/jlb/article/7/1/lsaa050/5860822">to prioritise children</a>.</p>
<h2>Why children first?</h2>
<p>The risks and benefits of particular COVID-19 vaccination strategies depend on information we don’t yet have. For example, we don’t yet know whether vaccines work or are safe for specific population groups, such as the young or the old. </p>
<p>But it is worth thinking about the ethics of different strategies in advance. In a pandemic, time can save lives. </p>
<p>A COVID-19 vaccine may be less effective in the elderly because their immune systems <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265901/">decline naturally with age</a>, making them perhaps less able to trigger an efficient, protective immune response after vaccination. </p>
<p>We see this <a href="https://www.sciencedirect.com/science/article/pii/S0264410X02000415?via%3Dihub#BIB4">with the flu vaccine</a>, which only reduces influenza-like illnesses by around one-third in the over-65s and deaths by around half.</p>
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Read more:
<a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">Why are older people more at risk of coronavirus?</a>
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<p>If there are similar results for a COVID-19 vaccine, to return to normality, we may need to also prevent community transmission through vaccinating <a href="https://academic.oup.com/jlb/article/7/1/lsaa050/5860822">young people</a>, who generally mount a stronger immune response. This would in turn protect older, more vulnerable people because the virus would be less likely to reach them. </p>
<p>Yes, this is controversial. Children cannot autonomously consent to being vaccinated. Adults, who make these decisions on their behalf, are also likely to benefit from a reduced risk of contracting the virus within their own household, making the decision a possible conflict of interest.</p>
<h2>When would this be OK?</h2>
<p>We do sometimes make altruistic decisions on behalf of children. Children can be <a href="https://journalofethics.ama-assn.org/article/should-children-be-asked-be-bone-marrow-donors-siblings/2016-01">life-saving bone marrow donors for siblings</a>, for example, despite the risks. </p>
<p>We can also apply the idea that we can restrict liberty where there is a <a href="https://ethics.org.au/ethics-explainer-the-harm-principle/">risk of harm to others</a>. For instance, if a child is infected with COVID-19, they need to be isolated and quarantined just like adults.</p>
<p>However, vaccination differs from both examples in one key respect. With vaccination, there is unlikely to be a single identified person the child will help, or whom they are uniquely placed to help. Instead, the potential benefits are collective, to the wider public.</p>
<p>If a child lived with a sibling who had an underlying condition that makes them particularly vulnerable to COVID-19, or lived with their grandparents, vaccination might be an easier choice.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child sitting on grandfather's lap reading together" src="https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/366004/original/file-20201028-17-adbjzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If a child lived with grandparents, vaccination might be an easier choice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/grandfather-grandson-family-reading-leisure-568104286">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Three factors could help us decide</h2>
<p>When weighing up whether children should be vaccinated ahead of adults, we can ask:</p>
<p><strong>1. How severe is the threat to public health?</strong></p>
<p>So far, <a href="https://www.worldometers.info/coronavirus/">more than a million people</a> have died from COVID-19. There’s also the risk of overwhelming health systems and the additional collateral damage in terms of economic, social, educational and risk of excess non-COVID-19 deaths as a result (for example through suicide, or delayed access to health care). COVID-19 affects everyone in society, <a href="https://www.unicef.org.au/blog/unicef-in-action/may-2020/coronavirus-hidden-impacts">including children</a>.</p>
<p><strong>2. Are there alternatives?</strong></p>
<p>If vaccination works well enough in vulnerable people, or there are other strategies to achieve the same effect, such as general adult vaccination, we should use those instead.</p>
<p><strong>3. Is the response proportional to the threat?</strong></p>
<p>As we vaccinate the vulnerable, and the general adult population, even if it is not fully effective, we will reduce the severity of the crisis. We should assess at that stage whether the remaining problem warrants vaccinating children. </p>
<p>Assuming we meet these conditions, we argue prioritising childrens’ vaccination, on a voluntary basis at least, is the right strategy.</p>
<h2>How about mandatory vaccinations?</h2>
<p>Mandatory vaccination <a href="https://jme.bmj.com/content/early/2020/11/09/medethics-2020-106821">can be justified</a> if voluntary strategies do not achieve herd immunity, or do not achieve it fast enough to protect the vulnerable. </p>
<p>To gauge whether mandatory vaccination is worth it, we might also need to consider how lethal and infectious a virus is.</p>
<p>For instance, smallpox had a death rate of <a href="https://www.who.int/biologicals/vaccines/smallpox/en/">up to 30%</a> (although contagion requires <a href="https://www.health.harvard.edu/a_to_z/smallpox-a-to-z">fairly prolonged contact</a>). It was eradicated by 1979 through vaccination, which was mandatory in many countries. With COVID-19, <a href="https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/">0.1-0.35% of infections are fatal</a>.</p>
