Global COVID vaccination drive shows promise as Australian rollout begins

Sunday marked a milestone for Australia, as the first Pfizer/BioNTech shot was administered to 84-year-old Jane Malysiak.
 
However, while it signalled the beginning of Australia’s rollout, other countries’ vaccination programs are already well underway.
 
The UK administered its first dose of the Pfizer/BioNTech vaccine almost three months ago, and it has been nearly two months since people began receiving the Oxford University/AstraZeneca candidate. Other countries, like the US – which has so far administered more than 63 million doses – and Israel, which has fully immunised almost one third of its population against COVID, have also made great strides.
 
The perceived delay had led to calls in Australia for the Federal Government to speed up its rollout. But other experts have been adamant that Australia’s low community transmission has put the country at a ‘significant’ advantage, as it gave authorities the chance to observe a real world trial unfolding in the northern hemisphere – from both a logistical perspective and clinical perspective.
 
And emerging data is certainly reassuring, with new infection rates starting to plummet.
 
To date, more than 205 million doses of coronavirus vaccines have been administered in 92 countries, with Israel, the United Arab Emirates, the UK and the US leading the way.
 
In the UK, where 27.24 doses per 100 people have been administered, the seven-day average number of new cases has dropped from 40,484 to 11,062 in four weeks. Deaths have also declined from 1224 to 488.
 
Similarly in the US, where 19 doses per 100 people have been administered, average daily case numbers have dropped from a peak of 192,311 to 69,002, as did deaths, from 3188 to 1983.
 
But even though the numbers are promising, Burnet Institute epidemiologist Professor Michael Toole told newsGP it is still too early to attribute the drop in numbers to the vaccine alone.
 
‘I don’t think that’s due to the vaccine … I think it’s because they’ve been in lockdown for months and there’s just no social movement at all in the UK, particularly big cities like London,’ he said.
 
‘It’s the same in the US. Mask wearing rates are the highest they’ve ever been, and that might be because of the new administration. [Now] you have to wear masks on airplanes and all public transport.
 
‘A lot of [other] places have also been in some form of lockdown, so it’s starting to kick in. I think vaccines will add to that, perhaps to prevent third waves … so it will be enormously helpful.’
 
So far, Professor Toole says the majority of information is emerging from Israel, thanks to its agreement with Pfizer to publish all data.
 
To date, 32% of the population is vaccinated, with more than 80% of people aged over 60 having already received two doses. Since 21 January, the seven day average of new cases has dropped from 7209 to 3666, with hospitalisations falling 57% in those aged 60 and over.
 
‘We’ve learned a number of things there. For example, 14–28 days after the first dose there was certainly a reduction in infections in a large group of healthcare workers, about 9000 that were followed up over time,’ Professor Toole said.
 
‘It seems after the second dose there’s a fourfold reduction in viral load in those people that do get infected.
 
‘They have also learnt that it’s safe in pregnant women, and they are the first country to authorise the Pfizer vaccine in pregnant and breast feeding women.’
 
Additionally, Bloomberg has reported that the Pfizer/BioNTech vaccine may stop infection by as much as 89.4%, although peer review data has not yet been released.
 
Meanwhile in the US, the Centers for Disease Control and Prevention’s (US CDC) surveillance system has provided valuable insight into adverse effects.
 
‘They were the first to recognise that some people have an allergic reaction to a component of the vaccine – it’s an incredibly rare reaction but … that learning has certainly been important,’ Professor Marc Pellegrini, an infectious disease physician at the Walter and Eliza Hall Institute of Medical Research (WEHI), told newsGP.
 
‘The data would suggest that around about 10–11 people out of a million will have an allergic reaction. So we’re well and truly prepared for that.
 
‘We’re now making sure that anyone who has the Pfizer vaccine is monitored for 15–30 minutes just to make sure they don’t have that allergic reaction.’
 
Professor Toole says what’s particularly reassuring is that the CDC has yet to detect any rare, unanticipated side effects.
 
‘People were nervous about Guillain-Barré syndrome [but] they had no cases of that and they’ve only had about 200 cases of anaphylaxis,’ he said.
 
‘All of those occurred within the 15 minute waiting time after receiving the vaccine, [and] almost all were treated with epinephrine and all have recovered.’
 
