The latest news on vaccines, the pandemic’s hidden toll on public health workers, and some critical findings on health literacy – these are some of the issues investigated in the latest COVID-19 wrap.
Alison Barrett writes:
To be consistent with the name used overseas, the Therapeutic Goods Administration (TGA) has approved AstraZeneca’s request to change the name of the AstraZeneca COVID-19 vaccine to Vaxzevria.
It is expected that by using the same name used overseas, including in the European Union and Canada, that the AstraZeneca (Vaxzevria) vaccine produced in Australia will be recognised as the same product produced overseas.
This may alleviate previous concerns that some countries may not recognise the AstraZeneca vaccine on Australian vaccine passports.
TGA advised the rebranding will take effect in late 2021.
Recap on Moderna’s vaccine
On 9 August 2021, the Therapeutic Goods Administration (TGA) granted provisional approval for Moderna Therapeutics’ mRNA-1273 COVID-19 vaccine, Spikevax, to be administered to Australians who are 18 years or older.
Moderna’s phase three clinical trial in 30,000 participants found the vaccine to be 94.1 percent effective in preventing COVID-19 symptoms after two doses were given 28 days apart.
Mild side effects reported by participants include fatigue, headache and muscle aches, and injection-site pain which reduced in most participants within two days after vaccination.
Similar to the Pfizer mRNA vaccine, systemic side effects, such as headache, fatigue and muscle aches, were more common after the second dose than first.
A study in vaccinated frontline workers by the US Centers for Disease Prevention and Control (CDC) found that two doses of a mRNA vaccine had 90 percent efficacy against COVID-19 symptoms, supporting efficacy data in the clinical trials. Unfortunately, the authors were unable to calculate efficacy data for each individual vaccine due to low numbers of COVID-19 infections in people after immunisation.
An interim analysis of Moderna’s phase two/three trial of the vaccine in 12 to 17-year-olds was recently published in the New England Journal of Medicine.
Findings from the trial indicate that the vaccine is safe for adolescents, with similar side effects noted in this group as in the adult trial. Most common side effects include injection-site pain, fatigue, headache, muscle aches and fever. No adverse effects from the vaccine were reported.
The vaccine was successful in prompting an immune response, similar to that in young adults (18 to 25-year-olds) in the adult trial.
Due to the low incidence of COVID-19 during the trial (only four cases in the placebo group and no cases in the vaccine group), efficacy of the vaccine could not be determined with certainty, but was estimated to be 93 percent, similar to that found in the adult trial.
Moderna’s Spikevax has been approved for use in adolescents (12 to 17-year-olds) in the UK and European Union, and currently is being reviewed by the US Food and Drug Administration for use in the US.
The TGA is currently evaluating the use of Spikevax in adolescents in Australia.
Intentions to vaccinate
The Australian Government Department of Health has published results from surveys conducted in June, July and August 2021 that identified Australian sentiments towards COVID-19 and vaccination.
The August summary shows that 79 percent of the Australian community intend to be, or are already, vaccinated, which is an increase from 70 percent in both June and July.
Main concerns for the unvaccinated include concerns about long-term side effects from the vaccines, that the vaccine development was rushed, and that there was inadequate testing and research of the vaccines
Report: Issues, barriers and perceptions about the COVID-19 vaccine among culturally and linguistically diverse communities in NSW
New South Wales Council of Social Service (NCOSS), July 2021
Research by the New South Wales Council of Social Service (NCOSS) highlights that 58 percent of culturally and linguistically diverse (CALD) people in New South Wales (NSW) intend to get, or already are, vaccinated against COVID-19.
Of the remaining 42 percent in the study sample, 29 percent were hesitant or unsure about the vaccines, and 13 percent reported that they would not get vaccinated.
The research aimed to identify the issues, barriers and perceptions about the COVID-19 vaccine among 199 members of CALD communities in NSW and was undertaken in May and June 2021, prior to the outbreak in Sydney and NSW.
Participants reported similar concerns as those outlined by the general public, but also reported fear about blood clots from the AstraZeneca vaccine (renamed Vaxzevria on 19 August 2021), limited understanding about how the vaccine works and that the perception that vaccines will make you sick.
Other factors causing vaccine hesitancy in the CALD community include confusing public health messaging and that, worryingly, almost 20 percent of participants said they did not know where they could get vaccinated.
Highlighting potential channels for communicating vaccine information, the study found that friends and Facebook were most commonly relied upon for information about COVID-19.
Less than ten percent of participants reported that Government websites were a primary source of information.
It is important for vaccine communication to be tailored appropriately to the audience, being mindful of health literacy (more on this below) and English-language literacy.
The authors wrote:
[The research] reminds us of the immense value of the long-standing trust and strong relationships that exist between local, place-based services and the communities they work with – close connections that should be utilised to advance public health outcome.”
