Close up of arm with green COVID-19 vaccination sticker

The case for vaccination

Vaccines offer a way out of COVID but its success is not without challenges. How do we overcome the gaps in understanding so that we’re backing the best chance we have in keeping ourselves and the community safe?

A year ago the world was racing to find a vaccine for COVID-19. Now, in 2021, we have effective vaccines available, but its effectiveness is contingent on uptake and acceptance amongst populations. 

With increasing cases in Australia, particularly amongst younger age groups, it is now more important than ever to get vaccinated. But in spite of the historical and scientific evidence, and health advice about the benefits of vaccines, vaccine hesitancy and misinformation continue to influence uptake.

Facilitated by ABC’s Tegan Taylor (co-host of Australia's chart-topping health podcast, Coronacast), this discussion is grounded in the science, with insights from:

  • Professor Cheryl Jones, paediatric infectious diseases physician and Head of School and Dean of Sydney Medical School, who is also an ATAGI member;
  • Professor Kirsten McCaffery, Principal Research Fellow at the Sydney School of Public Health; 
  • Professor Ramon Shaban, Professor of Infection Prevention and Disease Control; 
  • Mustafa Dhahir, a current Doctor of Medicine student and Pharmacy graduate, with experience in community vaccinations and he uses social media to empower the public's understanding of health.

We hope this discussion will help you get informed about COVID-19 vaccines and help you have productive conversations with friends and family.

This public talks event was held virtually on Wednesday 18 August, 2021.

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Welcome. This is the Sydney Ideas podcast, bringing you talks and conversations featuring the best and brightest minds at the University of Sydney and beyond.



Well, welcome everybody. I'm Fenella Kernebone, I'm the Head of Programming for Sydney Ideas and it is a great pleasure to have your company today for what is a very important topic.



Before we begin proceedings though, I would firstly like to acknowledge and pay respects to the Traditional Custodians of the lands on which we all meet that we live, we work and we share ideas, wherever you happen to be joining us today. I also acknowledge the Gadigal People of the Eora Nation because it is upon their ancestral lands that the University of Sydney is built.



And as we share our own knowledge, our teaching our learning, and our research practices within our University, may we also pay respects to the knowledge embedded forever within the Aboriginal custodianship of Country.



Again, we welcome you to our panel conversation today. A very important one, very timely, 'The case for vaccination'. It is my great pleasure to introduce you to your moderator, Tegan Taylor, who is the host of the ABC podcast, 'Coronacast'. And she is going to be managing and of course asking all the questions for today's conversation. So Tegan over to you and thank you.



Thanks Fenella, and hi everyone. I'm joining you from Yuggera and Turrbal land.



And a year ago, we were racing to find a vaccine for COVID-19, this new pandemic that was going around the world. Experts didn't know if it was going to be possible for us to make a vaccine at all. And now here we are in Australia with two very safe, effective vaccines; a third one on the way so like, we're home and hosed now, right? No. They only work if people get them in their arm and an overwhelming majority needs to do that for them to really make a difference here.



Australia and especially Sydney is really hurting from extended lockdowns and getting vaccinated is our pillar, one of our main pillars to get out of it. So to get our heads around COVID-19 vaccines, to answer your questions, we have some experts from the Faculty of Medicine and Health at the University of Sydney.



I would like to introduce them to you now and they are Professor Cheryl Jones, pediatric infectious diseases physician and clinician-scientist, Head of School and Dean of Sydney Medical School and a member of ATAGI, the Australian Technical Advisory Group on Immunisation.



Professor Kirsten McCaffrey, Principal Research Fellow at the Sydney School of Public Health. She's a respected voice in shared decision making health literacy and the assessment of psychosocial outcomes.



Professor Roman Shaban, the Inaugural Clinical Chair and Professor of Infection Prevention and Disease Control at the University of Sydney and Western Sydney Local Health District within the Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity. Ramon is an expert in infection control and emergency nursing.



And Mustapha Dhahir, Pharmacy graduate, current Doctor of Medicine student with experience in community vaccinations. In all of his spare time – who has any at all? – Mustafa uses social media to improve people's understanding of health. He's on Tiktok, his name is @Pharmustafa and he has over 200,000 followers. We will actually watch one of Mustafa's TikToks in a bit. But before we do that, let's get started.



I'd love to start off just with Ramon. Give us a sense of the landscape at the moment with this Delta variant, how it's changed the landscape of COVID in Australia especially.



Thanks very much, Tegan and good afternoon, folks.



So this most recent outbreak in New South Wales, and indeed Australia is a new variant of coronavirus and this is the Delta variant. And it's certainly not our first outbreak. But this particular outbreak and this variant exhibits a number of really interesting characteristics which are different to other outbreaks. We know that in this outbreak and this variant, the virus is more transmissible by means such as contact, droplet and airborne. And because of that, and because of some other population based factors, it's much more easily spread between people, between communities and families. And so we're faced with a situation now where we've got really large volumes of virus in the community in populations spreading quite quickly.



You would have seen on the news today, more than 600 cases for New South Wales, a large majority of them located in two particular Local Government Areas. And importantly, we've got large numbers of individuals who, when diagnosed are not in isolation, or are in the community, which means that there is a real risk that others are exposed to the virus, and the virus is spread from person to person. And so this is really a very serious situation that we have that we face at the moment, and it's all the more reason as to why we should throw everything we have in our toolkit to prevent and control that infection. And of course, vaccination is a really important part of that.



Yeah and so we're really here specifically to talk today about vaccination. Cheryl, I wonder if you could just give us an idea of what risks and benefits ATAGI's weighing when it's approving vaccines, and in particular, what we know about the Pfizer and AstraZeneca vaccines that we've currently got access to?



