covid vaccination

“Historic” drop in US life expectancy

October 7, 2022 by Madeline Lucre Leave a Comment

The average life expectancy of Americans fell alarmingly in 2020 and 2021 – the sharpest two-year decline in nearly 100 years.

In 2019, Americans could expect to live, on average, to 79 years. Two years later, life expectancy had dropped to 76 years.

The decline has been catastrophic among Native Americans, with life expectancy dropping by four years in 2020 alone, according to the US National Center for Health Statistics (NCHS). The decline for Native Americans since the pandemic started, more than six and a half years on average, has brought their life expectancy to 65 – on par with the figure for all Americans in 1944.

While COVID has driven most of the decline in life expectancy, a rise in accidental deaths and drug overdoses also contributed, as did deaths from heart disease, chronic liver disease and cirrhosis, according to the new CDHS report.

Dr Steven Woolf, from Virginia Commonwealth University, told The New York Times that the drop in life expectancy in the US was “historic”.

He said no other high-income country had such a poor record, thanks to their successful vaccination campaigns during COVID and with populations that were more willing to take behavioural measures to prevent infections, such as wearing masks.

“The US is clearly an outlier,” he said.

Dr Woolf attributed the difference between the US and other developed countries, to a fragmented, profit-driven healthcare system and pervasive risk factors such as smoking, widespread access to guns, poverty and pollution.

Victorian health service can fire nurses who refuse COVID-19 vaccine, court rules

December 2, 2021 by Madeline Lucre Leave a Comment

An injunction to stop Victoria’s largest public health service from firing nurses who refuse the COVID-19 vaccination or refusing to disclose their vaccination status was thrown out by the federal court in November.

A group of 90 nurses from Monash Health argued before the court that they should have been consulted before any disciplinary action was taken against them.

The health service was acting on a directive from Victoria’s chief health officer under the Public Health and Wellbeing Act 2008 (Vic), which made it clear that health workers must be fully vaccinated, having received at least their first COVID-19 vaccine dose by 29 October in order to work in a healthcare setting. They had to provide evidence of vaccination to their employer.

In the federal court, Justice John Snaden said the public health directions did not permit Monash to do anything else other than terminate employment.

He dismissed the nurses’ argument that they should have been consulted before disciplinary action was implemented.

He described their case as “at best, weak”.

Chris O’Grady QC, representing Monash Health, said the employer had simply been following the chief health officer’s directions.

“In light of the CHO directions, it goes without saying that anyone working in the health sector is going to have difficulty working in that sector, absent their willingness to either be vaccinated or disclose their vaccination status,” he said.

The Supreme Court has also rejected several challenges to NSW Public Health Orders as has the NSW Civil and Administrative Tribunal.

The Federal Court judge described the nurses’ case as ‘at best, weak’.

Cultural safety and awareness are key to addressing the COVID-19 vaccination gap for Aboriginal patients

November 25, 2021 by Madeline Lucre Leave a Comment

Thanks to the ongoing commitment of General Practice, NSW has made significant progress in COVID-19 vaccination, resulting in a rapid rise in second dose coverage and further easing of restrictions across the state. However, Aboriginal people still have lower vaccination rates than non-Aboriginal people, placing Aboriginal communities at increased risk of contracting COVID-19 and developing serious illness.

Most Aboriginal people who have been vaccinated in NSW did so in a General Practice setting – highlighting existing trusted and supportive relationships. Creating a culturally safe and welcoming environment for Aboriginal patients who haven’t received their vaccination could be the encouragement others need to take up the COVID-19 vaccine.

Cultural safety for Aboriginal patients includes clear and respectful communication; respectful care informed by an understanding of culture; patient-empowered decision making; and often the inclusion of family members. Better health outcomes for Aboriginal people are produced with culturally safe care.

