The rollout of the Pfizer Covid-19 vaccine in New Zealand began last week, but recent research suggests significant levels of “vaccine hesitancy” in the community. Here’s Dr Anthony Jordan, one of only two Māori clinicians working in immunology in Aotearoa, to explain the science.
Vaccination is one of the most successful public health interventions at our disposal. Full stop. It’s right up there with access to clean water and sanitation.
Vaccination programmes have led to the elimination and control of diseases that were once common in Aotearoa. Before vaccines, many Māori became severely ill or died from infectious diseases such as smallpox, polio, diphtheria, measles, and whooping cough.
With the widespread use of vaccines, smallpox has been eradicated worldwide, and polio and rubella are a distant memory to those of us alive today.
We only need to think back to 2019 to remember what happens when we forget.
That year saw our largest growth in measles cases in over 20 years. Our case rates were second only to the Philippines in the Western Pacific region.
More disturbing was that Māori were disproportionately affected — nearly 40 percent of those hospitalised were Māori. There was also the shame we felt as we saw what exporting measles did to Sāmoa, where very low levels of immunity existed.
It’s hard to show the lives that have been saved by vaccination, but let’s continue the measles example. Between 2000 and 2018, an estimated 23.3 million people did not die from measles worldwide because vaccination works.
Today, we’re faced with Covid-19, but thanks to our elimination strategy in Aotearoa, we’ve been spared the death rates seen in many other countries.
And there lies the problem.
Many Māori haven’t experienced the loss of loved ones because of Covid-19, nor do they remember the fear of the wide-scale death and suffering experienced with previous pandemics. Maybe this is why we see our highest vaccine acceptance among our older people — those who remember diseases like polio and those most likely to suffer the worst outcomes from this pandemic.
So how does a vaccine prevent you from getting sick with Covid-19?
Vaccines typically work by giving us a part of a virus, or a protein from a virus — enough to stimulate our immune system but without giving us the disease. The Pfizer (mRNA) vaccine is new technology and works differently. It provides a short-lived instruction to our cells to make a viral protein — which, in the case of Covid-19, is the “spike” protein found on the surface of the coronavirus. When our immune system encounters the protein, it makes antibodies and memory cells. This allows our immune system to recognise the protein if we’re ever infected with the coronavirus, so it can lead a targeted and quick attack to wipe it out.
So, what are the benefits of the Pfizer vaccine?
First, the population bit. That’s where we see the 95 percent success rate you hear about. Let’s say I vaccinate 100,000 people. And let’s assume the risk of getting Covid-19 is about 1 percent because of all the other things we do — border restrictions, handwashing, social distancing, mask wearing, QR-code scanning and contact tracing. That means, instead of 1000 people getting sick, only 50 people will.
In addition to that, there’s the individual bit. If you’re one of the unlucky ones to get sick despite getting the vaccine, you’re about 90 percent less likely to get severely unwell compared to people who were never vaccinated — that’s what the trial data told us.
The recently published data from Israel is even more reassuring because it shows how the vaccine works in the real world. There they looked at over half a million people vaccinated with the Pfizer vaccine and then compared them to over half a million matched people who were not yet vaccinated. Seven days after your second dose, you were 92 percent less likely to get infected with Covid-19 or develop severe disease in the follow-up period.
Now, to be fair, there are side effects to every treatment whether it be having your tonsils removed, grommets inserted, or taking antibiotics — and vaccines are no different. But they’re nothing compared to catching this disease.
The most common side effects with the Pfizer vaccine are pain at the injection site, tiredness, headache, chills and muscle aches.
So yes, injections can hurt a little, but in general these vaccines report very similar side effect rates to other vaccines.
I know the biggest fear out there is safety — I get that. But over 200 million doses have been given now and there are no new safety concerns from those seen in the studies. Rates of allergic reactions are looking less than originally seen.
There’s one thing we all agree on: catching Covid-19 is by far the more dangerous option.
What about the other comments? This is still a phase-3 trial — we’re guinea pigs!
No, the original phase-3 Pfizer trials have finished. However, regulators will continue to collect information about the vaccine to keep us safe, which we should be glad about.
Other trials using different vaccines, and trials asking different questions, are continuing. We still want to know: How well does the vaccine work for the new strains? How well do the vaccines lower transmission rates? Does it prevent asymptomatic disease? These questions still need answers.
A number of the patients that I care for aren’t afforded the luxury of choice. My patients are the ones unlikely to respond to the Covid-19 vaccine.
Every day they worry about infections that could make their lungs worse, making it harder for them to breathe, or even worse, kill them. Through no fault of their own, they’ve been born with or had conditions which have wiped out their immune systems. Others have had reactions to previous vaccines which means they’re advised to avoid further vaccinations.
These people want and deserve protection from this pandemic as well. They tell me that they wish they could have the Covid-19 vaccine. There’s nothing more sobering than removing hope and choice to remind us how precious a gift those two things are.
We mustn’t squander that gift.
Fear is a powerful thing. It erases whanaungatanga, that relationship and duty that bind us as Māori. In its place, it inserts false logic, slapdash principles, and conspiracies.
Last of all, trust and expertise are difficult things. They’re not absolute nor are they universal. They are earned, proven through hard work and diligence.
So feel free to ask questions — but make sure those you listen to have the knowledge.
Dr Anthony Jordan (Ngāti Wai) grew up in Te Tai Tokerau and went to Pompallier College in Whangārei. He graduated from the University of Auckland School of Medicine in 2004, and now works as a physician, clinical immunologist and allergist in Tāmaki Makaurau where he treats patients with disorders of the immune system. Anthony is a member of Te Rōpū Whakakaupapa Urutā — the National Māori Pandemic group.
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