How to have a conversation with someone who is vaccine hesitant.

The COVID-19 vaccination conversation in Australia has been more than a little confusing. 

We’re being bombarded with sometimes contradicting guidance from doctors and politicians, particularly when it comes to the AstraZeneca jab - one of two options available to us here in Australia. 

We were told it was only for over 60s, then the Prime Minister changed that advice overnight because of Sydney’s growing COVID outbreak. Now anyone can talk to their GP about potentially accessing it, but it’s still not the preferred vaccine for young people because of a rare but serious side effect. 

Even though it’s been cleared by all relevant medical authorities for older Australians, the confusion has led to many refusing to get it. The Australian Bureau of Statistics reports 35 per cent of 50 to 69 year olds and 26 per cent of people aged 70 and over cited wanting a different vaccine as a key reason for not yet getting the jab, despite being eligible.

Watch: How to talk to anti-vaxxers. Post continues after video.

The AstraZeneca confusion, paired with misinformation from the anti-vax movement and genuine confusion from vaccine-confident people when it comes to things like fertility side effects and the length of human trials, has left even the most well-informed double guessing themselves. 

So. We’ve gathered all of the concerns and questions and given you the tools to debunk any lingering myths that are being circulated by friends and family. 

“I don’t want AstraZeneca because I might get blood clots and die.”

Let's start with the facts. When experts say the risk of a blood clot from the AstraZeneca vaccine is rare, they mean four-six people in every one million rare. 

That’s 0.0005 per cent. 

Australia's national fatality rate from COVID-19 is three per cent with 912 deaths in just over 30,000 cases. So far out of just 900 cases in the current Bondi outbreak, we’ve had two fatalities. 

In the US, the death rate is 1.8 per cent, with our particularly high fatality rate attributed to the virus hitting our nursing homes really hard. In the UK, the death rate is 2.5 per cent. 

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By way of comparison we've had three people die in Australia from possible links to AstraZeneca, out of 5.4 million doses.

Now. This is of course a side effect to consider before taking this vaccine. Right now, the Australian Technical Advisory Group on Immunisation (ATAGI) recommends AstraZeneca for the over-60s. The reason for this is, the risk of thrombosis with thrombocytopenia (blood clots) appears to be caused by an overactive immune response. The younger you are, the stronger your immune system is and therefore the likelihood of this reaction increases.

But you also have to put the risk into perspective. You are far more likely to die from COVID-19, as the figures above show. If you are living in a hotspot right now and you’re under 60 with no date on the horizon for the preferred vaccine for your age group (Pfizer), that’s a risk/ benefit conversation you should have with your GP.

If you’re over 60, it’s important to remember that 95 per cent of COVID deaths are in this age bracket. With the risks of the clotting far less for older Australians, the risk/benefit conversation becomes a lot more skewed in the direction of benefit. 

"I am having a lot of conversations with people over 50, and saying yep your chance of having a blood clot is about one in a million. We're also getting better at responding to it, so we know what drugs to give people, we know how to identify it in the hospital, and it's very unlikely that even if you do get a clot, that you will die from it. Most people are pretty understanding and can assess those risks compared to getting COVID," Sydney GP Dr Brad McKay told Mamamia's The Quicky. 

“It’s ‘my body my choice’ not to get a vaccine.”

For the COVID-19 vaccine to be properly effective, we need to achieve a ‘herd immunity’ where the majority of our population is protected. 

The argument of “it’s my body my choice” to take a vaccine, is co-opting the language of pro-choice politics to argue something completely different. 

Getting a vaccine is about public health. It’s about being a member of society. By not getting it, you’re affecting the wider community who is relying on widespread inoculation to be safe. Vaccines remain our only ticket to getting out of this constant yo-yo of lockdowns and border closures.

Getting an abortion on the other hand, which is one of the reasons the pro-choice movement exists, doesn’t affect the wider community. That’s a personal choice that affects you, not the society you live in. 

