Introduction by Croakey: The “shocking global disparity” in access to vaccines remains one of the biggest risks to ending the pandemic, the World Health Organization’s Director-General warned this week.
Dr Tedros Adhanom Ghebreyesus said high and upper-middle income countries, representing 53 percent of the world’s population, have received 83 percent of the world’s vaccines.
By contrast, low and lower-middle income countries account for 47 percent of the world’s population but have received just 17 percent of the world’s vaccines.
Speaking to a media briefing on 10 May, Dr Tedros cautioned against complacency as the number of COVID-19 cases and deaths plateau globally, notwithstanding rapidly increasing cases numbers and deaths in the South-East Asia region.
“Any decline is welcome, but we have been here before,” he said. “Over the past year, many countries have experienced a declining trend in cases and deaths, have relaxed public health and social measures too quickly, and individuals have let down their guard, only for those hard-won gains to be lost.”
The WHO Foundation has launched a “Together for India” appeal to raise funds to support WHO’s work in India, including the purchase of oxygen, personal protective equipment and medicines.
Dr Tedros said the spread of variants, increased social mixing, the relaxation of public health and social measures and inequitable vaccination are all driving transmission.
“My message to leaders is, use every tool at your disposal to drive transmission down, right now,” he said.
“Even if your country has a downward trend, now is the time to surge your capacities. Even in countries with the highest vaccination rates, public health capacities must be strengthened to prepare for the possibility of vaccine-evading variants, and for future emergencies.”
Meanwhile, public health researcher Alison Barrett details some of the latest research news on COVID vaccination and useful vaccination resources in the latest edition of the COVID-19 wrap, as well as reporting on the pandemic’s impact on women.
Impact of COVID-19 on young women in South Australia
Report: Loss of work, isolation and worry: the disproportionate impact of COVID-19 on young women, by The Working Women’s Centre South Australia, 29 April 2021
Young women in South Australia (SA) have experienced job losses, reduced income and work hours, and increased isolation as a result of COVID-19, according to a report launched by the Working Women’s Centre SA (WWCSA) on 29 April 2021.
The survey of 293 women in SA, undertaken between September 2020 and February 2021, also found that 71 percent reported increased anxiety, sadness and/or depression.
While some participants’ income increased due to support by JobKeeper, nearly one-third of participants experienced reduced hours and/or income, resulting in financial hardship. Some participants reported they needed to skip meals or were worried about having a place to live.
Thirty percent of participants said they were worried about losing their job, and 44 percent were concerned about future work opportunities.
Their concern may be justified. An analysis of labour force data from the Australian Bureau of Statistics (ABS) found that young women in their twenties accounted for a greater decline in labour force participation than their male counterparts in 2020.
This is likely because young women are more likely to work in retail and hospitality industries, which were among the worst impacted by COVID-19 prevention measures.
On top of this, young women are also more likely to take on unpaid caring roles than men, which often meant they had to reduce paid work or school attendance during lockdowns to care for family members.
Forty percent of the participants reported that they were worried about getting COVID-19 because of the work they do. In addition to hospitality and retail, young women commonly work in essential service jobs, such as health and aged care, and education, and therefore faced daily concerns about keeping themselves safe from COVID-19 while at work.
The findings in the WWCSA report are not dissimilar to findings from a survey of 7,000 young women aged 15 – 24 years from 14 different countries, conducted by Plan International, between June and July 2020.
Emphasising that the pandemic has impacted young women across the globe, the Plan survey found that 31 percent of young women were unemployed and 25 percent believed the pandemic would affect their future income.
While the WWCSA report highlighted that COVID-19 had impacted young women negatively in many ways, some participants highlighted that the pandemic has taught them self-care strategies, adaptability and provided them an opportunity for clarification about their career goals.
This report offers important insights into the gendered impact of COVID-19.
Some key recommendations were identified through the survey and consultation process:
- Invest in creation of secure jobs for young women
- Fund a program of dedicated apprenticeships or traineeships for women
- Introduce gender responsive budgeting
- Create a mechanism for young women to be heard at a policy making level.