Absolutely. Good afternoon, everyone.



And I just need to preface saying I'm giving my personal view today, not the view of a ATAGI as an ATAGI member.



So but the things that we weigh out are, firstly, the effectiveness of the vaccine, particularly against causing disease against COVID. So that means getting into hospital, having serious disease, admission to intensive care, or death. And that's the main goal of the vaccination program. So how effective are these two currently licensed vaccines and more to come?



The second context we have is, what are any harms from these vaccines that we can prove? And that very important signal – but rare – that came through from the AstraZeneca vaccine was this clotting syndrome, the TTS syndrome, where our platelets react in some people abnormally and cause quite serious clots. We look at the frequency of that, and are there any groups of people where that may be more common? So we know what advice to give.



The other thing we have to take into account is the availability of vaccines, but also the circulating context of the virus. So we are now in Greater Sydney and many other places with this very serious Delta virus that's infectious, that causes serious disease, admissions and even death in young people. And we need to then put that in the risk-benefit equation.



Just a follow up there, Cheryl, one of the questions we've had before the event started was around like, age-based recommendations and how that shifts in an outbreak versus not an outbreak. It seemed like, Yeah, okay if you're over 60, your risk is higher of catching COVID; if you're under 60, maybe don't get AstraZeneca. That's really shifted, especially for people in Greater Sydney.



At no time was there ever, "Don't get a particular vaccine" from ATAGI. I think that's really important. So the very clear message was these are two approved vaccines for all eligible individuals except with their particular medical contraindications. But where we have the availability of vaccine and a choice is available, when there was low circulating virus or low variance of concern, then a situation could be where we would target based on risk of these rare side effects in certain age groups. So that was why in younger age groups where we had of choice of vaccines available, and not much – no community transmission – and not much virus of concern, you would put an age-based recommendation about a preference for Pfizer. But at any time, all people could have any vaccine, if they were eligible.



We are now in a situation in Greater Sydney where we have and some other areas, where we have a very serious strain, causing high rates of infection, admissions and deaths, but also serious consequences in our community. That means that everyone at all age groups has a greater benefit from all vaccines, including AstraZeneca, to stop serious disease in themselves, admission in themselves, and passing on to vulnerable people as well.



Rebecca has asked the question, which I'm going to put to Kirsten: Why can't authorities just mandate that everyone has to get a vaccine given that we're in such a health crisis at the moment?



Thanks Tegan and hello everyone. It's great to be here.



Mandates are such a topical question. The problem with mandates is that it risks backfiring, it risks forcing people into a corner; and people who are undecided or hesitant, it can push them into being unwilling to be vaccinated. So it's not the best strategy to get the maximum number of people vaccinated. And really what you need to do is, you know, work on strategies targeting that undecided group who need questions answered, who are unsure about certain things, safety issues, questions; you need to make vaccines really available and really easy to get rather than a blanket mandate, which can really backfire.



So one of the people who are trying their best to spread the good word is our friend Ramon here. Ramon's on TikTok like we said. He's more than just his TikTok account but it is pretty cool. We might actually play one of Ramon's TikToks and then talk about what role social media can play in helping debunk myths.


[TIK TOK VIDEO]  10:07

Can someone tell me which ingredient the COVID vaccine you guys are worried about? Thank you for everyone that's been answering. So we had someone that was worried about the last ingredient, someone mentioned SM-102 and someone mentioned graphene oxide.


[TIK TOK VIDEO]  10:16

Now let's actually talk about these ingredients. These are the ingredients of a blueberry. Just because an ingredient sounds scary doesn't mean it actually is. Trust science people, get vaccinated.



So Mustafa can you talk a bit about what you're trying to achieve with your TikTok stuff. You're obviously already working as a pharmacist, studying be a doctor; you've got a bunch of stuff going on. Why TikTok?



I think Tiktok is one of the largest growing social medias at this current point in time. And I think it's the easiest way to reach out to so many people. It's quick, it's quick videos, so they're under about under one minute, and that's really good to keep people's attention, right.



So if you upload a large 10 minute video, for example, sometimes people will click away after the first 30 seconds or they won't even click on the video if it's too large. The good thing about TikTok is short and concise information, they can just send through directly to nearly everyone because once you upload a video, it circulates on something known as a 'For you' page. And when people are interested in a specific topic or subject, the hashtags on your video will bring your video onto their screens.



So a lot of people who are for example, hesitant regarding COVID, or unsure, the algorithm would pick that up as well, if they've watched a lot of COVID conspiracy videos or whatever it may be. And then that would allow my videos to pop up on their screens. And hopefully, it can reach out to as many people as possible.



My approach to making videos is to make sure it's as simple as to understand as possible. So my target audience isn't like people with Bachelor degrees, or professors or whatnot. My kind of method of thinking when making videos is to make sure that even even maybe a 10-year-old can understand my videos.



And in that video that you saw there, I posted originally a video asking people which ingredient they were worried about in the COVID vaccine. And then when I got about 30-40 responses, I took that video down and I made a reaction video pointing out the ingredients that they spoke about, and I identified that was actually the ingredient of a blueberry. It wasn't actually the ingredients of a COVID vaccine. So I just wanted to highlight to people that just because an ingredient is difficult to understand what it does, and it's not something we're all familiar with, doesn't mean it's necessarily harmful.



Kirstin, how does Mustafa's approach fit with what we know is best practice in terms of debunking? Bearing in mind, of course, he's sitting right here, so like, don't make him cry.



