October 9, 2024

covid vaccine

NSW considers end to COVID mandate for health workers

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NSW Health is consulting with staff, health unions, and local health districts about proposed changes to mandatory COVID-19 vaccination requirements for healthcare workers.

NSW Chief Health Officer, Dr Kerry Chant, said if consultation leads to any change to the current COVID-19 vaccination mandate, NSW Health will continue

to strongly recommend all its workers stay up to date with their vaccinations, in line with its advice for the broader community.

“COVID-19 vaccination continues to provide strong protection against severe illness, particularly for people at higher risk of serious illness and death from COVID-19, including older adults and those with underlying health conditions,” Dr Chant said.

“While the latest evidence shows most people have now developed protection from serious disease due to

vaccination and/or previous infection, COVID-19 remains a serious public health issue.”

In August 2021, during the pandemic, NSW Health introduced mandatory COVID-19 vaccination for all healthcare workers, to protect staff and their families, patients, visitors, and the broader community.

Under the current work health and safety framework for infectious disease screening and vaccination,

NSW Health workers are required to have had at least two doses of a COVID-19 vaccine unless they have a medical contraindication.

NSW Health has said, as with all public health policy, it conducts regular reviews to ensure policy reflects the latest expert advice.

COVID vaccines saved 20 million lives in first year

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The unprecedented rapidity of development and rollout of COVID-19 vaccines is hailed as “an extraordinary global health feat”.

A study published in The Lancet Infectious Diseases modelled the spread of the disease in 185 countries and territories between December 2020 and December 2021. It found that without COVID vaccines, 31.4 million people would have died, and that with the vaccines, 19.8 million of these deaths were avoided.

Many more deaths could have been prevented if access to vaccines had been more equal worldwide. Nearly 600,000 additional deaths – one in five of the COVID deaths in low-income countries – could have been prevented if the World Health Organization’s global goal of vaccinating 40 per cent of each country’s population by the end of 2021 had been met, the research found.

The researchers, from the Imperial College London, said: “The inequitable distribution of vaccines prolonged the pandemic, and exacerbated the probability and frequency of the emergence of variants of concern.”

“Provision of vaccine doses from high-income to lower-income countries is therefore not only moral but also pragmatic,” they said.

“The saving of more than 19 million lives by the unprecedented rapidity of development and rollout of COVID-19 vaccines is an extraordinary global health feat.”

The study highlighted lessons to be learned from the pandemic: improvements in vaccine supply, cold-chain operations, and public confidence.

COVID-19 administration of vaccination FAQs

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The Australian Government and NSW Health are updating information regularly. This information is a guide only. Please check the relevant government websites to ensure information is current. 

Can a registered nurse, enrolled nurse or midwife, who is not an Authorised Nurse or Midwife Immuniser, administer COVID-19 vaccines? 

 Yes, all registered nurses, enrolled nurses and midwives may possess and administer vaccinations, including COVID-19 vaccination, as part of their normal duties when they have an order from an authorised person. This includes nurses and midwives registered on the pandemic sub-register. 

 The order can be a standing order as noted in ‘Standard operating procedure for administration of COVID-19 vaccines in NSW vaccination clinics’ that can be accessed on the NSW Health information page ‘Covid-19 vaccination: information for NSW Health immunisation providers’.

All registered nurses and midwives administering any vaccine must be familiar with the procedures as outlined in the Australian Immunisation Handbook regarding preparation, route of administration, preparation of the person receiving the vaccine, vaccine injection techniques and injection sites. 

 AHPRA has provided additional FAQs here, noting that health.gov.au is the official site for the latest information about the novel coronavirus pandemic. 

 Can a student nurse or student midwife administer COVID-19 vaccines? 

 Yes, as of 28 June 2021, nursing and midwifery students can administer COVID-19 vaccines under certain conditions. This only applies to students working in a NSW Health vaccination clinic. The student nurse or student midwife must: 

  • successfully complete additional training on vaccination administration 
  • be enrolled in an NMBA approved course leading to registration as a registered nurse (division 1) or midwife and have undertaken at least one clinical placement of the relevant qualification 
  • an enrolled nurse student currently enrolled in a NMBA approved course leading to registration as an enrolled nurse (division 2) and have undertaken at least one clinical placement of the relevant qualification  
  • The student must work under line of sight supervision of a Medical/Nurse Practitioner, Authorised Nurse (or Midwife) Immuniser or Registered Nurse (year 2 and above). 

 A student can administer but not assess patients for their suitability to receive the vaccine or to obtain informed consent. 

 See the ‘Statewide Protocol for the Supply or Administration of COVID-19 Vaccine’  and ‘Standard operating procedure for administration of COVID-19 vaccines in NSW vaccination clinics’ for more information. 

 Can any other persons administer COVID-19 vaccines? 

 Yes, Assistants in Nursing and previously registered nurses and midwives can administer COVID-19 vaccines at NSW Health vaccination clinics (a hub) under certain conditions. 

 Assistants in Nursing 

 Assistants in Nursing can administer COVID-19 vaccines at a NSW Health Vaccination Clinic if: 

  • they hold a Certificate III Health Service Assistance (Assisting in Nursing Work in Acute Care); AND 
  • can demonstrate relevant clinical experience in NSW Health 
  • they complete additional training on vaccination administration as directed by NSW Health. 

