AstraZeneca hesitancy: How experiences at home and overseas can help Australian clinicians have conversations with patients about getting vaccinated

Now that we have had the Delta variant shutting down the lives of 12 million Australians, we desperately need the community protection that vaccines can provide.

The Delta strain has taken off around the world.  In the UK, the British vaccination program, largely with AstraZeneca, appears to be keeping hospitalisations and deaths lower than last year. Public Health England claimed in June that vaccination has prevented more than 7 million COVID infections and 27,000 deaths.

So, if your patients are weighing up the risks versus benefits of having the AstraZeneca vaccine here is a summary based on Australian data.

If patients are under 50, it is hard to estimate the risk of a clotting syndrome accurately because the numbers are so low, but it is around 3 per 100,000 first doses.

If patients are over 60, the risk is lower from 1.4 to 1.9 cases of clotting per 100,000 first doses of AstraZeneca.

On the other side of the ledger, here are the estimated benefits of vaccination if we were in an environment like Victoria’s second wave of last year with last year’s variant.

In 18 to 29-year-olds vaccination would prevent around 10 hospital admissions per 100,000 doses and that rises to 260 hospitalisations prevented in the over 80-year-olds.

Both the AstraZeneca and Pfizer vaccines are highly effective at preventing severe illness and there is not much difference between them. People will still get sick, but the severity is reduced, and the UK experience has been repeated elsewhere including Singapore.

At Singapore’s Changi Airport an 88-year-old member of the airport cleaning crew who was fully vaccinated tested positive for the virus on 5 May 2021. Of the 28 airport workers who became infected, 19 were fully vaccinated with either the Pfizer or Moderna vaccines, the two approved for use in Singapore.

Whilst new restrictions were put in place after the workers become infected, none of the vaccinated cases linked to the airport outbreak resulted in critical illness or death, according to officials. In fact, even though the Singapore outbreak involved over 30 clusters and hundreds of cases, not a single fully vaccinated person ended up in hospital unlike partially or unvaccinated individuals. The only deaths were in totally unvaccinated people.

Paul Ananth Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the rise in cases was not overly worrying.

“The reason for my optimism is that we now have effective vaccines, better diagnostics, proven treatments and even potential prophylactic agents,” he said. “If these are employed in a targeted approach, it is unlikely that we will end up with the same problems we had last year.”

Singapore has also recently announced that it will respond differently to future COVID outbreaks and will be treating COVID-19 similar to other illnesses with a focus on hospitlaisation data rather than daily case numbers.  They will, however, continue protective measures such as social distancing and mask wearing.

According to information recently published by the Centers for Disease Control and Prevention (CDC) there was an outbreak in a German aged care facility where a lot of people were immunised with Pfizer. And what they found was that there was a high attack rate in the facility, but nobody got serious disease, they had either no symptoms or mild ones. 

This again emphasises that you can get infected, but you are protected against the severe disease, and again AstraZeneca offers similar protection.
Leading Practice Intelligence Platform Cubiko has developed new features to help you find the right patients to vaccinate at the right time.  Visit https://www.cubiko.com.au/ or email info@cubiko.com.au 

References

https://www.abc.net.au/7.30/dr-norman-swan-addresses-the-confusion-over-the/13426062
https://www.abc.net.au/radio/programs/coronacast/ok-lets-talk-about-fleetingness-is-it-more-infectious/13401540
https://wwwnc.cdc.gov/eid/article/27/8/21-0887_article
https://wwwnc.cdc.gov/eid/article/27/8/21-1145_article
myDr
Author: myDr

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