Look, Mustafa's given a really great example, a really brilliant example of how to do it wll.



First, as he said, he's making the message clear and simple. And writing it for an audience aged 10 and aged 12. And we know that typically when we write health information or develop health information, we develop it for people who've got university education and that's just not going to work.



The other thing that Mustafa talks about is making it short and sharp, and also what we want in messaging is having clear, actionable advice and relating that to everyday things. We like the blueberry, that's a brilliant example of relating the information to something that everyone can understand and use.



And also, of course, is using TikTok, not relying on old traditional forms of media. We need to get better at using all sorts of different platforms to communicate in effective ways. And this was a great example.



And there's a question here: Is there any information on whether vaccines reduce transmission from vaccinated to unvaccinated people? It feels like one for Cheryl.



Yes. So there is emerging evidence that it does. It's not complete, reduction. But there is definitely strong evidence that you approximately halve – depending on the vaccine –that risk of passing the virus across. What we know is these vaccines don't stop the virus attaching to yourselves in the first place, so causing that infection by and large, but what it seems to do is reduce that likelihood of how likely you are to pass it on, and also for how long you might shed the virus.



A question from Kelly, I'm gonna put this one to you Ramon, Kelly's asking, How do we know that the vaccine is going to be safe long term when we haven't had a chance to do long term clinical trials? Because we've only sort of just got them.



That's a good question. Thanks, Kelly.



So these vaccines, like all vaccines follow a fairly systematic and standardised approach to the development of them so they haven't been developed by any particularly special or truncated means. It's the same, phase trials, phase 1, phase 2a, and so forth and so on.



What we've done in this time frame is to work as fast as what we can to develop the evidence around how they work, and what kinds of adverse effects or side effects occur in them. What we've seen in the adverse events around these vaccines is what occurs with any medication, any vaccine. And so as they emerge and as they are used over time, the more they're used,  the more information we gather about how they work, how efficient they are, what kinds of side effects that do occur. And the important part of that really is, when you do go and get your vaccine, and you do get these surveys by text message or by SMS about, "Do you have any reactions from the vaccine?", it's important that you fill that out, even if you have no response, or no side effects, or even mild effects, because the more information we gather about these reactions, however small or large they may be, the better it is for everybody. So we should expect and have confidence in these vaccines, in the same way that we have confidence in other vaccines and other medications more broadly.



Cheryl, do you have thoughts to add to that?



Only that, again, we have to put it in the context of the harms we have from this virus. This virus causes clots, this virus causes serious disease of our lungs in death. And that's far far greater and far, far more likely than these rare [audio interruption] effective vaccines. And also to add, I was one of those people 12 to 18 months ago that was really frightened as a vaccine and virus expert that we might not have vaccines, and now we have a number around the world. They're gonna get us out of this situation.



Mustafa, did you have your hand up?



Yes. Just to add on to your Ramon's point. I agree with everything he said. A lot of what I've spoken to people, a lot of their points are that they think the vaccine was whipped up in something like a week or two, and they've just come up with all the research on the spot. I think it's important to note that a lot of the research that we're basing the vaccines around has existed for decades. So for example, the AstraZeneca vaccine, we're using adenoviruses. This isn't the first time we've ever had adenoviruses, for example. Most of our other vaccines use that same kind of method to vaccinate people. With the mRNA technology – although this is probably the first time we've applied it –there are papers dating back to 2012 about mRNA vaccines. So this isn't this isn't new.



This research has existed for a long period of time, and it's based on decade's worth of research. So I think we always talk about "future" regards to long term side effects, but we'r not taking into consideration that we've got plenty of data from every other vaccine we've ever developed.



That's a really good point. And we've actually had a couple of questions from Kathy, from Frances, Bronwyn and others basically asking versions of the same thing, which is, having conversations with people that you love, or relationships that are important to you, where these people are hesitant or maybe they've been listening to misinformation about vaccines. Kirsten, how can people navigate those conversations without completely burning bridges?



It's such a challenge, isn't it? And I think so many of people have faced this difficulty and whether you're talking about your grandparents or cousins or whether you're a practitioner and you're talking to a patient – Look, I think the first advice is to be respectful, and to listen. To Listen to the concerns, because people do have genuine questions and concerns.



Also recognize that you don't need to go into battle about everything and decide which battles are worth going into.



The other advice that I think is really wise, is to have conversations if you're going to challenge someone's views or beliefs, do that in private, not in public, so that there's a potential for loss of face.



And also the other thing I'd say is we know that personal stories can be really influential, they're more engaging than bold facts and more relatable and understandable. So you could for example, rather than try and fight with facts, which people kind of blow off and try to argue against with other counter facts, you could try talking about personal stories about individuals who have had bad experiences, died, got long COVID; and make those stories relatable to the person you're talking to that. So similar age group, a similar type of person.



And the other advice that's given, which I think is helpful if you do want to go down the kind of fact route is to use something called the 'truth sandwich', which is a quite neat little fancy –



– It sounds delicious.



It does sound delicious, doesn't it?



Basically you start there with stating the truth clearly and simply. Then you try to to debunk the myths or the conspiracy that's been talked about by your friend or colleague and then go back to the truth again, and clearly restate the truth and that works because not only do you repeat the truth, you say it twice. So it's more memorable. But you said it first and last, which almost always, also makes it more memorable too. So those are a few techniques.



And the other thing people say is to talk about very positively about your own vaccine experience. So normalise vaccination.



Ramon, you had your hand up?



