Bringing it forward

By August 26, 2021Science

As I have related here, I had my first AstraZeneca vaccination at lunchtime on the last day of June and was due to get the second dose the requisite 12 weeks later (i.e. September 22)1. However, as things have become more desperate in New South Wales and that has overflowed into the Australian Capital Territory, it has been suggested by the Australian Technical Advisory Group on Immunisation (ATAGI) for people in areas where there are outbreaks, that they should bring forward their second dose of AstraZeneca. ATAGI has also urged younger people who are unable to get access to the Pfizer vaccine because of its limited supply, to consider getting the AstraZeneca vaccine2. The AstraZeneca vaccine (two doses) has been shown to lead to a 60-67% reduction in the likelihood of symptomatic disease and a 92% decrease in the likelihood of hospitalisation3.

Most of the side effects of the AstraZeneca vaccine were much as I had after my first dose, just a feeling of tiredness and mild illness1. However, in rare cases there are severe side effects. These can include anaphylaxis3, the possibility of which is the reason I had to hang around in the doctors’ surgery for 15 minutes after my first dose1. The other side effect is perhaps the more dangerous TTS, which is shorthand for thrombosis with thrombocytopenia syndrome3.  

TTS involves blood clots (thrombosis) and low levels of blood platelets (thrombocytopenia), In Australia symptoms of TTS have occurred between 4 and 42 days after the first dose of the AstraZeneca vaccine. The blood clots can occur in various parts of the body, and can lead to death. The mechanism that causes TTS is not fully understood, but fortunately, TTS is very rare and only averages 1.4 cases per 100,000 in my age group (60-69). The risk increases as you get older (it is 1.9 per 100,000 for those over 80), but the risk is greatest for those under 50 where it reaches 3.1 cases per 100,0004.

The reason the AstraZeneca vaccine was not suggested by ATAGI for younger people was because their risk of dying from Covid-19 is very low, especially where the number of cases is low. The increased risk of TTS for younger people in this situation essentially makes the risk of death from the vaccine more likely than from the disease. However, in the middle of a large wave of infection, such as that in Sydney, the risk from the disease is greater.

Bringing your second dose forward has given rise to some concern that this will lessen protection against the virus. The efficacy of the vaccine against symptomatic disease ranges from about 62% to 73%, with the higher efficacy seen after a longer 12-week interval between doses. However, the efficacy is still fairly good when a second dose is given even as early as three weeks after the first dose, at about 60%, according to ATAGI5.

Given that the ACT is in lockdown and there are cases (fortunately not the huge numbers of Sydney) cropping up every day, I decided to bring forward my second AstraZeneca dose, and have booked in for September 1st. This is 9 weeks after my first dose, rather than the 12 weeks initially recommended. I just rang the doctors’ surgery and asked them if I could change my appointment, and there was no problem in doing so.

Professor Adrian Esterman, chair of Biostatistics at the University of South Australia, has said “When you look at the vial with AstraZeneca in it, it says to give the second dose from between four to twelve weeks” and, “If you have both shots, whether at eight or twelve weeks, or whether you are fully vaccinated with AstraZeneca or Pfizer, you are pretty much covered against severe disease and death”5. Sign me up.




  • James Faulkner says:

    While I appreciate the supply issue re Pfizer, the AstraZeneca is clearly the second rate option. Forcing AZ onto the population because the govt is run by incompetents and economists is, well excuse my language, pretty fucking shit behaviour. This would not be an issue if Morrison had actually done his bloody job. As far as I’m concerned, we’ve been let down once again. I have no confidence that the govt decisions at any level will not lead us down the path of a greater case load and more avoidable deaths.

    Convince me otherwise, if you can.


    • admin says:

      You won’t get an argument from me. Morrison has been murderously derelict in his duty, as I explain here:
      Morrison is one of the most disgusting, venal, narcissistic politicians I have ever seen. He belongs in gaol. He and Berejiklian seem to have run up the white flag in the face of this outbreak in NSW. That means there will be many more cases and many more deaths. It also seems like the hospitals are already overwhelmed in that there are deaths of sufferers at home. Of course, the disgraceful Berejiklian will never admit this.

    • Jon says:

      Agree James. Partner and I are not in the highest TTS risk category and had our first AZ injection early August, basically because it was clear that Berejiklian’s overconfidence in her “gold standard” abilities was about to come crashing down, and because we felt that Pfizer should be left to younger people given the enormous fu by the Penetcostal Malingerer and his equally incompetent minions – who all had Pfizer vaccines as soon as it became available. Hypocrites all.