“I’ve heard the vaccine will affect my future fertility.”

The Therapeutic Goods Administration (TGA) is Australia’s independent national regulator of therapeutic goods and is responsible for ensuring that only safe and effective health technologies are marketed for supply in Australia.

As the Department of Health explains, “the TGA will not approve a vaccine for use in Australia unless it is safe and effective. This includes impacts on fertility. None of the COVID-19 vaccines currently approved, or under review by the TGA cause sterilisation/infertility.”

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The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) reported this month that they have received more than 13,000 reports from women (out of 68 per cent of the population who have received at least one jab), who have experienced changes to their period after having the vaccine. A much higher 25 per cent of women who contract COVID-19 see changes to their menstruation cycle. 

Dr Viki Male, a reproductive immunologist at Imperial College London, said women should feel confident getting the jab and that reports of changes to your period are not unexpected. She added that there is no scientific link between vaccination and fertility and told Sky News, women can be more susceptible to problems during pregnancy if they contract COVID-19. 

“We don’t know enough about the vaccine, they were rushed through the trial stage.”

Traditionally, vaccine development begins with research and discovery, and progresses from preclinical to three clinical phases, to vaccine licensure, then large-scale production. It normally takes between 10-15 years. COVID-19 vaccines were developed in around 12 months.

But as Stacey Cheung, a Senior Research Assistant at the School of Chemistry and Molecular Biosciences at the University of Queensland explains, none of those aforementioned steps were skipped, and the reason we were able to get from step one to four so quickly is because of four major factors: science, time, money and volunteers. As she explains, we could make ALL vaccines quickly if we had the same four factors on our side. 

“No corners have been cut, no safety steps have been compromised,” she wrote on Instagram, in an informative infographic you can have a flick through below.

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A post shared by Stacey Cheung | Scicomm (@sciencebikerchick)

But what about long-term risks? I hear your vaccine-hesitant friends retorting. 

Well, adverse events typically occur within 6-8 weeks after a vaccine is administered. We know this from watchings trends with the polio, MMR and yellow fever vaccines. 

As science commentator Nini Munoz explains, the trials were done on tens of thousands of volunteers. One of the biggest challenges drug developers have is recruiting enough participants for this phase.

“Waiting to enroll more would have resulted in many more lives lost and detecting events that occur in the order of one per million would have required millions of volunteers,” she explained.

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“COVID-19 and the flu are the same thing, and we don’t shut the economy down for a cold.”

Yes, both the flu and COVID-19 are caused by viruses, but they are not the same thing.

As Australian GP Dr Preeya Alexander explains, COVID-19 is far, far more contagious and the risk of death compares as such: 

A study in the British Medical Journal analysed 3,600 patients hospitalised with COVID-19 compared to 12,600 hospitalised with influenza. 

The rate of death was 18.5 per cent compared to 5. 3 per cent for influenza. 

Even when adjustments were made for age, rage and other differences, the rate of death was nearly five times more for those infected with COVID-19. 

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"Big Pharmas are just raking in the cash."

It is true that money is made in the sale of coronavirus vaccines to the world. No business works for free, and in order to produce a vaccine pharmaceutical organisations like Pfizer and AstraZeneca have to fund their research and development. 

But let's put this into perspective. 

If vaccination rates dropped - COVID-19 aside - there would be an increase in preventable illnesses, many of which have high rates of complications resulting in hospitalisation and expensive treatment. For example, the WHO reported that the number of measles cases in the first three months of 2019 quadrupled in comparison to cases reported at the same time in 2018.

Why? As the WHO reports, vaccination rates have stagnated in recent years thanks to an increase in misinformation and complacency. 

Paediatrician Dr Scott Dunlop can attest to this, telling Mamamia, "Even though they are thankfully a minority [anti-vaxxers], there is no doubt that in my clinical practice there are more un-immunised children than there were 10 years ago."