Yeah, Kirsten's given some really very useful advice. For me, one thing that I always remember is it's never actually really about the knowledge based question. There's always something behind the question itself. And that's often things such as access to vaccination, you know, some social issues around peer pressure in family settings, or local settings – and so I tried to understand what might sit behind the question that seems to be about knowledge, when it's actually about other things there in.



A question from Jenny to – I might put this one to you, Mustafa. The side effects and deaths from these COVID vaccine seems to be much higher than any other vaccines in history, according to their VAERS, yellow card TGA. How do you want to respond to that?



If everyone's that unfamiliar with this, VAERS is the recording website for America, so if there's any adverse events regarding any vaccinations or medications or whatnot, you report it VAERS. Now  that is raw data. Okay, so that's unfiltered and unchecked. So if you actually go on the VAERS website, it gives you a disclaimer to say that everything on this website is not causative. So there's no there's no causation, okay? So it may say, for example, 10,000 deaths from the COVID vaccine, but these are not confirmed. So this could be – anyone can report onto VAERS to be honest, it's not just healthcare professionals. So I think there was someone on TikTok, who made a point of this, by claiming to VAERS the vaccine turns you into the Incredible Hulk, and VAERS recorded it. VAERS actually recorded it onto their website, okay, because they do legally have to put it up there. Now, it's up to the FDA in America and the TGA in Australia to confirm it, investigate these things.



So in Australia, I believe – this might outdated information – I think back in July, there was around 300 reports of deaths regarding the COVID vaccine. But there was only, I think, two that were confirmed. And I think that number's increased now. But there was only two that were confirmed. So it's important to note that these numbers that you'll find it on VAERS aren't always reliable. And read the disclaimer that does say that this is not causative.






And just to add to that, as you heard, Cheryl also said earlier, we have to weigh up the risk-benefit of you know, vaccine versus infection and disease.



We know, globally speaking, that about eight out of every 10 individuals who get COVID-19 have a sort of mild to moderate illness. One in every 10 has a moderate to severe illness, and one in every 10 has a severe illness or dies. And so if you compare those kinds of population based figures, to the risks and adverse events from vaccines, in particular, perhaps the AstraZeneca vaccine, which is actually only a fraction of that, it's very easy to see how the risk-benefit ratio can be explained in a way that makes it much more reasonable to say, actually, you know, this is what the risk might mean, to me.



At the moment that most popular question on Slido is, How do you explain that Australian health authorities are now recommending AstraZeneca vaccines for under 40s whereas before the lockdown, it wasn't recommended for younger people due to recognised side effects? Cheryl.



So again, it was never not recommended. So I think people need to be quite clear about that all of these vaccines have been approved for all age groups. What we were saying was when there was low circulating virus, and where you had available Pfizer vaccine, then the preference would be to have Pfizer vaccine, because of the slightly higher risks of these rare but serious consequences of AstraZeneca vaccine. Now we've got a situation; there is virus in Greater Sydney and some other regions that is – you will meet this virus sometime. And it's a serious virus. So that rare, rare side effect across all age groups, is far less than the benefit of protection against this very serious virus. So that changed advice, which has always been there, but it was re emphasised in the context of a really serious outbreak of this very nasty variant, the Delta variant.



A question here from Kathy via Zoom. Kathy makes the point that just hearing about young people feeling pressured to have AstraZeneca and being unable to access that; get us access to their choice to receive a Pfizer vaccine instead. And the question is why focus on people who are hesitant when there are so many people who want the vaccine who still can't get appointments for the vaccine that they want? Who wants to jump on that one?



Yeah, I'll just speak quickly on that one. Yeah, you're absolutely right, we've really got to address these practical barriers. It's easy to focus on vaccine willingness and hesitancy and anti-vax attitudes. But actually, there is a lot that we can do to improve access to vaccines; making them really easy to get convenient, close, you know, many at all hours of the day, maybe not all hours of the day, but many hours of the day – just really addressing those issues. And I know in Western Sydney now, they're doing all sorts of things to kind of make getting a vaccine really, really easy, and we didn't do that as well as we could have done at the at the start for sure.



Hesitancy's about more than just your mood towards a vaccine, as well as isn't it? It's about access and equity.



Absolutely, and we know that it's not equal. There are social inequalities in terms of vaccine access, for sure. And barriers, like taking time off work, worries about being sick after the vaccine and having to care for children, and older people, also transport to vaccination sites and clinics. These are all things that make it harder for people who are socially and economically disadvantaged, to get vaccinated. And these social inequalities absolutely need to be addressed.



Mustafa and then Ramon had some comments too.



Just to add on to that, I think it's important to keep things in perspective as well. There are a lot of countries in the world that don't actually have access to any vaccines at all. And I think we're very fortunate to have access to these great, safe and effective vaccines. I know sometimes, you know, you might want the Pfizer instead, but look, that is changing, we are getting more vaccines coming in, I think we're gonna have a choice of three vaccines soon, we're going to be getting the Moderna soon, and we're gonna have more Pfizer coming in.



But it is really important to note that all three vaccines are very safe and effective. And some countries think, I read in Myanmar the other day was, don't have access to vaccines at all, and people are begging for the vaccines, and they can't get it. So I think it's really fortunate that we do have access to at least one or two, and now we're going to get three.






Yeah, and in addition to that, when I think about ways to solve these practical problems, one of the most important conversations that I have had and that we all will ever have, will be with our regular, trusted general practitioner, if you don't have a regular general practitioner, who knows you, who understands you, who knows what your knowledge is like, and how you think about the world, and your health and welfare, it's very difficult to then have a conversation about what's the plusses and minuses of this vaccine versus another. If you have to sort of doctor shop from medical centre medical centre, it's very difficult to build a rapport and spend any more than 10 minutes talking about the pros and cons of vaccines. And so, you know, getting yourself a regular GP who you know, and trust, who knows you; will help make these kinds of decisions that affect you ultimately, in the best possible way.