<p>By definition, mandatory vaccination involves some form of coercion. This can include withholding financial benefits or access to early childhood education (<a href="https://www.health.nsw.gov.au/immunisation/Pages/no-jab-no-pay.aspx">No Jab, No Pay</a> or <a href="https://www2.health.vic.gov.au/public-health/immunisation/vaccination-children/no-jab-no-play">No Jab, No Play</a> in Australia); preventing children from entering school (<a href="https://www.cdc.gov/phlp/docs/school-vaccinations.pdf">USA, with specific rules varying by state</a>) to fines (<a href="https://link.springer.com/article/10.1057/s41271-019-00163-8">Italy</a>). France even has <a href="https://link.springer.com/article/10.1057/s41271-019-00163-8">legal provision for imprisonment</a> for parents who refuse certain vaccines.</p>
<p>Mandatory vaccination (of some kind) could be justified in groups who are at increased personal risk from COVID-19 — such as health-care workers, the elderly, men, or people with other health conditions — if incentives such as increased freedoms, or even payment are not sufficient. For these groups, the vaccine is win-win: it both protects others and the person vaccinated.</p>
<h2>And mandatory vaccinations for children?</h2>
<p>The situation is more tricky with children. Unless they have underlying health conditions or have a <a href="https://www.abc.net.au/news/2020-09-04/pims-ts-kawasaki-covid-19-children-disease-australia-explained/12627610">rare but serious</a> inflammatory condition after infection, children are less likely to have severe <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1095/5885157">COVID-19 or die from it</a>.</p>
<p>So the risk of the vaccine itself (as yet unknown) weighs more heavily. </p>
<p>On the other hand, children benefit from grandparent relationships, and other freedoms afforded by a pandemic-free society.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-may-need-to-be-vaccinated-against-covid-19-too-heres-what-we-need-to-consider-146404">Children may need to be vaccinated against COVID-19 too. Here's what we need to consider</a>
</strong>
</em>
</p>
<hr>
<p>Mandatory vaccination might be justified in children if the following criteria are met:</p>
<ul>
<li><p>the vaccine is proven to be very safe for children (including in the long term, as yet unknown), and safer than the effects of the disease</p></li>
<li><p>children are significant spreaders of infection (<a href="https://theconversation.com/behind-victorias-decision-to-open-primary-schools-to-all-students-report-shows-covid-transmission-is-rare-147006">which does not appear to be the case for COVID-19, at least for pre-teens</a>)</p></li>
<li><p>there are other non-COVID benefits to children, such as return to normal social and educational life (school), and access to normal health-care services which they otherwise could not have</p></li>
<li><p>measures are reasonable and proportionate, for instance, by limiting child care benefits (rather, for instance, than sending parents to prison). </p></li>
</ul>
<p>We are certainly not close to meeting these criteria for mandatory vaccination of children against COVID-19 yet, especially as we don’t know how effective and safe candidate vaccines are in different populations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-our-immune-responses-to-covid-vaccines-are-unique-145248">5 ways our immune responses to COVID vaccines are unique</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/147899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Savulescu receives funding from the Wellcome Trust, Australian Research Council, and the Oxford Martin School for relevant projects. He receives salary support including from the Murdoch Children's Research Institute. He is a Partner Investigator for an Australian Research Council Linkage award. The project has industry partnership from Ilumina, but there is no industry funding to or under the control of Savulescu. </span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from the NHMRC, Australian and Victorian Government Departments of Health, MCRI and WHO. She holds a clinician scientist fellowship from the University of Melbourne. </span></em></p>There’s no guarantee future COVID-19 vaccines will work in the elderly. So we can consider vaccinating the young first to protect them. Here’s what we need to work out first.Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children's Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of OxfordMargie Danchin, Associate Professor, University of Melbourne, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433702020-07-29T10:44:25Z2020-07-29T10:44:25ZA coronavirus vaccine may require boosters – here’s what that means<p>In the global race to contain the coronavirus pandemic, there is hopeful news on the vaccine front, with a number of potential candidates being developed and some <a href="https://theconversation.com/oxford-immunologist-on-coronavirus-vaccine-our-early-results-look-highly-promising-141558">promising early results</a>. Based on what we know so far, it currently seems likely that most potential vaccines designed to protect against the SARS-CoV-2 virus that causes COVID-19 will require boosters, perhaps regularly. Why is this? </p>
<p>When an infectious agent enters the body, the immune system will notice this and create a memory, so that the next time it encounters the agent there will be a swift, repelling response. In the case of most infectious agents, such as viruses, natural infection produces a long-lasting memory. But this is not always the case.</p>