In order for a vaccine to work - everyone needs to take it. That's why it's called 'herd immunity.' If we stop vaccinating illness increases, and our hospitals are inundated. 2020 showed us how badly hospitals can be overrun when just one un-vaccinated disease runs rampant. 

So yes, money is made from vaccines. But the money lost by global economies treating vaccine-preventable diseases far outweighs that. Thanks to the cost of coronavirus, in 2020 Australia entered its first recession in nearly 30 years.

"Vaccination causes autism."

Despite being debunked time and time again, this claim just doesn’t seem to disappear and pops up for every new vaccine.

It was a valid concern in the early 1990s, but we have 30 years of research, from multiple studies, that prove it’s completely false.

Autism rates in developing countries have risen in this time, but that’s likely to be because of increases in diagnoses, or changing definitions for autism.

In fact, in 2004 the author of British Medical Journal The Lancet, Dr Richard Horton who is behind a lot of the autism-vaccination link fears, retracted a study guilty of fuelling this myth.

In a statement the journal said "it is now clear that 'several elements' of a 1998 paper it published by Dr. Andrew Wakefield and his colleagues are incorrect, contrary to the findings of an earlier investigation."

Sydney GP Dr Keang-Sing Lim told Mamamia it is still among the most common queries parents-to-be ask at his clinic when it comes to the topic of vaccination.

“A lot of studies look at the rate of autism between those who have been vaccinated and those who haven’t. The rate is the same. Vaccination DOES NOT increase rates of autism,” he said.

"Disease can die out on its own."

A common trope of the anti-vaxxer movement is that: "Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation."

Right now we are seeing countries in Europe and America start to reopen, and it appears like they have 'reached their peak' and they're on the other side. But that's been accomplished with a combination of climbing vaccination rates and managing the numbers of infections. 

Yes, some countries have been able to slow the spread of coronavirus with hygiene and social distancing - and on the wider scale socioeconomic conditions have definitely had an indirect impact on rates of disease. 

However, if you look at the pattern of incidence of vaccine related illness once vaccines are introduced, you’ll see a pattern emerge: a real, permanent drop. The world is entirely free of smallpox today for example - a disease that killed an estimated 300 million in the 20th Century alone.

In the 1950s, vaccines were developed for polio and by the 60s and 70s countries were able to eradicate it altogether. 

As Stanford University immunologist Dr Mark Davis once put it, vaccines are “the single most life-saving medical innovation ever in the history of medicine”.

Coronavirus will always be there, waiting to reinfect unless we see that 'permanent drop' that a vaccine brings. 

**

Finally, while having these conversations with your loved ones, it's important to remember that the unknown is scary. 

As therapist Maysaa Fahour told Mamamia, humans have six core human needs: certainty, variety, significance, connection, growth and contribution. We are living in a very uncertain world right now which means emotions and fear are heightened. This is the environment in which conspiracy theories thrive, and thanks to social media and a few celebrity spokespeople, this misinformation has been able to infiltrate our phones, screens and psyches like never before. 

When it comes to vaccination, remind your loved ones to always go back to the experts: scientists and medical professionals. We should not be listening to influencers, celebrities, fitness trainers or cooks no matter how much research they say they've done. 

Research on the internet does not qualify you to be an epidemiologist. So, if you hear a myth or a strange possible side effect that has you worried: find the source reporting the concern before you blindly believe it. 

Read more:

• How to have a conversation with someone who thinks the COVID-19 pandemic is a hoax.
• "I'm a doctor, and here are the 6 questions I get asked most about the COVID vaccine - answered."
• 'I'm 34, and this is why this week I got the AstraZeneca vaccine.'
• This week, Mamamia released a podcast episode we were almost harassed into cancelling.
• "The GPs of Australia are confused". A doctor's perspective on the COVID-19 vaccine rollout.

Feature image: Getty/Mamamia.