Bridget Freeman-Rock looks at the Covid vaccine ‘big picture’, then reports on preparations here in Hawke’s Bay.
It’s a coronavirus déjà vu, writing this. Trying to pin down a moving target.
New studies, new developments, new news.
The horror locus now Brazil, where the pandemic rages, more deadly there than in India (which has more cases) with over 3,000 people dying a day.
Brazil’s worrying P.1 Covid variant, with its triple mutation spike-protein (started in the city of Manaus, which was devastated by Covid last April) is more virulent and capable it seems of “antigenic escape” (meaning vaccines might not work or as well), and is affecting pregnant women and the young more than other strains. Most patients in ICU are now under 40, says the Brazilian Association of Intensive Care Medicine. Women have been advised to delay getting pregnant.
Meanwhile, a woman in her 40s has died in Australia of a rare blood-clotting syndrome as a result of an AstraZeneca shot. The chances of blood clot from the AZ vaccine are statistically minuscule (though for this individual catastrophic): about 4 in a million. By comparison the chances of blood clots as a result of taking the birth control pill are 150-800 per 1 million women; in the Pfizer and Moderna vaccines there’s ‘no signal’ of this after hundreds of millions of doses given. But it’s a chance some won’t be willing to take.
Weighing the tragedy of one life against a magnitude. Weighing the hope that vaccination will save the day and end the pandemic against the realisation that it’s complicated. Ongoing.
Covid vaccination in a Covid-free country
There’s been a bit of scratchiness in the media about the Government’s vaccine roll-out: it’s too slow, too inept, we’re making it up on the fly, where is the urgency, etc. But on the ground, there’s a huge effort happening, and, says vaccinologist Helen Petousis- Harris, it’s the nature of the beast. Each country starts comparatively slow, encounters problems, irons kinks, adapts, before becoming more machine-like, slick.
NZ’s doing great, she says.
We need to keep perspective. And there needs to be more information.
The Government’s clear, direct messaging during alert levels (Stay home, wash hands, be kind, etc), won’t cut the mustard here. Those who are vaccine-hesitant don’t want to be told in simple paternalistic terms that the vaccine’s safe; they want to see the evidential backing, to understand the science behind it. They have valid questions.
In Hawke’s Bay we feel safely removed from the border. That between us and any risk is Auckland. Our everyday lives are not affected, and if you’re not elderly or vulnerable or anxious, and there’s no circulating virus, it’s hard to feel the urgency or even the need.
To be honest, hardly anyone I speak to is in a hurry to get the jab. That doesn’t make them (necessarily) anti-vaxxers or conspiracists. Vaccine-ambivalent, perhaps.
I also don’t know anybody, really, who has had corona virus. It’s something happening elsewhere, still.
Statistically, consistently, 20% of New Zealanders are in the ‘hesitancy’ category; 10% hardline nays. But the reluctancy percentage for the Covid jab amongst Māori and Pasifika has fallen – and that’s good news for the campaign, which needs to work hard to build trust, both in communication and experience.
Ashley Bloomfield believes there will be more uptake as borders open and risk grows, when the implications (of not vaccinating) become clear, when people want to travel, etc.
Already the opening of the trans- Tasman travel bubble is making some a little nervous.
Stories from Germany
Every time we spoke with my father-in-law in Berlin last year leading up to Christmas, another neighbour in his apartment block had just died of Covid – five in December alone. The threat was literally next door.
In February my father-in-law’s wife had a simple fall with a nasty result and was admitted to hospital. It would be weeks before he could even see her as Germany then was in lockdown. She alone in a hospital ward, he alone in their flat, an hour’s masked trip away by public transport. When it became clear she was not coming home but was dying of cancer, he was granted compassionate visitor rights for what would be her final days. He spent Easter by himself during another German lockdown, organising her funeral by phone.
He’s been vaccinated now, amidst Germany’s sluggish roll-out, as slowly restrictions start to lift again. In the end, in a community dogged by the virus, it’s as much about easing loneliness as it is about safety.
Antje near Stuttgart, who’s a midwife, has also had her jab. She said when it came down to it, it wasn’t a question: “I know too many people personally who have long-Covid. Fit and healthy before, they’re now debilitated – can’t work, can barely walk (some). I’ll take the risk of side effects any day over that.”
Again, it’s about perspective.
Not a silver bullet
The new normal is not going to be herd immunity, say experts in the international journal Nature (‘Why herd immunity is probably impossible’).
That threshold was once deemed possible if we vaccinated 60-70% of the population. The vaccine-willing, more or less. But Covid vaccines don’t stop infection altogether and it’s not clear if they stop the transmission of the virus. Nor is there a guarantee how long immunity (from vaccines and infection) lasts for. Perhaps only six months?
And we’re not vaccinating the kids.
The Pfizer vaccine, which New Zealand has begun rolling out has 90% efficacy in preventing symptomatic disease; with the more virulent variants, like Brazil’s P.1 its efficacy looks to be reduced (as per lab testing) to 60%.