<p>The idea behind any vaccine is to give the recipient a version of the infectious agent which will not cause the disease, but will still <a href="https://www.immunology.org/celebrate-vaccines/public-engagement/guide-childhood-vaccinations/how-vaccines-work">create the immune system memory</a>. How we achieve that varies based on the nature of the virus targeted by a vaccine, and how much we know about it. </p>
<h2>Two types of vaccine</h2>
<p>Some vaccines are made by disabling the infectious agent in some way so that it becomes safe to introduce to our bodies, but still goes through its normal life cycle. The theory is that this will stimulate something close to the natural immune response and produce the long-lasting memory without making the recipient sick. </p>
<p>This is the basis of the vaccine we are given for measles, mumps and rubella (MMR). It contains live but disabled versions of each virus. Children are given two doses of the vaccine a few years apart. This is in case the vaccine does not “take” the first time around and the immune system needs a reminder of what the viruses look like. This repeat vaccine is not technically a booster, but rather a second dose which allows for possible interference by other childhood infections the first time around, and because a pre-school child’s immune system is still developing. </p>
<p>The MMR approach has been possible because the viruses that cause measles, mumps and rubella are well established in the human population and virologists know a lot about how they interact with the human immune system. But it takes years to create a safe and effective live vaccine, so for SARS-CoV-2, research teams are trying different routes. A good approach is to use a killed version of the virus rather than a modified, live version as in the case of MMR. </p>
<p>The <a href="https://www.who.int/biologicals/areas/vaccines/polio/ipv/en/">inactivated polio vaccine</a>
and influenza vaccines both use killed viruses. The drawback of these vaccines is that the immune response does not last, which is why boosters are needed. </p>
<p>In the case of seasonal influenza, variations in the virus means a fresh vaccine is <a href="https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/vaccination">needed each year</a> anyway, but even if the virus did not change, boosters would still be required to keep stimulating the immune memory because the virus in the vaccine is not live.</p>
<p>In the case of polio, most countries now use the inactivated polio vaccine in their childhood vaccination programme instead of the live, oral version. As the disease is <a href="https://academic.oup.com/jid/article/221/4/504/5351111">close to being eradicated</a>, the theory is that giving each cohort of children a single dose should be enough to protect them as they start mixing with others. But if there was an outbreak, then everyone in close contact in the local area would need a booster.</p>
<h2>What a COVID-19 vaccine may look like</h2>
<p>The potential COVID-19 vaccine designed by <a href="https://valneva.com/press-release/valneva-confirms-participation-in-uk-government-covid-19-vaccine-response-program/">French company</a> Valneva, which will be manufactured in Scotland, is a killed vaccine. If it is effective in protecting against SARS-CoV-2, it could really help to reduce the spread of the virus. </p>
<p>In the case of this vaccine, regular (perhaps annual) boosters would probably be needed to help to ensure people keep their immune memory. In an outbreak situation, everyone in the affected area could be given a dose of the vaccine to help contain the transmission. </p>
<p>Another approach in vaccine design is to take the genetic code for a part of the virus which is known to stimulate an immune response, and place that into a carrier organism which cannot cause disease. </p>
<p>The Hepatitis B vaccine uses the code for the antigen found on the outside of infectious virus particles. This has been put into the genome of a harmless yeast and made into a vaccine. As the yeast grows and divides, it also makes the virus’s surface antigen, thus stimulating the body to <a href="https://www.tandfonline.com/doi/full/10.1080/14760584.2017.1338568">keep making an immune response</a>. This vaccine is given in three doses over six months in the first instance, and most people require a booster after about five years. </p>
<p>The COVID-19 vaccine developed by the team at Oxford University, which has shown <a href="https://www.research.ox.ac.uk/Article/2020-07-19-oxford-covid-19-vaccine-trials">promising early results</a>, uses a broadly similar approach, in that researchers have taken the code for the SARS-CoV-2 “spike protein” and put it into a harmless virus carrier. </p>
<p>So, it is possible that the initial schedule for everyone who received this type of vaccine would involve one or two booster doses a few months after the first, in a similar way to the Hepatitis B vaccine. We are not really sure how long we would protected against COVID-19 using this approach, by analogy with Hepatitis B – but it could be a few years. This might be enough to contain the spread of SARS-CoV-2 around the world.</p>
<figure class="align-center ">
<img alt="A 3D medical illustration of 2019 Novel Coronavirus, depicting the ultrastructural morphology of the virus." src="https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349951/original/file-20200728-33-1wvs0l4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Oxford University coronavirus vaccine candidate uses the genetic code from the virus’s ‘spike protein’.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:3D_medical_animation_coronavirus_structure_vie.png">https://www.scientificanimations.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The need for a booster should not provide a barrier for the roll-out of any potential COVID-19 vaccine, as our experiences with Hepatitis B, MMR and influenza prevention have shown. </p>
