Some practical answers to COVID-19 vaccine questions

THESE are strange times. A pandemic, a relatively new type of vaccine technology, widespread fear coupled with suspicion of government and expertise, and social media.

We could almost be forgiven for throwing up our hands and saying “none of this was even invented when I went to medical school!” Almost.

On the other hand, our patients and our community need us to be informed. We need not all retrain in infectious diseases, virology, epidemiology and vaccine development, but we do need to know where to find reliable information and how to share it.

It is under these very conditions that misinformation can flourish. Never before has the community been informed of every step and every result in vaccine testing, every adverse event (whether proven to be linked to the vaccine or not) and every step in approval. People who had never heard of “polymerase chain reaction” (PCR) or “messenger RNA” (mRNA) are now spouting opinions about false positives and “genetic engineering”. Those who form an obsession and read everything they can find on social media and elsewhere on the internet can feel that they have “done their research” and now know “more than my doctor”.

This is when our knowledge and understanding of biochemistry, physiology and infectious diseases needs to come forward, together with our ability to recognise reputable sources of information.

One patient may want to know a comparison between SARS-CoV2 and influenza mortality, having read that COVID-19 is less deadly than flu (which is wrong by orders of magnitude). What, then is COVID-19 mortality, in Australia and worldwide? Sites such as the Department of Health’s COVID-19 current situation page can be helpful. It is updated at 9 pm AEST every day. At the time of writing, this government site reports that Australia has had 909 deaths from 28 879 cases, making a case fatality rate of 3.2% – approximately ten-fold the death rate from influenza. Having these data and their legitimate sources at our fingertips can be a real advantage in dealing with patients’ concerns.

Addressing the relatively new mRNA technology is also important. A quick refresher on the role of mRNA is easily available, such as this site from the Centers for Disease Control and Prevention. The same site has information suitable for community readers (here).

We can be prepared to answer common concerns: “Can mRNA alter our DNA?” “No, our DNA is in the cell nucleus. The injected mRNA does not go there. All it does is tells the cell to make a type of protein (like the spike on the surface of the SARS-CoV-2 virus), then the mRNA degrades after a few days”.

We must also be prepared for concerns about new vaccines being “rushed” to market, “not properly tested” and “experimental”. This article, from the University of Chicago, explains how COVID-19 vaccines were able to be brought to market without the usual delays that affect new vaccine development.

We can explain to our patients and friends what we understand about the scientific method – the stages of testing, what the testing was designed to detect, the difference between “what is the use of vaccines that don’t block transmission” versus “these initial vaccines were tested for efficacy and safety, because these are the immediate priorities – we don’t yet have the data on how much they block transmission, but that is coming”.

Finally, we can reassure our patients when we don’t hesitate to take the vaccine ourselves. For those who want to wait “until it’s been around for a while”, we could ask: “who do you think should take it before you?”

Dr Sue Ieraci is a specialist emergency physician who has worked for 35 years in public hospitals and now works in telemedicine.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.