Strengthen the Aboriginal cultural safety and shared decision-making approach within your practice, including around COVID-19 vaccine, through the following:

1: Complete the RACGP Aboriginal Cultural Awareness and Safety training (available free to NSW non-RACGP members)
2: Make your practice welcoming and inclusive for Aboriginal patients using this checklist (RACGP accreditation standard)
3: Use a culturally appropriate SMS script to contact/re-contact Aboriginal patients and offer a vaccination information appointment (see MBS items), giving them time to ask questions and understand their options
4: Use the NSW Health shared decision making tool to facilitate conversations on COVID-19 vaccines with Aboriginal patients. The shared decision-making process allows patients and health care professionals to make informed, preference-based decisions together, and is helpful for patients who have questions or concerns. Watch a video about the tool here.

Click here for more strategies, tools and resources to promote vaccination to Aboriginal patients.

The science behind COVID-19 vaccines

October 5, 2021 by Madeline Lucre Leave a Comment

In a recent NSWNMA webinar, Dr Jessica Stokes-Parish (PhD, RN), who works in an ICU, and Romy Blacklaw (IPN, RN), a clinical nurse in a COVID-19 vaccination hub, responded to common questions and concerns about COVID-19 vaccines.

Vaccine development

Conventional vaccines can take three to 10 years to develop. In the case of COVID-19 vaccines, researchers and developers, backed by huge private and government funding, were able to work quickly and collaborate globally to develop a safe vaccine. Scientists built on decades of coronavirus research (e.g. SARS and MERS), recent advances in mRNA therapies (for cancer and viruses), and early identification of the genome sequence of SARS-CoV-2, to quickly develop potential vaccine candidates.

Vaccine safety

Both the AstraZeneca and Pfizer vaccines have had extensive safety testing. No shortcuts were made in what are acknowledged to have been gold standard vaccine trials. Tens of thousands of participants were enrolled in the clinical trials, some of the highest numbers ever seen.

Were COVID-19 vaccines rushed through?

The Therapeutic Goods Administration (TGA) provisionally approved COVID-19 vaccines after assessing all available data. Provisional approval is a process that allows temporary registration of promising new medicines and vaccines where the need for early access outweighs any potential risks. The TGA engaged early with pharmaceutical companies about their vaccines, assessing clinical trial data as it became available, rather than at the end of the three clinical trial phases. This sped up the review process.

What are the side effects of COVID-19 vaccines?

The Pfizer vaccine is generally well tolerated by most people, but side effects may include aches, pains and fever. While these effects are not very pleasant, they are a very good sign that your immune system is working. These symptoms are more common in younger people, who generally have more robust immune systems. Side effects are also more common after a second dose of the Pfizer vaccine. Most side effects occur within 24 hours of getting the vaccine, with symptoms typically resolving within 48 hours. AstraZeneca vaccine has similar side effects. Again, they are more likely to occur in those who are younger, and most side effects occur within 24 hours of getting a vaccine, with symptoms typically resolving within 48 hours.

What about adverse effects?

In any large-scale vaccination rollout, some people will experience a new illness or, sadly, pass away after vaccination. In some cases, these illnesses or deaths will be coincidental, and not caused by the vaccine. The TGA reviews all deaths reported in people who have received the vaccination, to assess whether the death was related to vaccine safety, or a side effect of the vaccine, or related to other causes.

A very rare adverse effect of the AstraZeneca vaccine is a rare type of blood clot – thrombosis with thrombocytopenia syndrome (TTS). Symptoms include nausea, blurred vision and pain in the head or legs that do not resolve with pain relief like paracetamol, and it is important to talk to your doctor immediately if you have any symptoms, as the condition is treatable. Fortunately, the risk of developing the syndrome is only 0.0002 per cent, based on the UK data.

In safety reports from the TGA, (as of 27 July), doses of the AstraZeneca vaccine given were 6.1 million, with six deaths. That gives a vaccine mortality rate of 0.00009 per cent. In contrast, in the same timeframe there were a total of 33,081 cases of COVID-19 infection in Australia, which resulted in 918 deaths – a case mortality rate of 2.78 per cent.