<p>But it will require a concerted effort to make billions of doses of the vaccine and distribute them efficiently and fairly around the world. All countries will need a robust vaccination programme in place to invite everyone to have the first dose and then remind them to have the second or third dose as required. It will also be important to monitor how people respond to make sure that the booster works as planned.</p>
<p>If we can manage this, getting immunised against COVID-19 may just become a normal part of our routine health care duty – like regularly going to the dentist.</p><img src="https://counter.theconversation.com/content/143370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Pitt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether a coronavirus vaccine involves a live virus or a carrier organism, it will probably require more than one injection. But that’s not a bad thing.Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, Fellow of the Institute of Biomedical Science, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1400702020-06-15T01:55:41Z2020-06-15T01:55:41ZGetting vaccinated at the pharmacy? Make sure it’s recorded properly<figure><img src="https://images.theconversation.com/files/341425/original/file-20200612-93521-ezks13.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C1000%2C651&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccination-242399758">Shutterstock</a></span></figcaption></figure><p>Pharmacists are vaccinating more and more people, but those shots are not always ending up in your immunisation record, our <a href="http://ncirs.org.au/reports">report</a> out today shows.</p>
<p>This means your records could be incomplete, leading to unnecessary repeat vaccinations, or it could affect your eligibility for government benefits or work. </p>
<p>Incomplete records also mean health authorities cannot accurately monitor vaccination uptake across the population. </p>
<p>And if we have a vaccine for COVID-19 delivered through pharmacies, accurate record keeping will be important for both individuals and health authorities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-the-who-says-a-coronavirus-vaccine-is-18-months-away-131213">Here's why the WHO says a coronavirus vaccine is 18 months away</a>
</strong>
</em>
</p>
<hr>
<h2>Pharmacy vaccination is popular and becoming more so</h2>
<p>Our report, by the National Centre for Immunisation Research and Surveillance, shows pharmacy vaccination is becoming more popular. </p>
<p>In 2017, it accounted for 0.1% of all vaccinations reported to the <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register">Australian Immunisation Register</a>. However, by 2019, that had risen to 2.7%, the vast majority (95%) of those influenza vaccine.</p>
<p>Pharmacists have also been allowed to give a wider range of vaccines to younger people over recent years. For instance, appropriately trained pharmacists in all states and territories can give:</p>
<ul>
<li><p>influenza vaccine to anyone aged 10 years or over</p></li>
<li><p>measles-mumps-rubella (MMR) or diphtheria-tetanus-pertussis (dTpa) vaccine to anyone aged 16 years or over.</p></li>
</ul>
<p>The rules for other vaccines vary depending on the <a href="http://ncirs.org.au/sites/default/files/2020-06/NCIRS%20Information%20Sheet-%20Vaccines%20from%20community%20pharmacy_updated%2010%20June%202020_final.pdf">state or territory</a> you live in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pharmacists-can-vaccinate-adults-against-whooping-cough-measles-and-the-flu-but-it-might-cost-you-more-122191">Pharmacists can vaccinate adults against whooping cough, measles and the flu, but it might cost you more</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>In <a href="https://www.health.nsw.gov.au/immunisation/Documents/pharmacist-new-standard.pdf">NSW</a> and the <a href="https://www.legislation.act.gov.au/View/di/2020-88/current/PDF/2020-88.PDF">ACT</a> it’s mandatory for pharmacists to report vaccinations to the Australian Immunisation Register. It’s strongly encouraged in other states and territories.</p>
<p>However, we found substantial under-reporting of pharmacist vaccinations. </p>
<p>Pharmacies are said to have administered <a href="https://www.psa.org.au/pharmacists-protecting-australians-from-the-deadly-flu-virus/">over one million</a> influenza vaccinations in 2018. That’s ten times more than the number we found recorded in the Australian Immunisation Register that year.</p>
<p>In 2019, there were reported to be <a href="https://ajp.com.au/news/give-us-the-nip-guild/">over two million</a> influenza vaccinations in pharmacies, four times more than actually recorded.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341401/original/file-20200612-38695-zl08jo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all pharmacy vaccinations are properly reported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-making-prescription-record-through-computer-483541759">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why does this matter?</h2>
<p>Under-reporting of pharmacy vaccines is less of an issue for influenza vaccination, which is needed every year. But it is more important for vaccines only needed in one or two doses or at long periods apart, such as the two doses of MMR vaccine.</p>
<p>And as pharmacy vaccination expands to travel vaccines – such as cholera and hepatitis A (which can both now be given by pharmacists in Queensland) – having an accurate immunisation record is important when travel restrictions ease.
