By Dr Sheri Fanaroff MBBCh FCFP MFamMed, a Family Physician, practicing in Melrose, Johannesburg. Fanaroff is a member of GGPC (Gauteng General Practitioners Collaboration) which has created a platform for doctors to share resources during Covid-19. Look for #voicesthatcare on the GGPC Facebook page.
You may be young, healthy and have no comorbidities. You may feel that COVID-19 is not a risk to you. You may be lucky enough to have experienced a mild version of illness and felt like it was “just another flu”. You may even feel that COVID-19 is not a young person’s illness, and question whether you should subject yourself to the “risk” and inconvenience of a vaccine.
It is unlikely at this stage though, that you do not have a friend, family member or work colleague who has been severely affected or died from COVID-19. Now that registration has opened to younger adults over 35 years, these are some of the common queries regarding vaccine hesitancy that doctors address every day.
FAQs regarding Covid-19 Vaccines for over 35yrs
1. COVID-19 is not a risk to my age group
Really? Stats SA’s Covid data published in December 2020 showed significant infection rates in the age group 35 to 49 years:
- almost 2 out of every hundred people in this age bracket in South Africa contracted the disease, and
- approximately 5% of those infected in this age group needing hospitalisation from Covid.
- In the 35 to 49 age group, this data showed that 1 in 200 people who contracted COVID died from it.
- Of the total reported COVID-19 deaths in this same report, 14.2% were from individuals in the age group 35 to 49.
I suspect that with the Delta variant, these figures are much higher, but age related data is not yet readily available.
2. Shouldn’t I wait until people more at risk than me have been vaccinated?
While a few months ago, I completely agreed that the first vaccines should be given to frontline healthcare workers and the elderly, who were most at risk, there is now sufficient vaccine stock so that younger age groups can be included.
At this stage it is important for as many people as possible to be vaccinated, to get us closer to herd immunity. Older people were given first priority, but it is now important that all resources are used to get the maximum number of people vaccinated in the shortest possible time. There have been empty vaccine centres with the capacity to vaccinate many more people, and not enough people arriving. So you are no longer asked not to jump the queue as you are not taking away a dose from someone more vulnerable than you. Your time is here – grab the opportunity!
3. How does having a vaccine benefit me?
There are many benefits. It goes without saying that the vaccine for over 35yrs:
• prevents you from hospitalisation and dying, i.e. severe Covid
• greatly reduces your chances of Long Covid. Most young people who have mild illness suffer for months afterwards from debilitating fatigue, breathing difficulties, loss of smell or taste and “brain fog” (changes in cognitive function, memory and focus).
• gives you freedom to travel: many countries already require a vaccine passport, with proof of vaccination allowing entry. It is likely that people who remain unvaccinated will be limited in respect of which countries they can visit. (simialr to yellow fever and TB vaccine passports).
• gives you access to restaurants, gyms and clubs that may not allow entry to unvaccinated people once open (not yet effective in SA).
• reduce strict quarantine requirements once a greater number of South Africans are vaccinated (Current CDC guidelines state that fully vaccinated people can “refrain from quarantine following a known exposure if asymptomatic”. While this is not yet applicable in our country due to the very small numbers of vaccinated people, it will become a reality once less people are vulnerable to becoming infected).
• Vaccinated people will ultimately have less requirements to wear masks, particularly when engaging with others who have been vaccinated.
4. How does me having a vaccine benefit others?
• Being vaccinated makes you less susceptible to getting infected, which in turn makes you less able to transmit the virus to others.
• We await clear data as to whether an uninfected vaccinated person can still transmit infections, but there are promising reports that vaccines also reduce transmission rates.
• Younger people being vaccinated is crucial to us reaching “herd immunity”. This is the point at which enough people in the community (somewhere between 60% and 80%) have either been infected or been vaccinated. When this point is reached, there are so few people left vulnerable to the virus that it cannot continue to be successfully transmitted.
•While many people remain vulnerable and the virus continues to spread unchecked, there is a high risk of it mutating, causing new variants. Like the Delta variant that has driven our third wave, these new variants may be more transmissible and more dangerous. Vaccines still show good efficacy against current strains, but future mutations may bring variants that are vaccine resistant. (**Translation – Have a vaccine as soon as possible, to help drive herd immunity before there are new mutations).
• Getting vaccinated in this age group can help to save the economy – as fewer people are infected, businesses and restaurants will be able to remain open.