      The current situation is a SMALL window into what is likely to occur when 80% open day is reached unless SIGNIFICANT rules are put in place (and strictly enforced) AND there is very high levels of public compliance in the states/territories. Morrison always uses the best case scenario from the Doherty Institute report when talking about opening up. He also avoids talking about the numbers of modelled deaths. The best case model is one which imo has almost zero likelihood of being attained and for which there is little evidence anywhere across the world. The next level down from that also appears optimistic based on overseas experiences, and puts enormous responsibility on health workers – many of whom will be unable to work because they are isolating with covid, or are physically exhausted/mentally fragile due to the responsibility of managing dying people at a time where relatives are excluded from offering support to their loved ones. I’ll have to have another look but I can’t recall seeing modelling for health worker numbers or the resultant risks anywhere in Doherty.

      The second level predicts about 1900 deaths in the first 180 days. I can’t recall them modelling the numbers of people who will have ongoing effects (“long covid”) but statistics overseas, while extremely murky, currently suggests that number will be much higher.

      Bottom line. Get vaccinated asap. Follow health advice wrt masks, social distancing, isolation if you have symptoms. Have consideration for the vulnerable – kids, people who can’t be vaccinated, have other conditions etc – and don’t expect any magical solutions. Worst comes to worst wave your hands in the air and chant pentecostal platitudes.

      • James Faulkner says:

        I get my first Pfizer on Monday. Had to wait since I have preexisting blood clot history and AZ was a big no as far as my GP was concerned. My mother has the same condition, but since she is over seventy has been convinced she is expendable.
        It’s going to be an absolute shitshow regardless of how they manage it.

        Out of interest, do you know if there is a measure of “success” against the pandemic which is charted against a country’s privatisation of public resources. I’d be interested to know if there is a clear link between excessive capitalism and failure to control.

        • admin says:

          That would be an interesting investigation. The only study I have seen regarding the effect on economic performance of the reaction to the pandemic. It showed that those countries that have done best in dealing with the pandemic, have also done best economically. The first time I saw this study was, I think, in the Financial Times.

          • James Faulkner says:

            I’ve no doubt that that report was true. It’s notable that all those countries have developed infrastructure and economies predating COVID by decades if not centuries. or supported by US funding (Israel, we’re looking right at you). That would allow them to cope better with any crisis in general.

            I’m suspicious of the economic argument as being a marker of the success of a country. It strikes me that any country, state, person or group whose economy is more important than the well-being of its people is an unbalanced and probably psychopathic one.

          • admin says:

            Not all the countries who have done well at keeping Covid-19 down are US client states; just those not run by psychopaths. I agree that economics is not necessarily a marker of success. These days it tends to be solely based on GDP, the share market, and how much wealthier the wealthy have become. I’d argue that these markers are almost entirely of how sick a nation is; of how much inequality there is. That is not success.

          • James Faulkner says:

            I guess the real question then is how can we repair such a damaged society?
            Is it possible?

          • admin says:

            The main problem is that the neoliberal economic model is very much in the interests of the wealthy and corporations and it is they who purchase politicians by making donations to political parties and candidates. Firstly, political donations from organisations must cease, and if they are to continue from Australian citizens (and only citizens without dual nationality), then they must be capped per donation and capped per annum at a quite low level to prevent significant bribes. Secondly, there needs to be a fairly large federal integrity commission, which is funded completely independent of budgetary shenanigans, and completely independent of any political influence. Thirdly, there needs to be truth in journalism legislation and the press council needs to be independent of the publishers (who now fund it) and of government, and which has significant ability to fine transgressors. Fourthly, there needs to a breaking up of the near monopolies of media organisations such as News Corp and Nine. That is just the tip of the iceberg of what is needed. We also need to look at taxation, both of people and corporations, and such scams as negative gearing and excess franking credits (both of which I have benefited from in a modest way). Something I wrote some years ago on the trickle-down scam:
            The only way it is possible to even begin to make these changes is to get rid of the Morrison government.

          • James Faulkner says:

            This might be why we need a clean sweep republic, as much I resent the idea of a ‘president’ ( old school yank hater here). Although knowing the greedy elites, they’ll twist it to their needs like they did our fine commonwealth (before they sold the wealth out from under the commons to the private sector).

            I honestly don’t know how to effect change. The controlling interests have tied up all the reasonable avenues of social and political change with legal and economic jiggerpokery.

          • admin says:

            If the Morrison government is re-elected then we will have to take to the streets. If they are not, then we will have to pressure the Labor Party (on the assumption that they have the power to do so) to do what is required. While I can understand why the Labor Party is currently making itself a small target with most of the media arranged against them, I hope they have a much better policy platform than they have proffered so far. If we cannot do that, we will have to take to the streets.

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