It’s likely a long time between overseas trips and remembering which vaccinations you’ve had can be difficult.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prepare-for-a-healthy-holiday-with-this-a-to-e-guide-69552">Prepare for a healthy holiday with this A-to-E guide</a>
</strong>
</em>
</p>
<hr>
<p>As pharmacist vaccination expands to include younger ages and vaccines on the <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule">National Immunisation Program</a>
(the series of vaccinations given at specific times throughout your life) there’s greater potential for confusion if records are not complete. Any unrecorded vaccinations could affect certain <a href="https://www.servicesaustralia.gov.au/individuals/topics/what-are-immunisation-requirements/35396">government support</a> or access to child care under <a href="http://www.ncirs.org.au/public/no-jab-no-play-no-jab-no-pay">No Jab No Pay or No Jab No Play policies</a>. </p>
<p>An accurate record of vaccinations can also be important to meet requirements for some university courses and jobs, particularly related to health care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
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<h2>It’s not just pharmacists</h2>
<p>Generally, vaccines given to young children (who are mostly vaccinated in GP clinics) are reliably recorded, but our <a href="https://cdn.theconversation.com/static_files/files/1068/2018_AIR_data_tranfer_report_FINAL_0.pdf?1591918206">2018 report</a> found some reporting errors. So it pays to check.</p>
<p>Reporting of adult vaccinations has been less reliable. Another of our <a href="https://cdn.theconversation.com/static_files/files/1069/Analysis_of_adult_vaccination_data_on_AIR_Nov_2019.pdf?1591918354">recent reports</a> showed true vaccination uptake for the shingles vaccine, largely given in GP clinics, could be up to twice as high as that recorded in the Australian Immunisation Register.</p>
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Read more:
<a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">How rivalries between doctors and pharmacists turned into the 'turf war' we see today</a>
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<p>Many vaccinations given in workplaces – for instance hospitals and commercial providers of workplace influenza vaccination programs – are also not currently captured in the Australian Immunisation Register, although such vaccination providers can now register to report them.</p>
<h2>How can you check your immunisation record is accurate?</h2>
<p>If you are getting a vaccination from a pharmacist, or any other vaccination provider, you can check they will be reporting it to the Australian Immunisation Register and ask for a paper record of the vaccination.</p>
<p>You can then later request an immunisation history statement, which shows all the vaccinations recorded on the Australian Immunisation Register. You can <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register/how-get-immunisation-history-statement">do this</a> via your Medicare online account (through myGov), the Express Plus Medicare mobile app, the Australian Immunisation Register help line (1800 653 809) or your vaccination provider. </p>
<p>If vaccinations are missing, you can contact the relevant vaccination provider and ask them to update your Australian Immunisation Register record.</p>
<h2>What can we do about it?</h2>
<p>Ultimately, it shouldn’t be your responsibility to regularly check your immunisation records are accurate and up to date. It should be the responsibility of the vaccination provider to report your vaccinations to the Australian Immunisation Register.</p>
<p>So we recommend further <a href="https://www.servicesaustralia.gov.au/organisations/health-professionals/subjects/air-education-vaccination-providers">education and training</a> for pharmacists, legislation to make Australian Immunisation Register reporting by pharmacists compulsory in all states and territories; and increasing and improving use of <a href="https://www.servicesaustralia.gov.au/organisations/health-professionals/subjects/web-services-digital-health-and-aged-care-channels">electronic reporting methods</a>.</p>
<h2>How about a vaccine for COVID-19?</h2>
<p>If a COVID-19 vaccine becomes available, we will likely need a mass immunisation program to vaccinate as many people as possible. Pharmacists may be part of this program. Legislation in Queensland <a href="https://www.abc.net.au/news/2020-04-11/coronavirus-queensland-pharmacists-medication-dispensing/12141376">is being amended</a> to allow for this. </p>
<p>Hopefully, by then, we will have addressed some of these issues.</p>
