Hesitant about the vaccine?

I was a guest speaker at an International Women's Day webinar on Friday and before we started, one of the moderators asked me whether I would get the COVID-19 vaccine. I was absolutely floored! As a doctor it really is a no-brainer - of course I am getting the vaccine, and whichever one is offered. This is because I know it's safe, it will protect me from being hospitalised or dying from COVID-19, it will reduce the risk to those I come in contact with, and it's the only way we will ever put this pandemic behind us. This level of confidence sometimes makes it difficult for me to understand why others don't feel the same way, but I have come to realise that, while the phrase of 2020 was "You're on mute", the equivalent in 2021 could very well be "I'm not an anti-vaxxer, but...". 

This so-called vaccine hesitancy is no doubt a very real thing, and its prevalence appears to be increasing, including in Australia. Recent research conducted by ANU academic Professor Nicholas Biddle indicates that vaccine resistance and hesitancy have increased substantially over recent months, with 21.7% of Australians surveyed saying that they probably won't or definitely won't get a COVID-19 vaccine when it is available1. This is concerning. Vaccines will not be mandatory (so are not a violation of human rights) but the more people who get vaccinated, the safer everyone will be. 

Have shortcuts been taken in production and clearance of the vaccines that will mean they may not be safe? 

This is a very common concern due to the speed at which vaccines have been produced. While those of us in the medical profession are extremely impressed at what is one of the greatest achievements in medical history, others hark back to statements early in the pandemic that predicted a vaccine wouldn't be available for up to 18 months. This overlooks the fact that the best minds in the world have been focussed almost solely on this one goal. In addition, governments and private organisations have poured billions of dollars into solving the problem even before knowing the results at each stage of the research, which is not the standard practice. The bottom line is that all vaccines available in Australia have had to pass the regular rigorous processes of the Therapeutics Goods Administration (TGA) and would not have been cleared for use unless they were both safe and efficacious. In other words, the risk of getting COVID-19, including "long COVID" far outweighs the risk of getting the vaccine.  

Do the new mRNA vaccines (those made by Pfizer and Moderna) change your DNA? 

No - this is not possible. Messenger RNA or mRNA are naturally used by cells to direct the production of all the proteins needed for a cell to do its job. Each cell has 100s of 1000s of different mRNAs and they are read from DNA but cannot alter DNA. The mRNA vaccines simply add one more message to cells where the vaccine is injected. The vaccine message is to make a version of the COVID-19 spike protein that will trigger an immune response and give us immunity to the disease. Just like all the other mRNAs making proteins in these cells, the vaccine mRNA cannot change your DNA and do not enter the nucleus of the cell where the DNA resides. 

Is one vaccine better than another? 

While there are differences between vaccines in terms of their effectiveness against getting any COVID-19 disease, both vaccines available in Australia will give nearly 100% protection against severe disease or death.  

Should I wait for a better vaccine - one that is 100% effective against all variants? 

Getting vaccinated significantly reduces the risk of getting COVID-19 from all known variants, although the vaccine may not be as effective against some. Waiting for a vaccine that is 100% effective is a fruitless exercise, as the longer we delay vaccinating everyone, the more chance that new variants will emerge. And it is unlikely that any vaccine will ever be 100% effective against all disease in all people. 

Vaccine technology is advancing all the time, and modifications are being made to counter these variants in the form of "boosters". It's the same reason we have a new 'flu shot every year - because the influenza virus continues to mutate and throw up new variants and we need to stay ahead of the virus. 

I'm young and young people don't get very sick from COVID-19. Why do I need to have a vaccine? 

Although the risk of developing disease seems to be lower in young people, young people can get severe disease and die from  from COVID-19. As well as the immediate illness caused by this virus, some people develop "long COVID" and this can be people who have not had very severe disease. And you are not only taking the vaccine for yourself - you are taking it to reduce the risk to your community, including your parents and grandparents. 

How do we know if there are any long-term effects from the COVID-19 vaccines? 

Some other types of vaccines (i.e., not COVID-19 vaccines) that are in common use have been shown to have delayed effects, but these usually happen within two months of vaccination. Clinical trials that enrolled many thousands of people were started more than 8 months ago and very widespread vaccination has been ongoing with millions for almost 3 months. Over 300 million doses have been given worldwide so far! Not only have the vaccines produced very few serious adverse events, but no long-term effects have also been observed. The myth that any vaccination is associated with autism has long been disproved. 

I am pregnant - can I take the vaccine? 

This is a more difficult question. We have no reason to believe that the vaccines will not be safe and effective for pregnant women and their babies, but the vaccines were not tested on this group and so we do not have data to fully support that position. In general, we are even more cautious about the introduction of any new treatment to pregnant women and so the same approach is taken with the COVID-19 vaccines. However, many pregnant frontline workers in the US and UK have chosen to be immunised, believing the risk of catching COVID-19 while pregnant is much greater and so far, no serious adverse effects have been reported. Clearer advice on this will be provided as the months progress so we advise that it is something you should discuss with your health care provider.  

Will the vaccine give me COVID-19? 

None of the vaccines used in Australia or planned to be used here contain the whole SARS-CoV-2 virus in any form, so they cannot give you COVID-19. The vaccines introduce just one protein from SARS-CoV-2 into your body - that's just one protein out of more than a dozen that the virus needs to work. The vaccines may make your arm sore, in some cases they may make you feel a little tired or even have a mild fever, but this is an indication that the immune system is working to give you protection against COVID-19.  

I am sure that there are many other questions you may have or will think of over the coming months as we all move closer to becoming eligible for the vaccine. Unfortunately, there is also a lot of misinformation circulating on social media, by email and private messaging. COVID-19 has upended our lives and has quite reasonably increased anxiety about our health, but it is still important to be very careful what you read and follow.