According to Professor Pellegrini, the rollout programs in both the US and UK should be ‘reassuring’ for Australia, with the smooth execution and good uptake in the UK of both Pfizer/BioNTech and Oxford University/AstraZeneca vaccines provide particularly useful insights.  
 
‘That’s a really important thing as basically we were wanting to see whether there was anything untoward, whether there were any mitigation plans we would need to roll out,’ he said.
 
‘And there really hasn’t been anything that would suggest that the rollout of a vaccine might have to be compromised or altered in one or other ways … I think that we’re well on top of things.
 
‘In the next few days we’ll certainly see the uptake of the Pfizer vaccine and I would hope that it’s incredibly high.’
 
However, Professor Toole says the pushback on the Oxford University/AstraZeneca vaccine in countries like Germany, which that has led to attempts of ‘vaccine shopping’, is likely to be seen in Australia and that GPs should be prepared.
 
‘The argument to get it is that it’s very effective at preventing severe disease – as effective as those other two vaccines,’ he said. ‘But the other two are more effective at preventing mild or moderate illness.’
 
New peer-reviewed data published in The Lancet showing a 12-week dosing regimen for the Oxford University/AstraZeneca candidate is actually 81% effective against the main strain of coronavirus will likely also help improve faith in the candidate.
 
Recent Australian Bureau of Statistics (ABS) data indicates almost three in four Australians are willing to get a COVID vaccine. However, concerns emerged overnight, as a crowd at the Australian Open Final started to boo Tennis Australia Chair Jayne Hrdlicka at the mention of vaccinations being a sign of ‘optimism and hope for the future’.  
 
Professor Pelligrini said while the reaction is a little worrying, it was likely a ‘biased sample of people’ and says Australia should at the very least be assured that unlike the UK and US, Australia still has time on its side.
 
‘The rollout of the vaccine in Australia can be distinctly different,’ he said.
 
‘The initial uptake has to be really amongst the healthcare workers and hotel workers to really try and create a fence in terms of the virus spreading outside of those areas into the general public. So it doesn’t worry me if on the first day everyone doesn’t show up to be vaccinated.
 
‘We are incredibly fortunate; we don’t have a massive outbreak ongoing at the moment, we can take that slightly longer approach in saying “well if you don’t want to have it today, you can wait and think about it, [but] we encourage you”.
 
‘The more data they see to support it, and the more people they see actually taking up the vaccine will give them confidence to come forward.
 
‘So I think, if anything, Australia might actually do better than a lot of these other countries.’

Australia will likely use at least three vaccine candidates as part of its COVID vaccination program.
 
The World Health Organization cites the need for at least 60–70% uptake to achieve herd immunity, but the goal posts have since moved, with the US’s Chief Medical Advisor Dr Anthony Fauci having recently said 70–75% will be necessary.
 
While other experts have said it is impossible to predict what level of coverage is required in order to achieve herd immunity, Professor Toole says based on Dr Fauci’s estimate, it is unlikely Australia will achieve herd immunity with the current candidates on offer.
 
‘If you do the mathematics, it’s just not possible because we’re not vaccinating children and there’s about 20% of people who won’t get the vaccine,’ he said.
 
‘I would continue to roll it out. But it’s a pretty modest rollout plan, so we’re not going to get anywhere near 50% of the population by July.
 
‘So I think we’ll have to bring in Novavax – we can probably get that by the middle of the year. That will speed up the acquisition of population immunity.’
 
In the meantime, Professor Toole says looking to Israel, there is a clear lesson for Australia to bolster its hotel quarantine system to avoid getting complacent.
 
‘Most of the cases [in Israel] are in young people, and they have been since the second wave,’ he said.
 
‘They’re still reporting 3000 cases a day with a population of less than 9 million – it’s extraordinary. So they’re not going to get on top of that until they get right through their population.
 
‘That risk won’t change overnight – we have to be ready.

‘All the capital cities on the mainland have had quarantine breaches since November, so I can’t see why that won’t happen again unless we get a 100% watertight quarantine system. I think we’re getting close to it in Victoria, but New South Wales still employs private security guards, so there’s no national approach whatsoever.’

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