The full report, which can be viewed here, provides valuable information for public health workers and health communicators who are responsible for communicating vaccine information to CALD communities.
Consider health literacy
Mac, O and colleagues, The Medical Journal of Australia, Preprint, 29 July 2021
As mentioned in the previous summary, it is important to consider health literacy when communicating vaccine and other public health messaging to ensure, or give everyone the best shot at understanding, important messages being communicated.
Health literacy is about how people understand, use and access health information and impacts people’s health outcomes. As per the Australian Institute of Health and Welfare, people with low health literacy have less ability to self-manage their health, have higher hospital re-admission rates and engage less with health services.
In the context of COVID-19 in Australia, low health literacy has been linked to a poorer understanding of symptoms, low importance placed on physical distancing and greater likelihood of supporting misinformation about COVID-19, thus emphasising the need to address health literacy in public health communications.
While improving health literacy via individualistic approaches, such as health education programs, are important, systems and organisations should also provide health information in a format and way that is accessible to target populations.
Researchers from the School of Public Health at The University of Sydney analysed the readability and understandability of public health information about COVID-19 on Australian, New Zealand and British government websites in addition to information on websites for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC) and World Health Organisation (WHO).
Specifically, they analysed the readability (using a tool called the Simple Measure of Gobbledygook (SMOG)) and understandability (using the Patient Education Materials Assessment Tool (PEMAT)) of information about COVID-19 vaccination, face masks and physical distancing.
The researchers found that all of the content that was analysed surpassed the recommended Grade 8 reading level for general audiences. The median reading level of all information was Grade 12, and the median reading level of vaccine information was Grade 13.
While the authors found some content on the websites that was easy to read and understand, they highlighted this content was hard to find.
In conclusion the authors wrote:
The high health literacy demands of vaccination information is a pertinent issue in Australia and has important implications for vaccine uptake.
Successful management of COVID-19 requires a whole of community response. This necessitates effective public communication and a strong commitment to health literacy.”
Prevent Epidemics In-depth Science Review, 2 August 2021
A review of three studies about the mental health impact of COVID-19 on public health workers has revealed, perhaps unsurprisingly, a high prevalence of mental health symptoms in public health workers contributing to the COVID-19 response.
The mental health impact from the pandemic on frontline healthcare workers has been well documented (Croakey has covered it here and here), but not as much is known about the impact on public health workers.
During the pandemic, public health workers have been responsible for developing and implementing infection prevention measures, contact tracing, and epidemiological investigations into the spread of the virus, among many other tasks.
Public health workers play a vital role in the COVID-19 response.
Three studies were reviewed that explored, via surveys, the mental health impact on public health workers in China and the US. They found that half of the survey participants reported at least one mental health condition, including depression and anxiety.
The Chinese survey found that 40 percent of public health workers had experienced limited cooperation from the public and 14 percent experienced verbal abuse.
Worryingly, 87 percent of those who reported mental health concerns did not seek professional health care, saying they had limited time and access to services and their mental health was not important during the pandemic.
The second US study also highlighted that mental health conditions in public health workers were more prevalent than in the general US population (53% compared to 40.9%), but similar to healthcare workers.
As the three studies indicated they did not explore participants’ mental health history, they were unable to determine a certain association between working on the COVID-19 response and mental health. However, the studies provide important information about the public health workforce, highlighting that mental health support is required in the public health workplace.
Mental Health America made the following recommendations for public health workers to support their mental health, which could arguably be beneficial for everyone:
- Ask for help when it’s needed
- Focus on the basics of self-care, such as sleeping, exercising and healthy eating
- Take time to rest and unwind
- Spend time in nature
- Take time away from the news
- Maintain routines and structure to your day
- Maintain COVID-19 prevention measures
- Connect with community.
The University of Melbourne publish weekly vaccine updates, reporting any changes in efficacy, effectiveness and safety data.
The most recent update, for week ending 12 August 2021, is here.
Below are some shareable resources that explain vaccines and discuss answers to common concerns.
Dr Samantha Yammine (science communicator with a PhD in cell and molecular biology) discusses the long-term safety of vaccines on TikTok, one of the most common questions she gets asked.
How vaccines work, a Twitter thread to share
Gigi Gronvall (senior associate at John Hopkins Center for Health Security) explains how vaccines work, in layperson language.
Australian vaccine experts answered some common questions and concerns about vaccines in the Conversation, on 24 February 2021.
Who to follow on Twitter for COVID-19 updates in Australia:
Croakey Health Media has compiled lists of Twitter accounts for people to follow for information about COVID (and various other health issues).
One of the more recent lists compiled is of people to follow for regional NSW COVID news.
Dr An Leavy covers most press conferences around the country each day. Follow her on Twitter.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
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