Should we re-think who gets the vaccine first?

Tegan Taylor: Hello, this is Coronacast, a daily podcast all about the coronavirus. I'm health reporter Tegan Taylor.
Norman Swan: And I'm physician and journalist Dr Norman Swan, it's Friday, 22 January.
Tegan Taylor: So, the vaccines are coming, as we keep saying and we keep hearing, but one of the big discussion points this week is who should get it first. So we've talked about this before, we've talked about high risk groups like elderly people because they are at high risk of severe disease, being at the front of the queue, and healthcare workers because they have a high likelihood of both catching it and also spreading it. They are obvious ones.
But there have been arguments that teachers should be given priority treatment and supermarket workers because they are front-line workers, and maybe we should also consider giving it to people who work in quarantine hotels or transport because they have been spreaders in the past. But when we have a limited supply of the vaccine straight up, Norman, who should be at the front of that queue?
Norman Swan: It's hard to argue with the priorities that the federal government has put out, and in fact hotel quarantine workers, border workers, dealing with people coming overseas, like drivers, they are actually at the front of the queue and they need to be because they are our first line of defence and they are also the most vulnerable, so they need to be protected. And if the vaccines do prevent transmission, they will also be a ring of defence so that if they do get infected they will resist infection and not spread it into the community. So they are very much early recipients of the vaccine, it will be the Pfizer vaccine.
Healthcare workers are hard to argue with, particularly in aged care, as are frail elderly in aged care because they are extremely vulnerable to serious illness. So again, it's hard to argue with that. You've really got to go for care and protection and saving lives and saving severe disease as your first priority, and also if possible preventing transmission to the community. And remember, aged care has been a transmission point as well once it gets into aged care, and they have been focuses of clusters.
So then the debate is a perfectly reasonable one, people who are dealing with, say, young kids, teachers and others at the front lines such as supermarket workers. You can argue that too on the basis of protection.
There is another argument here. Once you've covered the people who are most vulnerable, whether in fact by then you'll know more about reduced transmission and whether you should switch tack because in fact if you really want to reduce transmission in the community, you need to immunise people who are at most risk of infection, and those are not the elderly, the people who are at risk of infection are the younger people in the community.
Tegan Taylor: Because they are more mobile.
Norman Swan: They're more mobile, they are out there, they are socially mixing, and so that you'd head off for people aged over 18 and under 65 and they might become the higher priority, because if they are protected from infection, they will then protect other people, and that's true herd immunity, and then you nibble away at that. So that would require a bit of a radical change in approach and an assumption that you are reducing transmission. But there should be more information coming in from the tens of millions of people who have now been immunised overseas. There is already some evidence from Israel of reduced transmission. But again in Israel they haven't yet moved into those age groups, so you can't really tell. But by the time we get there, we might be in a position to say 'let's pivot', and we will actually really go hell for leather for younger people.
Tegan Taylor: So we know that in Australia we are getting two different types of vaccine, we are getting a smaller supply of the Pfizer shot and then a lot of the Oxford AstraZeneca shot, which has been a source of debate in Australia because there is different efficacy between those two vaccines, and we've actually had a question about that from one of our Israeli Coronacasters, Gary, who lives in a kibbutz. And Gary makes the point; in agriculture, when we give a treatment against pests or disease, a good farmer does not repeat the same treatment twice in the same season, you should use different products, different methods to attack the same disease or pest. And he is wondering whether the same would bear out with a vaccine.
Norman Swan: Well, if we move away from the mango and avocado plantations on an Israeli kibbutz towards vaccines, the reality with the vaccines is that almost all, if not all at this stage, have been designed based on the Wuhan version of the coronavirus from almost a year ago. So it's a good question, but the reality is that changing vaccine is not going to change the target, the target is the spike protein from the Wuhan virus.
It may be as time goes on, and particularly with the worry about the South African variant of the virus, that you might be getting what's called antigenic escape or antibody escape, and you might need to redesign the vaccine with a new spike protein, in which case probably the Pfizer and Moderna vaccines are going to be most flexible to do that, and they say they can do that within six weeks. So it's not so much about varying the vaccine technology, because the vaccines are all targeting the same part of the virus.
Tegan Taylor: So Norman, we've received some really lovely feedback that I'd love to share with you and our audience. So back on October 26, we had someone write in and say they live in Melbourne and they hadn't left their home since July and they were feeling very, very anxious and agoraphobic and just so traumatised they couldn't even contemplate going out and they were really feeling trapped. But this person has written back to us and said; 'I just want to thank you for addressing my question and to let you know that I'm a lot better. I did go out into the world, I've gradually been able to extend how long I can wear a mask, from not at all, to almost an hour.' And their most important discovery was when they felt suffocated, they found that breathing hard with force proved to themselves that they weren't suffocating. I guess everyone needs to find out what works for them.