This all means you need as many people as possible to be vaccinated (the 100% Bloomfield is aspiring to), if you want that threshold, which means bringing everyone on board.
The whole purpose is to go beyond our island bubble, but globally there’s huge variance in vaccination roll-outs – mostly it’s wealthy countries attending to themselves first. And the risk in countries where the virus runs unabated, is that new variants emerge and spread, outsmarting vaccines, and the cycle repeats. Huge global inequities may ultimately mean no one wins.
Vaccination will help in protecting our vulnerable and guarding our border. It will help to significantly reduce frequency and degree of severity, even if a variant like Brazil’s P.1 made it ashore. It will in time, enable the virus to “dissipate” of its own accord, to become endemic in due course like influenza, perhaps, without causing such havoc.
But in a globally connected world, we won’t be throwing away the tools of distancing and mask-wear, vigilant testing and genomic sequencing, and follow-up contact-tracing any time soon, I’m told.
Vaccination is not a silver bullet, but better than a lead one, my mother quips.
26 March 2021: the hospital’s Covid vaccination centre “is heaving” with clinical staff receiving their first jab from fluro-vested vaccinators. It’s the first day of the Tier 2 roll-out and there is a definite buzz in the air.
It’s also a year and a day since the country went into lockdown, when overseas in places like Italy, health workers were making extraordinary decisions on who to treat and who to let die as colleagues around them succumbed. The anxiety on the frontline was real.
Now, as Ngaira Harker, the DHB’s clinical coordinator of the roll-says, “the vaccine is another added layer to our protective armour”; “the next big step forward.”
By all accounts, it’s a very quick prick, over before you know it. Rounded off with ginger nuts and cups of tea.
Border workers and whānau (Napier Port, the airport) have already been vaccinated, the focus now being on the health and disability workforce, beginning with just under 2,000 frontline workers (from nurses working in general practice doing swabs, to emergency doctors, to midwives and orderlies, security staff), before turning to a further 7,000 workers in the sector, which will take the roll-out to early May.
Then priority “pounamu” members (the elderly, the more at-risk – Tier 3), then the general population (Tier 4), scheduled for commencement in July and consistent with the national timeline.
New Zealand has purchased enough of the Pfizer vaccine to cover the country in the largest-ever public health endeavour in its history. The Pfizer’s considered one of the best and most effective of the Covid vaccines, but it’s a tricky, fragile vaccine to handle, which makes for creative logistics.
Because of its rapid expiry date (5 days) after being taken out of the Ultra-Low Temperature storage facility in Auckland, distribution requires a careful pairing of supply to demand. It comes in multi-dose vials, provided in 30-dose packs that must be delivered on the same site. Once a vial is opened it must be used within 2 hours.
As Ngaira explains in her Covid-19 Vaccination Progress Report (March), it can’t just be woven into business as usual by providers, but requires specific training and discrete clinics; many community pharmacies and general practices won’t have the capacity, workforce or infrastructure to do this.
The DHB’s Vaccination Project team are engaging with bigger providers who can (such as the Hastings Health Centre and Te Taiwhenua); will be setting up mass vaccination centres (Napier’s Memorial Convention Centre, Hastings Race Course have been proposed; churches, marae, community centres); and allocating vaccine and resource to Māori and Pasifika providers for older people and their whānau/carers living in harder to reach locations.
Full vaccination requires two doses, given 21 days apart, so there’s call back and follow up, and overlapping schedules. One of the challenges is the need for a national booking system to support this, which (at time of writing) is not in place.
Ngaira cautions: “There is risk in attempting to increase our delivery too quickly. The roll-out needs to be managed in a controlled, safe and appropriate way which takes time to develop.”
CEO Keriana Brooking (who worked alongside Ashley Bloomfield in the ministry as deputy director general of the Covid-19 Health Response last year) says “We won’t be making any decision in haste.” And that the DHB is “running a very collaborative model”.
Community leaders are engaged and want to assist in getting the right number of people in at the right time, and there are plans in place to offer overflow vaccinations, so there’s no waste. “It’s a case of logistics and flexibility.”
For example, if more people arrive at a centre in a remote place like Mahia than have been prioritised, if there is enough vaccination, they’ll get jabbed too.
“We’re not going to turn people away because they’re technically on the list for having it in three weeks’ time.”
Regarding healthcare staff who are not keen on the jab. “There are some who are hesitant and want to be informed,” says Keriana. “But there’s a difference between hesitancy and not wanting to get vaccinated at all.”
Providing good information will be key. For the general public the DHB will use a mix of national and local communication, with a strong Māori and Pasifika presence. A lot of on ground work, social media, face to face.
“We will respect people’s choice. Vaccination is not compulsory in this country. We will be relying on people to be informed and to make the decision that’s best.”
But Keriana is “confidently optimistic” that Hawke’s Bay has this in hand.
“There’s an expectation from the Government for us to make every effort to vaccinate the population by Christmas, and we are.”