Absolutely. And Holly mentioned that a trusted pharmacist as well is a good thing – Mustafa's giving a smile there. Another question from Slido for Cheryl, who's asking – you're not asking it Cheryl – this person is. Why should a young healthy person with no comorbidities take a vaccine for a virus that has a 99.7% survival rate?



Well actually, firstly, the Delta variant isn't as safe as the other variants; so those alpha variants. So that survival rate is actually not as good as you think. So we now have people in their 20s, who've been admitted to hospital, who've been admitted to intensive care, and there have been deaths in that age group. So I think don't think this is a safe vaccine. But apart from those direct effects of you, as a younger person, you know, on preventing disease, very importantly, it's preventing also indirect effects. So your capacity to pass it on to someone that you love, or people in your workplace who are more vulnerable. And they have the main important effects across all age groups.






We know in this particular variant and outbreak, you know, some 70% of cases occurs in either household or workplace clusters. And so if I'm not vaccinated, and I live with family, who sometimes might be vulnerable clinically or medically, then I pose a risk to not only myself, but to those who around me at home and even at work. And so, that in part reflects that this disease and this infection and this virus is much more transmissible in these kind of close units; and so it really is about the benefit for everybody more broadly.






I think one thing to also focus on is not just survival rate. So everyone says, I'm going to get the virus, I'm gonna survive and then it's going to be a-ok. I think it's really important to note that if you do get the virus, there is a high chance of other permanent damages like permanent lung scarring, losing taste and smell. I mean, if you ask me, if I can't taste my food, what's the point of eating right? But other than that, there is a lot of permanent damage. And that can lead to further complications down the line that will not only in fact impact your social circle your work, your ability to actually – it might cause more sick days. So it's not just about survival. I think everyone's the focus so much on that. And in saying that, that 99.7% statistic, I'm not sure where they get it from. I've seen a lot of TikTok as well. But that's actually not the case.



So even if you do a quick math, you know, calculation right now, we've had 900 deaths in Australia and 35,000 cases in Australia as well – divide that, equals about 2%. So 2%, if 2% of Australians die from from the COVID virus, that as a ratio would work as 75,000 Australians dying, I mean, just one is too much, right? So I think it's not just about survival. It's about you know, morbidity as well.






Yeah, just to pick up on Ramon's point, actually, going back to that now, choosing to be vaccinated isn't just an individual decision, it's a decision that will affect your family, your elders, your children, people around you, people who are immune suppressed. It's not just about you, it's about it's about much, much more than you. And we often see people doing enormously generous things actually, for the community in all sorts of ways. And this is also something to think about when you're making your mind up about vaccination.



So there's a lot of numbers that get bandied about. This 99.7% survival rate, and this is one in maybe it's one in 40,000, maybe it's one in a million chance of getting a blood clot or whatever it is. I'd love to talk about how to weigh risk. And I'll start with you, Kirsten, because when numbers get big, our human brains just don't seem to be able to handle it.



Yeah, that's so true. We're just not designed really to understand those enormous numbers and it's really hard. The best evidence is to use those pictographs and those are the sort of little dot diagrams, I don't know, if you've seen them with, you know, thousands of little people or thousands of dots, and then you show the absolute frequency of an event occurring. So those have been used by ATAGI and other people who are the groups who have developed decision aids to show the likelihood of a serious adverse effect and the likelihood of benefit. So that that's one way.



I'm a big fan of having some sort of contextual or contextual information or reference point. So you know, the chances of being struck by lightning. Or you know, there was some great examples from some advertisers who put together a little piece on AstraZeneca and compared the risks saying, "You're more likely to die from having a bath; You're more likely to die from eating a hamburger." I think that helps people put those huge numbers into some sort of relatable context.



And I think with risk, people understand risk in different ways. So I think we've got to use lots of different techniques to communicate those risks and also have the right comparisons, right? So for a long time, we were just comparing the chance of a serious event from AstraZeneca against not having a vaccine. That's not the comparison, it's the chance of having COVID and having horrible effects or having the vaccine and you know, when you see that comparison, there's no decision in a way really, so it's about how you present the information. It's got to be presented in lots of different ways and try and make it really relatable to people






Kirsten just raised a point that Mustafa touched on. You know, this notion of long COVID. Coronavirus – this outbreak's only been with us for on average about 18 months, and we don't actually know yet what the long term effects of infection actually are. It may very well be that, there are late signals in terms of what this has done in terms of our lungs, our other parts of the body. And so, personally, I don't want to take a gamble with the disease where we don't know what the outcomes might be when I've seen what it does do to patients and their families. And from that perspective, when we're talking about the risk to individuals and families, as a practicing clinician who saw the very first cases of COVID-19 in New South Wales and have seen them all along – I can't tell you how many times I've seen or managed or treated individuals who thought that they were bulletproof. And thought, "Oh, this is just a mild illness and you know, it's gonna be okay." And when they've got it, their infection has resulted in others who've got it, and they've had very serious consequences from their infection and they felt terrible, really remorseful; you know, shame and so, that's a really difficult concept that I think is not often that visible in terms of how we talk about this disease. And that's very real for a lot of a lot of people.



We've been spared a lot of the pain in Australia up until very recently.



– For now.