Norman Swan: What a great response and feedback. I don't think we said very much except for the person to seek help, it was just quite clear this person was extremely distressed, had a high level of psychological distress. And when I talk about psychological distress, I'm really talking about depression and anxiety, but this anxiety, anxiety about going out. And you really do need to get help, it's just hard to do all this stuff by yourself when it is really affecting your life. So it's fantastic that this Coronacaster does sound as if they got help and also helped him or herself.
Tegan Taylor: And hopefully their experience has been helpful to other people because I'm sure that they weren't the only one, and even though the Melbourne lockdown, which was so long and so hard, was some time ago now, we've still had lockdowns coming in and out of effect all over Australia and I'm sure there's many people who are dealing with similar things.
Norman Swan: Yes, and if people have got a high level of anxiety, even if they are not in the state where there's a bit of a lockdown, they can be retraumatised by that and the anxiety comes back. It is important to seek help. There actually are some very good online psychotherapy programs to help anxiety, and I think Beyond Blue has got a note of those to help you, and I think the federal government as well has had a look at those online psychotherapy programs so that you can choose a reliable one rather than going into the internet at random.
Tegan Taylor: Well, yesterday we put out the call for Quickfire Friday questions and, boy, did you deliver, people! We've got heaps to get through today. Norman, are you ready to go?
Norman Swan: Deep breath. Let's go.
Tegan Taylor: Barbara says; how can a person demonstrate that they have received the vaccination, which you might be required to do some time down the track?
Norman Swan: Well, you can ask your doctor to put it in your My Health Record. It will be in the Australian Immunisation Registry. New South Wales is talking about putting it into the Service New South Wales app so that you can show, just like a QR code, when you're going to a place that you have been actually immunised. It shouldn't be too hard to do if you're willing to let other people know about it.
Tegan Taylor: Paul is asking; if Covid is detected in the sewerage water of a particular area, why aren't the authorities insisting on all residents in that area being tested, like make it compulsory to get a test?
Norman Swan: There's two things here. One is I think you've got to be careful about what you make compulsory and whatnot. Making masks compulsory, mandated, is an easy thing to ask people to do. But to come forward to be tested and really force that is just difficult, as well as the fact that you're asking people who don't have any symptoms at all to come forward. And we haven't really had a policy so far of high-density asymptomatic testing. Really the asymptomatic testing that we're doing is in fact the sewerage, and then we ask people with symptoms to come forward.
Tegan Taylor: Matthew is saying; is anyone anywhere making coronavirus vaccine that targets something other than the spike protein? If the spike protein is the part that does infectiousness of the virus and is going to be changed in new variants, would we be better off targeting different parts of the virus particle?
Norman Swan: Well, that's what the Chinese have done in one of their vaccines. So what they've got in their vaccine is pretty much the same as the flu vaccines, so they've killed the whole virus and basically give you dead virus in the vaccine. It sounds rather macabre but in fact that's what happens with influenza immunisation, it's a killed vaccine.
The early data from the Chinese vaccine, even though they have not had a great randomised trial, is that it's about 70% to 80% effective. So it's not far off the Astra vaccine. So it seems to be less targeted.
Tegan Taylor: One last question from Sima; since it is likely that I'll be getting the Astra vaccine, can I opt for a half dose to improve effectiveness?
Norman Swan: Well, you can ask your doctor, whether he or she is willing to do that. It depends on what the Therapeutic Goods Administration approves for this vaccine. So at the time of recording this Coronacast it has yet to approve the Astra vaccine and we won't know what the dosage that they are approving consists of, so it's possible they could approve a half dose followed by a full dose, although that would be on limited data. So let's just wait and see what the TGA suggests.
I would have thought that in a high throughput vaccination clinic you probably can't, they'll just give you what's on offer from the TGA. If you're getting it done privately through your general practitioner, if that's possible, then you might be able to negotiate that with your GP but they would be doing that off-label. And not that I'm a GP but if I was the doctor, I would be asking you to sign a consent form to say that that's what you want, and that's what I'll give you, but you can't expect them to say yes when there are rules and expose themselves to legal risk.
Tegan Taylor: Dust your hands off, Norman, that's another Quickfire Friday done and dusted, and another week done and dusted for Coronacast.
Norman Swan: It is. So if you want to ask a question, go to abc.net.au/coronacast, click on 'Ask a Question', and mention Coronacast on the way through. We're still getting swamped by lots of questions, keep them coming in.
Tegan Taylor: We love getting swamped.
Norman Swan: And we'll see you on Monday.
Tegan Taylor: See you then.