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<p><em>Kaitlyn Vette, Lauren Dalton and Kristine Macartney, from the National Centre for Immunisation Research and Surveillance, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/140070/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frank Beard is employed by the National Centre for Immunisation Research and Surveillance, which receives funding from the Australian Government Department of Health, NSW Health, and the Sydney Children's Hospitals Network </span></em></p>If your immunisation record is incomplete, you might repeat a vaccination unnecessarily, or miss out on government support, child care, or work. So it pays to check.Frank Beard, Senior Lecturer, School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1363012020-04-16T14:19:56Z2020-04-16T14:19:56ZCoronavirus risks forcing South Africa to make health trade-offs it can ill afford<figure><img src="https://images.theconversation.com/files/327985/original/file-20200415-153357-1pk9nc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children at window of a building in Hillbrow, Johannesburg. Children will be vulnerable if vaccinations are postponed.</span> <span class="attribution"><span class="source">Photo by Marco Longari/AFP via Getty Images</span></span></figcaption></figure><p>South Africa’s health authorities are testing, quarantining and treating individuals who have been exposed to the <a href="https://sacoronavirus.co.za/2020/04/09/message-by-president-cyril-ramaphosa-on-covid-19-pandemic-thursday-9-april-2020/">new coronavirus</a>. And the country is in lockdown in an attempt to slow <a href="https://sacoronavirus.co.za/2020/04/09/message-by-president-cyril-ramaphosa-on-covid-19-pandemic-thursday-9-april-2020/">the spread</a>. </p>
<p>Much has been said about balancing the economic trade-offs with the lives the country needs to save versus the social and <a href="https://theconversation.com/south-africa-needs-to-mitigate-the-worst-of-its-inequalities-in-tackling-coronavirus-135564">economic costs</a> of doing so. Less discussed are the trade-offs being made within health care as services are focused on COVID-19.</p>
<p>Child health is of particular concern. South Africa <a href="https://www.hst.org.za/publications/Pages/DISTRICT-HEALTH-BAROMETER-201819.aspx">has 5.8m children</a> under 5 years of age. This group <a href="https://www.bmj.com/content/369/bmj.m1327">appears to be less susceptible</a> to COVID-19. But, if the country doesn’t pay attention, the death rate for these children will soon increase. </p>
<p>The reason for this is measles, a highly contagious disease that mostly affects children under the age of 5. The basic reproductive number of measles in a susceptible population is between 12 and 18. This means that on average every person with measles will infect between <a href="https://pubmed.ncbi.nlm.nih.gov/28757186/">12 and 18 people</a>. While we don’t know with certainty, the reproductive number of symptomatic cases of SARS-CoV-2 is thought to be <a href="https://www.sciencedirect.com/science/article/pii/S0924857920300674">between 2 and 3.5</a>.</p>
<p>Measles remains a threat in countries across the world despite the fact that a safe and effective vaccine has been available since 1963. </p>
<p>Most measles-related deaths are caused by complications. The most serious includes brain swelling, severe diarrhoea and related dehydration, pneumonia, blindness and deafness. Severe measles is more likely among poorly nourished, young children. With <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf#page=33">27%</a> of the country’s children either stunted or wasted, any relaxation of the vaccination regime would place them at high risk of severe disease.</p>
<p>As it is, the country’s isn’t achieving its <a href="https://www.hst.org.za/publications/District%20Health%20Barometers/District%20Health%20Barometer%20Profile%2020182019.pdf">91% immunisation target</a>. The global target <a href="https://www.afro.who.int/news/reaching-more-8-million-children-measles-rubella-vaccines">set by the World Health Organisation is 95%</a>. South Africa’s vaccination regime involves providing the first measles vaccine at 6 months, the second dose at 12 months. </p>
<p>The danger is that health workers will be diverted to other tasks related to COVID-19, further compromising immunisation. This could well mean that South Africa will lose many children due to a measles outbreak which is completely preventable. </p>
<h2>The measles threat</h2>
<p>Previous research on the impact of measles catch-up campaigns on routine immunisations in 2010 can help inform the country’s thinking. These campaigns – or supplementary immunisation activities – <a href="https://www.ncbi.nlm.nih.gov/pubmed/23975755">required</a> the mobilisation of a large health workforce from within health system.</p>