Vaccine monitoring

After any vaccine is registered and administered to people, experts and regulators continue to monitor vaccine safety in several ways. Australia’s safety monitoring is robust, including passive and active measures of surveillance. This safety information is publicly shared via AusVaxSafety.org.au and TGA.gov.au.

Why two doses of vaccine?

There is strong evidence that a second dose of either Pfizer or AstraZeneca increases your defence against COVID-19. Clinical trials show the Pfizer vaccine provides 52 per cent protection 12 days after the first dose, with protection rising to 95 per cent after the second dose. AstraZeneca vaccine protection against symptomatic COVID-19 was estimated to be 76 per cent at 22 days after the first dose, rising to 81 per cent when a second dose was given 12 weeks after the first. Pfizer and AstraZeneca both appear to offer less protection against the Delta variant than for the Alpha variant, and a second dose is even more important to protect against Delta.

BREAKOUT

Myths about COVID-19

Myth: the mRNA vaccines alter DNA

This is simply not possible. The mRNA vaccine cannot get into a cell’s nucleus. The flow of information from DNA to RNA to proteins – in that direction only – is one of the fundamental principles of molecular biology. The flow of information cannot go the other way, from mRNA to change DNA.

Myth: COVID-19 vaccines affect fertility and are dangerous during pregnancy

There is no mechanism for COVID-19 vaccines to affect fertility. The safety data on vaccines shows no fertility safety triggers. The animal data showed no fertility issues, and there was also no impact on sperm. On the other hand, vaccination has benefits to pregnancy and breastfeeding. We now have evidence that passive immunity occurs as a mother’s antibodies cross to the milk. Research has also shown immune transfer by the placenta for Pfizer, and the vaccine does not cause problems with the placenta. The COVID-19 disease, however, does cause problems during pregnancy. The risk of COVID-19, particularly the Delta variant, for pregnant people is quite significant. COVID-19 disease increases the likelihood of a preterm delivery, and the risk of pre-eclampsia or eclampsia.

Myth: Vaccines cause viral shedding

Viral shedding refers to a process where virus is shed by an infected person. For a virus to shed, it must be intact and actively reproducing. COVID-19 vaccines are not live; they contain no virus that is capable of reproducing, and the vaccine’s mRNA and viral vector are non-replicating.

Rights and obligations around COVID-19 vaccination

October 5, 2021 by Madeline Lucre Leave a Comment

There are professional, industrial and work health and safety (WHS) perspectives that shape the rights and obligations nurses and midwives’ need to consider when making personal decisions about the COVID-19 vaccination.

NSWNMA supports vaccination and strongly encourages all healthcare workers to be vaccinated if there is no medical contraindication.

NSWNMA is aware that some nurses and midwives have concerns about the safety of the vaccine.

NSWNMA is also aware that some nurses, midwives, students and AiNs may decide for their own reasons that they will not receive a COVID-19 vaccination under any circumstances.

The following information outlines the professional and legal perspectives that delineate the rights and obligations that should be considered when making a personal decision about vaccination:

Professional rights and obligations

The Nursing and Midwifery Board of Australia Position statement on nurses, midwives and vaccination makes it clear that registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence are in breach of their professional obligations and may be subject to regulatory action.

The National Boards and the Australian Health Practitioner Regulation Agency (AHPRA) have published a joint statement – Registered health practitioners and students: what you need to know about the COVID-19 vaccine rollout – to clarify their expectations in relation to giving, receiving and advising on and sharing information about COVID-19 vaccination.

In this advice it is clear that all registered health practitioners and students (particularly those undertaking placements in various practice settings) are strongly encouraged to have the full COVID-19 vaccination course as scheduled unless medically contraindicated.