 Previously registered nurses and midwives 

  • As of 1 September 2021, persons previously registered (in the past 10 years) as a nurse or midwife may also administer COVID-19 vaccines at NSW Health vaccination clinic. 
  • To participate in the vaccination rollout, the previously registered nurse or midwife must make a declaration about any adverse findings by the National Registration and Accreditation Scheme when registered, such as conditions placed on registration, suspension or cancellation of registration. 
  • The previously registered nurse or midwife must also undertake the additional training on vaccination administration as directed by NSW Health. 

See the ‘Statewide Protocol for the Supply or Administration of COVID-19 Vaccine‘ and ‘Standard operating procedure for administration of COVID-19 vaccines in NSW vaccination clinics’ for more information. 

Does a registered nurse, enrolled nurse, midwife, student or other vaccination worker need to undertake the COVID-19 Vaccination Training Program to administer the vaccine under the order from an authorised person? 

 Yes, all registered nurses, enrolled nurses, midwives and students and other categories of Vaccination Worker must successfully complete the additional COVID-19 Vaccination Training Program developed by the Commonwealth Department of Health in partnership with ACN and other training as directed by NSW Health if working in a vaccination clinic. 

What is an Authorised Nurse or Midwife Immuniser? 

 An Authorised Nurse Immuniser or an Authorised Midwife Immuniser is a registered nurse or midwife who has been appropriately trained and accredited to deliver immunisation services and administer vaccines as an Authorised Nurse Immuniser or Authorised Midwife Immuniser.

A registered nurse or midwife who has not completed the specified training to become an authorised nurse or midwife immuniser may only administer vaccines under the direction and authorisation of a medical officer or nurse practitioner.    

See the NSW Health Authorised Nurse Immuniser and Authorised Midwife Immunisers Policy Directive PD2022_016

 Who provides nurses and midwives with the authority to immunise? 

The Chief Health Officer of NSW is the duly appointed delegate of the Secretary, NSW Health, provides the authorisation under the Poisons and Therapeutic Goods Regulation 2008 (NSW). 

 Updates to the list of authorised nurses and midwives (including COVID-19 vaccine) is found on the NSW Health website under Immunisation providers.  

How does a nurse or midwife become an Authorised Nurse Immuniser or Authorised Midwife Immuniser?  

A registered nurse or midwife must have:

  • successfully completed the NSW Department of Health Immunisation Accreditation Program for Registered Nurses prior to 2001, or 
  • The immunisation education program administered by the Australian College of Nursing or its predecessors prior to 1 December 2020, or
  • An immunisation course for registered nurses and midwives that conforms to the National Immunisation Education Framework for Health Professionals, following accreditation by Health Education Services Australia (HESA) and published on the list of approved courses on the HESA website, or 
  • An interstate immunisation education program that conforms to the National Immunisation Education Framework for Health Professionals, as approved by an education provider following the accreditation of their course by HESA and listing of their course on the HESA website. 

The immunisation education program for registered nurses and midwives is accredited by HESA if the course is based on the National Immunisation Education Framework for Health Professionals and is accredited by HESA as having met the Standards for Accreditation of Immunisation Education Programs.

A list of HESA accredited programs can be found here.

Authorised Nurse and Midwife Immunisers must ensure they follow the requirements outlined in the ‘Authorised Nurse Immuniser and Authorised Midwife Immunisers’ Policy Directive.’

Can an Authorised Nurse or Midwife Immuniser administer SARS-COV-2 (COVID-19) vaccine? 

 Yes, but only if the Authorised Nurse or Midwife Immuniser has successfully completed the following additional training: 

  • Core COVID-19 training modules from the COVID-19 Vaccination Training Program developed by the Commonwealth Department of Health in partnership with the Australian College of Nursing; and 
  • Additional COVID-19 training modules from the COVID-19 Vaccination Training Program, for each vaccine that the Authorised Nurse Immuniser or Authorised Midwife Immuniser is administering.  

 Does a medical practitioner need to be on site at a NSW Health vaccination Clinic (Hub) 

All hubs/clinics must have a medical practitioner designated to provide oversight and clinical advice to staff and patients. 

 The medical practitioner does not need to be on site. If the medical practitioner is not on site, an authorised nurse (or midwife) immuniser must be present if a medical practitioner is only available via phone or video consultation. 

NSW Health has published a ‘Statewide Protocol for the Supply or Administration of COVID-19 Vaccine’, which sets out the procedure for preparation of vaccines for administration and the clinical roles of all staff involved. 

‘Standard operating procedure for administration of COVID-19 vaccines in NSW vaccination clinics’ outlines the standard procedures for vaccination administration in vaccination hubs and clinics. 

US exceeds one million COVID deaths

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The US passed one million deaths from COVID-19 on 4 May 2022, according to NBC News.

The Centres for Disease Control and Prevention (CDC) said that more than 80 per cent of US deaths had been among unvaccinated people. However, during the Omicron surge in January and February this year, some 42 per cent of deaths were among vaccinated people. Most were over 75s who had been vaccinated but had not received boosters.

On 3 May, the CDC reinstated its recommendation for people to wear masks on planes, trains and buses.

Although 70 per cent of the US population aged over five is fully vaccinated, vaccines for young children are still not available. Both Moderna and Pfizer-BioNTech have asked the FDA for approval of vaccines for children under five.

A CDC report found that 60 per cent of Americans have had COVID, including three out of four children. The highly contagious Omicron variant was responsible for most of the infections.

The study found that roughly 64 per cent of adults aged 18 to 49 years, about 50 per cent of those aged 50 to 64 years and about 33 per cent of older adults had been infected.

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

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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

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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.

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