<p>This had a severe effect on the delivery of health. For example, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587392/">research</a> showed that during a three week campaign in 52 districts in 2010 there was a 30% decrease in children completing the primary course of immunisation. In addition, there was a 10% decrease in antenatal visits and a 12%-17% decrease in use of injectable contraceptives. </p>
<p>The COVID-19 epidemic has resulted in the provision of only “essential” health services in some provinces. If routine immunisation is not classified as an essential service there will likely be severe consequences. </p>
<p>In particular, measles will start rearing its ugly head and children will die needlessly. This has occurred in pockets all around the world as a result of campaigns run by parents who refuse to have their children vaccinated. Globally <a href="https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide">there were 140 000 deaths in 2018</a> – all avoidable.</p>
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Read more:
<a href="https://theconversation.com/explainer-a-history-of-the-measles-virus-and-why-its-so-tenacious-130262">Explainer: a history of the measles virus and why it's so tenacious</a>
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<p>The South Africa government should urgently put in place a plan that can be implemented once the lockdown is over. It should, for example, consider opening schools or day care centres as sites for immunisations. The campaign could use a mobile – information providing cell phone application called <a href="http://www.health.gov.za/index.php/mom-connect">Mom Connect</a> to send messages to those caring for children under 2 asking them to bring them to the chosen sites. School nurses together with a volunteer corps of retired doctors and nurses could administer vaccines.</p>
<h2>Additional trade offs</h2>
<p>The country risks making other health trade offs too.</p>
<p>South Africa is still in the midst of an HIV epidemic – with 7.9 million people infected. Some 2 million, however are not on treatment, which puts them at <a href="http://aidsinfo.unaids.org/.">high risk for COVID-19</a></p>
<p>An important lesson the country has learnt about the HIV epidemic is that prevention is critical. And that it needs to be started early (in the epidemic and in life) and needs to be continued for decades. This lesson has not yet been extended to health overall and health literacy for the whole population <a href="https://www.who.int/global-coordination-mechanism/working-groups/hl_kickbusch.pdf?ua=1">is a critical base</a> on which to engage a population when it comes to an epidemic.</p>
<p>South Africa has other areas of vulnerability when it comes to health. The country lags behind other comparable developing countries. We don’t achieve “a good bang for the buck” in terms of health. Peer countries such as Thailand and Brazil <a href="https://www.un.org/en/development/desa/population/publications/pdf/mortality/World-Mortality-2017-Data-Booklet.pdf">spend less on health and achieve better outcomes</a>. For example, under 5 mortality in Brazil is half of South Africa’s 32 deaths per 1000 live births.</p>
<p>The danger is that these statistics will get worse as a result of efforts to curtail COVID-19. </p>
<p>Other areas of concern are the growing burden of obesity-related disease such as hypertension, diabetes and common cancers, diseases related to tobacco use and alcohol misuse. Over the past two decades South Africa has not maximised cost effective investments in preventing and treating these conditions.</p>
<p>This means that millions of South Africans are now more vulnerable to COVID-19.</p>
<h2>What needs to be done</h2>
<p>South Africa needs to begin with prevention of disease and promoting health by focusing on risk factors, many of which are in sectors other than health. These include inequality and poverty, access to clean water and sanitation, healthy nutrition, alcohol and tobacco control. </p>
<p>Without this we will be even less prepared for the next pandemic.</p><img src="https://counter.theconversation.com/content/136301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the IDRC (Canada), UK Wellcome Trust, UK National Institutes for Health Research, Bloomberg Philanthropies and the South African Medical Research Council. In the past, she has also received funding from the Bill and Melinda Gates Foundation, WHO and UNFPA.</span></em></p><p class="fine-print"><em><span>Susan Goldstein does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa could lose many children due to a measles outbreak which is completely preventable.Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandSusan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.