Cheryl, did you have a –



To follow on from that there's also the consequences, for our families and also our children who get infected, this particular outbreak in New South Wales; you know, I was out of the Children's Hospital where I work the other day, and there are over 700 children infected, people aren't aware of this. And while they themselves are not particularly sick, their families are sick. There's incredible consequences for these children, with food and housing and other effects on them and their livelihood. So it's not just about the individual, as Kirsten and Ramon have said, it's about the consequences for those around us.






If I could just extend on that, Cheryl raises a really nice segue. We've sort of focused on the health aspect of COVID-19. But as we can all appreciate, there are very serious social consequences of this outbreak. We're all kind of locked in our homes or have very serious stay-at-home restrictions on what we can do; nd that has profound psychological, social and mental health consequences that are largely unmeasurable. How do you put a price on the suffering and the anxiety and the depression that people feel because they are – they lack social connection? And so we have to, I think, include that in our narrative and our discussion.



And whenever we have these really large numbers of cases and large numbers of cases in the community, that are not isolated  and are circling in the community, we're going to have longer and longer lockdowns and longer and longer restrictions; and so it's part of the whole suite of health and wellbeing.



Vaccination is a really important tool to see us through to be healthy, to have less – as Cheryl has said – less severe disease, less chance of death. But ultimately, it's there to help us get through this much more quickly, and have much less effects that go well beyond the individual medical process.



Yeah, on the social side of things – Kirsten, what are your thoughts on this?



I mean, it's really tough, isn't it? We know that, people who live alone find it particularly tough. So just a reminder to look out for people, your friends and family who are on their own.



We know that people who've had been diagnosed with mental health problems previously, find it tougher as well. It can be really tough for families, it can be really stressful.



And as Ramon said, vaccination is our quickest way out of it and that's what we need to focus on. Of course, we've got to stay well, physically well, mentally well, as we can. And you know, there are lots of good suggestions about that; going outside, doing exercise, creating some structure to your day, making sure you stay in contact with friends and family, you know, using Zoom, using FaceTime for social meetings, all of those things will will help.



But it's important, we want to make this this period; we want to get through it as quickly as we possibly can.



We've got Stephanie saying – Stephan sorry – and I'll put this one to Cheryl. What are the risks of a variant emerging that makes our vaccines ineffective?



So in the short term, not high, but as this evolves, this is why we need to – so viruses, just when they're making new viruses, get coding errors wrong. So they make some mistakes. Most of the time, that doesn't do anything. Sometimes it can make the virus no longer infectious to children viruses. Sometimes what's happened with Delta, it gives them an advantage, either making them more likely to cause infection and spread more or cause serious disease.



So at the moment, our vaccines are highly effective against these variants that we've identified. But that's something where we're going to have to keep monitoring as we go. And while we will need to tweak some of our vaccines and give boosters potentially if this occurs. The great thing is with our technology, we can do that and with our worldwide global cooperation, we know we can pick this up rapidly.



We had a couple of questions I've seen coming through about boosters. How regularly do you see us getting these? Will it be like an annual flu shot?



So we don't know the answer to that yet so there's two reasons we'll have to think about giving a booster. Our first priority is getting a vaccine, our first dose and our primary course in everyone's arm and that's where we're focused.



But the things we need to think about with boosters are firstly, how long do we have immunity against the virus, the particular strain with our vaccines? So we hear about waning immunity and we know that happens with a lot of vaccines.



The second thing we have to understand is, are there any new variants that make us think we have to tweak a vaccine or give a booster that may give us better protection? We're waiting to see this information and those information will be considered. And then advice around boosters will come likely towards the end of the year.



A question for the group, there's – I'll sort of merge two questions together. We've got someone saying AstraZeneca can cause clots. Pfizer can cause heart inflammation. What do I do as a young person? And another person saying – question that has become very familiar to me over this last year – "I want Pfizer but I'm not eligible. I'm really nervous about AstraZeneca. What should I do?" We might start with you, Cheryl.



So I would say if you're living in Greater Sydney, you're going to meet the real virus, the Delta virus, it's out there, and it's more likely to cause clots, it's more likely to put you in hospital, it's more likely to give you very long term serious disease than this very rare risk of a side effect from AstraZeneca. And that's why we're saying, at all age groups, please go out – unless there's some medical contraindication or you're in a different eligibility group – and get an AstraZeneca. I have even my own family have done that, and my young adult family have done that.



The other thing is that the causal effect of the heart inflammation from Pfizer hasn't proved to be causal yet, but it's actually quite a low risk that all the low numbers seem to be reported. It's relatively mild in most cases, and it wears off. What we also know though is COVID causes heart inflammation, serious heart inflammation of the lining of the heart of the heart muscle, and can cause death from that. So again, it's a relative risk.






I think it's important to note for everyone what we do in medicine is something known as a risk versus benefit analysis. So we need to consider the risks of being vaccinated or unvaccinated and being exposed to the virus. In saying that, so when we look at the risk of dying, for example, for the AstraZeneca vaccine, it's one in a million, okay. So there's a one in a million chance of dying from the AstraZeneca vaccine. And that's from the clots.



But if you look clots from the COVID virus itself; if you get infected with COVID, you're actually 100 times more likely to get a blood clot compared to the general population. So it's all about perspective.



If you say, I don't want the AstraZeneca vaccine, and you're made unvaccinated, you are at a very high – as Cheryl said – you're at a very high risk of actually contracting COVID itself. And in doing so you are at a much higher risk of getting blood clots.



And it's also important to note that since we are aware of these rare side effects, it's actually treatable, so if you are able to look out for the signs and symptoms of the blood clot, you can go to your local GP and pharmacy or whatnot. Discuss it with a healthcare professional, and then they can tell you, "Okay, go to the hospital or no, you'll be fine." And once you are monitored, and you're treated, you should be fine, and that's what we've noticed.






