How will GPs tackle COVID vaccine hesitancy?

Anastasia Tsirtsakis

11/12/2020 4:53:47 PM

Events like this week’s abandoned University of Queensland trial are unlikely to inspire confidence in people with questions about the safety of a COVID vaccine.

Vaccine production
The coronavirus vaccine process has been widely publicised by the media – something that has never been seen before.

Vaccine trials are not traditionally conducted in the public eye. Scientists running tests and crunching numbers are just not usually a concern for the average person on the street.
But the COVID-19 pandemic has presented something altogether different. An effective vaccine is seen as the ticket back to a ‘normal’ way of life, and people are keeping their eye on various global trials accordingly.
That is why Friday’s news that the University of Queensland (UQ) and CSL are abandoning their trials for COVID-19 vaccine candidate v451, after a protein resulted in 168 participants returning false positive results for HIV, could be so significant.
‘When we see stories of an adverse event here, or a strange thing happening there, everybody shows concern because they are now so invested in seeing this pandemic ended,’ UQ virologist Associate Professor Ian Mackay told newsGP.
‘[News of the abandoned trial] is a shame for a vaccine that showed lots of promise and had come so far. But, of course, I think the decision was the right one to make.’
The UQ vaccine was one of four candidates Australia had backed to date. It also represented the largest investment, with the Government previously agreeing to purchase 50 million doses pending successful trials.
But even though Federal Health Minister Greg Hunt has said there is likely to be more than one successful vaccine rolled out under the immunisation program, there are fears the unprecedented scrutiny on the development process – and subsequent reporting of trial pauses and safety concerns – may impact vaccine uptake.
As a result, Associate Professor Mackay believes GPs will have a vital role to play on the frontline of the vaccination rollout.
‘The public have certainly been learning a lot of things about vaccines they didn’t know before – hopefully they’re learning the facts,’ he said.  
‘There’s obviously a lot of noise coming out around vaccines and vaccination, as there always has been, but is continuing now.’
Associate Professor Holly Seale, a social scientist with UNSW Medicine’s School of Public Health, is a lead author of a recently published paper on a COVID-19 vaccination strategy to support uptake among Australians.
She is clear in her belief that GPs will have a critical role in allaying any uncertainties people may have about a COVID vaccine.
‘[GPs] are going to be critical because already we know that receiving a recommendation from a provider is one of the number one factors that will encourage someone to receive a vaccine,’ she said.
But in doing so, Associate Professor Mackay says GPs will need to be supported to assist national efforts.
‘GPs are really going to face a lot of that on the frontline, so they are the people that are going to need to help with the right information and messaging,’ he said.
‘They’ll need to have advice given to them about how to discuss that with patients that have specific concerns, and who have done a lot of reading and a lot of listening over the last year, seeing these things develop and who are invested in a particular platform compared to another platform.
‘That will have to be made clear to GPs so they can help patients understand that.’
While it is important for the public to have access to emerging data and be well informed, Associate Professor Seale says the media has a responsibility in how information is presented.
‘There are many other prototypes over the years that we don’t hear about as widely – they don’t get the press that something like COVID is getting – but they have gone through the same journey,’ she said.
‘It is about publishing the data in a way that it makes sense to people and provides them that understanding of what is happening – not sensationalising it.’

The University of Queensland vaccine initially showed a lot of promise. (Image: University of Queensland)