The National Boards also state that all regulated practitioners have a responsibility to participate in efforts to promote the health of communities and meet obligations with respect to disease prevention including vaccination, health screening and the reporting of notifiable diseases.

The National Boards recognise that while some health practitioners may have a conscientious objection to COVID-19 vaccination, all practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines relating to COVID-19 vaccination. Any queries about these should be directed towards the individual employer, health service, state or territory health department and/or education provider for registered students.

Industrial rights and obligations

Mandatory vaccination of workers in certain workplaces is not a new feature of the working and legal landscape.

Currently in the NSW public health system, there are a number of well-established vaccination requirements for staff via NSW Ministry of Health policy directives. Private hospital providers also have developed similar expectations of their staff. These existing requirements have to date been relatively uncontroversial.

In residential aged care, it is a legal requirement for its workers (as well as visitors) to have the influenza vaccination. In the absence of the influenza vaccination, the worker or visitor are not permitted to enter a Residential Aged Care Facility (‘RACF’) unless exceptional / special circumstances exist. This existing requirement for an influenza vaccination in RACFs has been extended to include a similar requirement for its workers to have a COVID-19 vaccination as of mid-September 2021.

There have been three recent decisions by the Fair Work Commission regarding dismissals related to refusal of mandatory vaccinations, in the childcare sector and in aged care. In both cases the Fair Work Commission considered that it was a valid reason for the employers to dismiss the workers for refusing to have an influenza vaccination.

Work Health and Safety (WHS) rights and obligations

Employers are required to do what they can to eliminate or minimise the risks associated with exposure to COVID-19 for both their workers and patients/residents. The best way to eliminate exposure is to ensure people are not bringing the virus into the workplace. Personal protective equipment (PPE) certainly has a place, but it is a lower order control because it is attempting to minimise the risk of the virus spreading rather than stopping it getting into the facility in the first place.

Workers must follow reasonable instructions and cooperate with policy and procedure. There is existing case law to say that vaccination is a reasonable requirement when working with vulnerable persons.

More information

NSWNMA Position statement on COVID-19 vaccination

NSWNMA Policy on Work Health and Safety

ANMF Policy on Vaccination and Immunisation

AHPRA Position Statement: Registered health practitioners and students and COVID-19 vaccination

Key points on rights and obligations

Professional (National boards and APHRA): all practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines relating to COVID-19 vaccination.

Industrial (Fair Work Commission): In three cases in child care and in aged care, the Fair Work Commission considered that it was a valid reason for  the employers to dismiss the workers for refusing to have a mandatory vaccination.

WHS Law: Workers must follow reasonable instructions and cooperate with policy and procedure. There is existing case law to say that vaccination is a reasonable requirement when working with vulnerable persons.

Getting a COVID-19 jab is an “act of love” says Pope Francis

October 5, 2021 by Madeline Lucre Leave a Comment

The pontiff has urged people to get vaccinated against COVID-19.

The pope’s appeal appears in a video, which also features catholic bishops from the United States and Central and South America.

“Thanks to God and to the work of many, we now have vaccines to protect us from COVID-19,” the pope says in the video. “Vaccines bring hope to end the pandemic, but only if they are available to all and if we collaborate with one another.”

Pope Francis says being inoculated with vaccines authorised by competent authorities was “an act of love”.

“Vaccination is a simple but profound way of promoting the common good and caring for each other, especially the most vulnerable,” he said.

The pope has previously spoken about the importance of vaccines, while emphasising that they must be distributed equally, especially to poor countries.

Not all senior catholic clergy, however, have been singing from the same hymn sheet. American cardinal Raymond Leo Burke has been an outspoken critic of vaccines and even of social distancing.

Burke said that the coronavirus “has been used by certain forces, inimical to families and to the freedom of nations to advance their evil agenda”.

Later, after a visit to Wisconsin, he tested positive for COVID-19, was admitted to hospital and was on a ventilator.