This question speaks to my area of interest in terms of health literacy and whenever we make medical decisions or decisions about our health, we are weighing up risks and benefits; and whether that's taking the contraceptive pill, whether that's taking medication, and in our lives, we do that every day when we get into a car or when we get into an aeroplane. But I think we need, as a society to get better at understanding medical risks and benefits, weighing those up carefully and making informed decisions.  I do that in my work in different areas, and we use decision aids to help people think carefully about the benefits and think carefully about the harms. But nothing in medicine is risk free and what we have to do is make the best risk-benefit calculation for any given decision, and we can do that. We actually do that a lot all the time, and we just need to do that here; and we need to help people do that better.






One of the greatest ways to do that is to talk to your trusted health professional, talk to your regular GP, talk about what is TTS, talking about the risks that Cheryl was talking about, and avoid places that are unreliable. Avoid places like some of the social media platforms where you might find conspiracy theorists or folks who think that the earth might be flat, and I know that sounds trivial, but it's really very important, particularly in the social context in which we live.



You know, we all have people in our lives who have dominant personalities, who exercise – who we look up to – all think make good sense, but that doesn't always extend to decisions around the health and welfare. That's why it's important to have a regular, trusted GP and pharmacists and nurses who actually understand you, and can look at the evidence and weigh this up as Kirsten and others have said.






Only to say that Kirsten was speaking about decision aids, and there are some fantastic decision aids available on the Australian Government COVID vaccine website, and that's both for you as an individual talking through. And I've seen in the chat, people are have been asking different personal circumstances, but also for health care providers. So if you have those questions about your own risk-benefit questions, and you want to go through that, look at those resources, but also take that to your health care professional, your GP, your pharmacist, and have that conversation because they're important questions, and they can help you work through that.



I'd love to talk about how to know if a source is trustworthy or not. Mustafa, what are your tips on this?



When it comes to reliability for the general public, I think it's important to know what are the levels of evidence. So speaking from the lowest level of evidence is anecdotal evidence. Anecdotal evidence is, He said, She said. For some reason, this is the highest level of trusted evidence we have in the community. So I see a lot more people saying, "Oh, my aunty said, she got X, Y and Z from this medication" and they would trust that over, for example, a doctor saying, "No, this medication doesn't cause this side effect" – and that's anecdotal evidence, so I think that's something we need to avoid. Or maybe take it with a grain of salt respectfully. So if your aunty does say she does have this side effect, don't just say, "No, you're wrong. Mustafa said, you're wrong." I think you respectfully take it with a grain of salt.



And there are a lot of reliable resources that end with .gov, for example so if it's a government resource, often it's been reviewed by scientists and other healthcare professionals. And what you see on Facebook and social medias and WhatsApp or whatever you use as a social media, that's all as well, anecdotal evidence.



Why are we humans, so reliant on anecdotal evidence?



I think it's just programmed into our genes, because we're social creatures. And look, I think we can harness that predisposition for personal stories, and turn it into good. And that's what really effective communicators do actually. They use personal stories and this is familiar with journalists. You use personal stories and combine it with facts and make the story meaningful and relatable.



But I think we're also speaking to the need to, to teach people a bit better, perhaps in schools about having what I would call critical health literacy, and that's an ability to critique the sources of information where you go and find health information; to understand conflicts of interest; to understand what's a credible source and what isn't a credible source. And Mustafa mentioned, websites, for instance; we know Cochrane Reviews are very independent. What's independent, what is evidence, in fact – we could be teaching this, these kinds of concepts in in schools, and I think that would that would be helpful.






Mustafa raises a really, really good example: the Aunty. You know, my aunty had said, this, my aunty had that. So that's a good example of a relationship that's trusted, of course. Everyone's aunty would want to do what's best for you. But that doesn't actually mean that my aunty knows the difference between AstraZeneca Pfizer or understands viruses. So it goes to this notion of a relationship. If we have a relationship with a GP or pharmacist who we trust, we're more likely to believe them, understand them, and they will understand you, and what drives you, what fears you have, what they think you can accept, and what you're prepared to risk take in terms of weighing up the difference between, you know, one versus the other.



We've got Donna making the great point, that connection helps with anecdotal evidence, putting a face to the sources tricky with websites; so that's just one, why humans sometimes find it difficult.



So we're coming very close to our closing, but I do want to sort of talk to each of you about what the future looks like. And starting with Cheryl, what are your sort of key tips for people navigating the pandemic over the next sort of six to 12 months?



So I think the first thing is we're not going to ou run this virus, it's with us and it's staying in our community and it will keep mutating, so we need to, firstly, where possible, get a vaccination to protect ourselves and to protect others.



And to get to a new way of living, we will have to keep some sort of COVID-safe measure, but that's good against respiratory viruses anyway. We've learned a lot about how to not pass on infections to our family and colleagues.



But the second thing is that, the amazing thing is that we have these vaccines, it is incredible and I just think, how the world has done this together – so that gives me great hope that we will continue to share our evidence around the world, continue to innovate, and get to a better state to manage this evolving virus and pandemic, and also anything we're faced with in the future.



Ramon. If we were to fast forward two years, what do you see the landscape looking like around COVID?



That's a good question, I would hope that we would see a situation where there would be very few active outbreaks of this virus. COVID-19 is going to become an endemic disease. In other words, it's going to be with us for a very, very, very long time.



But I would hope to see a highly vaccinated population, where there are very small numbers of cases that are easily identified, quickly controlled and prevented, and we have great confidence in our healthcare systems to keep us safe and well.