• Getting vaccinated protects the elderly in your family – even if your parents who are in their 70s or 80s are vaccinated, if you are not, there is still a risk that you can pass it on to them.
• Getting vaccinated also helps to protect your children who are not yet eligible for vaccines. (While it is rare for children to get severe illness, young children can get a multi inflammatory syndrome, and a significant number of teenagers suffer from complications of Long Covid). Studies show that children in a family are not usually the ones bringing infections into the home – infections usually originate from the adults.
5. I don’t want to have a vaccine that may affect my fertility.
Although there is a lot of social media misinformation about vaccines causing infertility, the respected BMJ (British Medical Journal) recently published guidance from the Association of Reproductive and Clinical Scientists and the British Fertility Society.
This states that “There is absolutely no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men. People of reproductive age should get a covid-19 vaccine, including people who are trying to have a baby or thinking about having a baby in the future.”
6. I’m pregnant or breastfeeding – I would rather delay my vaccine.
• Although pregnant women are at no greater risk of being infected by SARS-CoV-2, complications from COVID-19 infection are common and severe in pregnancy and in newborn infants.
• The benefits and possible risks of COVID-19 vaccination should be discussed by each pregnant woman with her Gynaecologist and GP so that an individualised decision can be made.
• Although there is not yet sufficient data for the vaccines in pregnant and breastfeeding women, there is a strong immune response conferred to mothers following vaccination as well as the benefits of immune transfer to the baby.
• It should be stressed that there are no known risks associated with other non-live vaccines given routinely to pregnant women.
• As such, Covid vaccination with either Pfizer or J&J is currently recommended for patients past the 14th week of pregnancy, as well as for breastfeeding ladies. However, please discuss this with your healthcare provider.
7. There are worrying side effects like Myocarditis and Clotting and Guillain Barre Syndrome in young people who have vaccines.
• The Pfizer vaccine does carry a very small risk of myocarditis and pericarditis, within a few days of vaccination, particularly following the second dose. Symptoms to watch out for are chest pain, shortness of breath or a pounding / fluttering heart after vaccination.
Please consider this in perspective – there have been around 1000 reports of myocarditis in adolescents and young adults (particularly males) from hundreds of millions of doses administered. Also note that COVID-19 infection itself carries a much higher risk of myocarditis than the vaccine. In almost all cases, myocarditis has been treatable and resolved.
• Thrombosis with thrombocytopenia syndrome (TTS) after Johnson & Johnson vaccination is also extremely rare. From more than 12.8 million doses of the J&J Vaccine, there have been only 38 confirmed reports of people who developed TTS. Most reports are in women under the age of 50 years. Again this needs to be looked at in perspective – smoking, the oral contraceptive pill and COVID-19 infection itself all carry much higher risks of clotting than the vaccine.
• There are recent reports of Guillain-Barré Syndrome (GBS) in people who have received the J&J Vaccine. GBS is a rare disorder where the body’s immune system damages nerve cells, causing muscle weakness and sometimes paralysis. Most people fully recover from GBS, but some have permanent nerve damage. After 12.8 million J&J COVID-19 Vaccine doses administered, there have been around 100 preliminary reports of GBS identified. These are still being investigated to establish if there is a causal link.
8.Having a vaccine might give me covid-19 or cause me to test positive for covid-19.
I am often asked this question. Someone is booked for their first or second dose of Pfizer, but they are worried about having it because they need a Covid test (for travelling or a hospital procedure) in a few days time. Being vaccinated CANNOT cause a positive Covid test result.
The PCR test measures actual coronavirus particles in the nose or throat. The vaccine is derived from a small non-replicating portion of viral protein that cannot be picked up either on a PCR test or on an antigen test. A false positive result caused by a vaccine is not possible.
Conclusions regarding vaccines for over 35yrs:
Covid-19 Vaccines for over 35yrs and other have proven to be safe, effective and life-saving. Like all vaccines, they do not give 100 percent protection, and while we are in the third wave in South Africa it is essential to continue safe practices including mask wearing, social distancing and sanitising. I also want to remind people to be cautious in vaccine queues, as we have seen many patients presenting with symptoms a few days after having vaccines. Please remember that you will only be fully immunised four weeks after a J&J vaccine or 2 weeks after your second dose of Pfizer.
The vaccine rollout in South Africa has gathered momentum over the last month and it is critical that we continue with the process, escalating if possible to 300,000 cases per day. It is thus vital that the next cohort of eligible people register and get vaccinated without delay. I encourage you to register and get vaccinated at the earliest opportunity.