Responding to the news of the abandoned trial, Queensland Premier Annastacia Palaszczuk said the outcome was disappointing, but conceded that ‘of course, there is going to be some winners and losers’ in the so-called race for a vaccine
The ongoing trend of referring to the vaccine search as a race, Associate Professor Seale says, is not helpful.
‘That language around racing may actually not be as beneficial to people because it causes concerns around what that means,’ she said.
‘Does it mean that the Government isn’t doing the due diligence by using a word like “race”? So we do need to be mindful of the language that we use.’
While there are a number of vaccines that have reached phase 3 trials, efficacy rates have varied considerably. Moderna has reported 94.5% efficacy, Pfizer/BioNTech has reported 90% and AstraZeneca’s interim data pooled from two trials is showing 70.4%.
Speaking to newsGP prior to the UQ announcement, Professor Dale Godfrey, Immunology Theme Leader at the Doherty Institute, says if multiple vaccines become available in Australia that individuals may in fact want one over another.
‘It may be that for a particular reason somebody will favour one vaccine because of what they’ve read, maybe based on science, maybe based on fear,’ he said.
‘There are some fears people express about genetic vaccines like the mRNA vaccines, others may simply be focused on the efficacy.
‘It’s not at all clear how that’s going to be worked out. I think like so many things with COVID, we’re learning as we go and what seems obvious today is not obvious tomorrow. But these are really interesting questions.
‘What will we do?’
Associate Professor Mackay agrees it is unlikely people will be given an option of which vaccine they receive.
‘We know that the different vaccines … that will be bought by Australia have been looked at in terms of two doses of themselves,’ he said.
‘We’ve got no safety data on one vaccine for the first dose and another vaccine for the next dose. So what we’re likely to see is that we’ll get two doses of whichever vaccine is around at the time.
‘As to whether we pick and choose or whether we gone options, I don’t think we will have [the ability to choose] initially. I think we’ll pretty much be given the best for us that’s available in the right numbers at the time.’
The Federal Government was told on Monday about the UQ–CSL trial results, with the national cabinet agreeing to cancel the agreement to buy 50 million doses based on advice from health experts.
Federal Health Department Secretary Professor Brendan Murphy said officials knew about the risk of a false positive for HIV, but given the HIV molecule was tiny, thought it would be ‘very, very’ unlikely.
Prime Minister Scott Morrison maintains that Australia’s immunisation program remains on track to begin in March, having since secured an additional 20 million doses of the AstraZeneca vaccine and a further 11 million of Novavax, boosting total supplies to 53.8 million and 51 million, respectively.
Professor Murphy said it could mean the vaccine rollout is sped up, as AstraZeneca’s candidate is already in production in Melbourne.
He said UQ’s candidate had looked promising, but Australians’ belief in a vaccine was more important.
‘We can’t have any issues with confidence,’ Professor Murphy said.
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Dr Muhammad Hafizei Muhammad Nasir   12/12/2020 11:09:45 AM

I wonder why HIV serology was tested?

Dr Rama Krishnan   12/12/2020 2:45:07 PM

Until I have the full information on the safety of this vaccine especially in the elderly, I will not be recommending this vaccine. Too many unknown grey areas for my comfort! Masterly inactivity at present!!

Dr Wendelin Ikarus Fischer   12/12/2020 10:22:56 PM

I think it will be of great importance to be very open and honest to our patients that all of the coming COVID Vaccines will be NEW technology compared to all our previous vaccines- hence many question about the long term safety (fertility) will need to be fully answered and assessed in experiments before they should be approved in Australia.
This might be different to the situation in the UK or USA where unfortunately the epidemic is so much out of control that the vaccines are being released without this being fully explored. (As we can read in the Pfizer Information for practitioners)

Dr Neil Donovan   14/12/2020 7:16:37 PM

HIV was used in the making of the virus. ( hence the testing )
We need to be professional and scientific enough to STEP UP. This is the community calling for leadership. Of course we will have more information by March, but lets not start with timid caution. Lets start by saying GP's should own the roll out, we are the BESTS service providers for primary care immunisation. If you were a politician would you trust the roll out to a group who sound so reluctant. ?
Trust the science, be committed, energetic, brave , dynamic or risk having pharmacists fill the role . Our job could end up being data entry to the Register.
Understand the new technology, so you can explain to the patient. as a GP you are well equipped.
Lets begin in a spirit of cooperation, this is our chance on the big stage

Dr Joveria Javaid   27/12/2020 1:02:22 PM

It is alarming to see the hesitancy amongst the GPs themselves. How is vaccine linked to infertility? What's the mechanism? Looks like GPs are more intune with the face book posts then the actual science. Pretty disappointing Dr Fischer.