Cheryl touches on a really significant aspect of this, we're not going to run this virus, we have two very, very good vaccines, and they'll there will be more to come. So we should also anticipate, if you like, more information, more challenges around, "Well, now, do you know do I get Moderna? Or do I get Pfizer?" You know, anticipate that. Think about what can I do to insure myself against those kinds of tricky situations. Like getting a regular GP, like talking to your regular pharmacist, like going to trusted sources of truth. Perhaps talking less to your third cousin's aunty who has a view about particular vaccines.



Kirsten, if you could give people just one guiding light to help them make decisions over the next 12 months, what would it be?



Gosh, that's a hard one. Find a credible source, find someone with knowledge, who you can trust, a trusted place to get advice; and that means, as Ramon said, not your second aunty. You wouldn't trust your aunty to give you advice about your car. Don't trust them for advice about your body, unless they're a medical expert; and our medical experts have done such amazing things.



As Cheryl said, there's been such innovation during this entire time, it's been a time of immense hardship and will be, but there have been amazing medical innovations, which which will carry us through so let's hold on to that, that positive innovation that then will come. It's coming.



And Mustafa, just looking back over the pandemic so far and kind of seeing where we've come from and where we are now, are there any sort of silver linings for you?



Look, I think there's a lot that has changed throughout the pandemic. But I think there's a bit of a future for us as well. I think the most important take home message from me to give to everyone is, although this virus has kind of isolated us from everyone else, companionship is like the number one thing to think about right now. So as Professor Ramon said earlier, health isn't just about the absence of disease, it's psychological, it's mental. So every decision you make, keep in mind that it can affect others.



So when you are getting vaccinated, you are protecting your family. And if you do get sick, that can affect your family as well. But even if you don't get vaccinate, or you do get vaccinated, it's always important to check up on your family and your friends and make sure their mental health is in check.



This is a very difficult thing. But we are all doing it together. It's not like we only have one population that's experiencning this. We are all in this together, as cheesy as that sounds, to be honest.



But one thing that I have noticed from the pandemic, the kind of silver lining is we are we are all kind of going in the same boat and hopefully we'll all carry each other through to the end.



What a beautiful note to end on. Thank you all so much, our audience for joining us today. I just would like to thank all of our panelists today, Cheryl, Kirsten, Ramon and Mustafa; and thank you so much for Sydney Ideas for hosting us.



Thanks for listening to the Sydney Ideas podcast. For more links resources or the transcript, head to the Sydney Ideas website or subscribe to "Sydney Ideas" using your favorite podcast app.

Professor Cheryl Jones recommends:

Professor Kirsten McCaffery recommends:

  • The ‘Ask Share Know’ NHMRC Centre of Research Excellence has links to excellent decision aids – Bond University and the University of Sydney have developed the AstraZeneca Vaccine Decision Aid and Pfizer Vaccine Decision Aid. 

Mustafa Dhahir recommends: 

The panel

Mustafa Dhahir is Pharmacy graduate and current Doctor of Medicine student at the University of Sydney. Has been working in community pharmacy for five years with experience in community vaccination of influenza, MMR, dtpa and now COVID-19 as part of the current vaccine roll out. He spends his free time as a social media influencer to try to educate and empower the general public to improve their health.

Cheryl Jones is a paediatric infectious diseases physician and clinician-scientist, and now Head of School and Dean of Sydney Medical School in the Faculty of Medicine and Health at the University of Sydney. FMH has arisen from a merger of four faculties and three schools to become the largest health and medical faculty in Australia.

Until 2018, she was Executive Director of the NHMRC AHRTC – the Melbourne Academic Centre for Health, Stevenson Chair of Paediatrics and Department Head, at the University of Melbourne and an infectious diseases paediatrician at Royal Children’s Hospital, Melbourne.

She is a world authority on childhood infectious diseases and a Fellow of the Australian Academy of Health & Medical Sciences (FAHMS) in recognition of her leadership of internationally recognized research networks, including the Australian Childhood Encephalitis (ACE) study, and authorship of diagnostic and management guidelines which have changed global policy and practice. She has obtained over $32 million in peer reviewed funding including 3 NHMRC Centres for Research excellence, and has over 160 peer reviewed publications.

Kirsten McCaffery is a Principal Research Fellow at the Sydney School of Public Health and currently holds an NHMRC Principal Research Fellowship. She has a national and international reputation in shared decision making, health literacy and the assessment of psychosocial outcomes, and has had four successive NHMRC fellowships.

She is Director of Research at the Sydney School of Public Health and Director of the Sydney Health Literacy Lab, a group of over 20 researchers and students at the School of Public Health. She is co-founder of Wiser Healthcare – a research collaboration of over 100 researchers across four Australian institutions (Universities of Sydney, Bond, Wollongong and Monash) and Node Leader of the Charles Perkins Centre, Health Literacy Node.

Her research focuses on psychosocial aspects of overdiagnosis and overtesting, health communication among vulnerable populations and behaviour change research.

Ramon Shaban is the Inaugural Clinical Chair and Professor of Infection Prevention and Disease Control at the University of Sydney and Western Sydney Local Health District, within the Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity.

As a credentialled expert infection control practitioner and emergency nurse, his inter-professional expertise in infectious diseases, infection control and emergency care are the basis of a highly successful and integrated program of teaching, practice, and research.

Tegan Taylor is a health and science journalist in the ABC Science Unit. She is also co-host of the popular Coronacastan ABC podcast that answers questions about coronavirus; breaking down the latest news and research to help the public understand how the world is living through a pandemic.


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