Maddie Sarre, Project Officer at WWCSA, said:
We have an opportunity through the COVID-19 recovery to improve the economic prospects of young women through the creation of secure jobs in sectors which employ a high proportion of women.
Let’s make sure there are good, secure jobs for young people so that those who returned home from interstate due to the pandemic will be able to stay.”
Read the full report here.
On vaccine side effects
Publication: Vaccine side effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study by Menni, C et al. on 27 April 2021, in The Lancet
Analysis of real-time data collected from users of the ZOE COVID Symptom Study app has highlighted the most common short-term side effects after being vaccinated with the Pfizer BioNTech or Oxford-AstraZeneca (AZ) vaccines.
The COVID Symptom Study app was launched in March 2020, initially to collect information about SARS-CoV-2 infections, virus symptoms, COVID-19 test results and whether self-quarantining, as well as age, comorbidity, and employment status data.
Researchers behind the app, led by Professor Tim Spector from King’s College London, have published many research updates based on data collected from the app, which you can view on their website.
Since December 2020, they collected data from 627,383 British adults who were vaccinated with either the Pfizer BioNTech or Oxford-AstraZeneca (AZ) vaccines before 10 March 2021.
App users were asked to record the date and type of vaccine they received, plus any side effects they experienced within eight days of vaccination.
Overall, 345,280 users had received the AZ vaccine and 282,103 the Pfizer vaccine. Of those who had the Pfizer vaccine, 28,207 had received a second dose. No second dose of the AZ vaccine had been recorded at that time.
One-quarter of users reported at least one systemic side effect (distant from the injection site) and two-thirds reported local side effects (at the injection site).
The most common systemic side effects reported (from both vaccines) are fatigue and headache, and local side effects are tenderness and pain at the injection site, occurring within 24 hours of the vaccination and lasting just over one day.
Other less common side effects reported include allergic skin reactions, chills, nausea, diarrhoea and unusual muscle and joint pain.
Comparing vaccine results
When comparing systemic side effects between the two vaccines (after first dose only), they were more common in people after the first dose of AZ than after the first dose of Pfizer (33.7% compared to 13.5% of app users).
In contrast, local side effects were less commonly reported by people after first AZ injection than by those who had received one Pfizer injection (58.7% compared to 71.9%).
For those who had received two doses of the Pfizer vaccine, a greater proportion of people experienced at least one systemic side effect after the second Pfizer dose than the first dose (22% compared to 11.7%).
In contrast, local side effects from the Pfizer vaccine were less common after the second dose than first dose (68.5% compared to 71.9%).
The authors highlighted that side effects were less common in this community-based study than in the Phase 3 clinical trials of both AZ and Pfizer vaccines.
Several reasons could account for this, including different demographic profiles between the clinical trials and real-life study and participant dropout. In clinical trials, study participants are monitored more carefully and may be less likely to drop out of a study than when using an app in real-life.
Women and people younger than 55 years old are more likely to report experiencing both local and systemic side effects.
Interestingly, the study found that people who had previously tested positive to SARS-CoV-2 and been vaccinated with either AZ or Pfizer were more likely to report side effects, local and systemic, than those who had not had a past infection of the virus.
Risk of infection after vaccination
As users of the app had also been recording information about COVID-19 tests and their results, the authors were able to compare infection risk between vaccinated and unvaccinated individuals.
While the vaccines do not promise complete protection from infection with COVID-19, this study found that at 12 days after the first dose of either Pfizer or AZ, vaccinated individuals had a lower risk of being infected than unvaccinated individuals, in particular in people aged 55 years or younger and those without other underlying medical conditions.
Summary
Some of the limitations of this study include that it was based on self-reported data, which may be subject to app user error, and as participants self-enrolled to use the app, they may not be representative of the general population.
However, the study’s strengths are the large sample size and ability to capture real-time data and information to perform comparisons about both AZ and Pfizer.
In summary, the study supports data from the clinical trials of both vaccines that the most common short-term side effects are fatigue, headache, tenderness and pain at the injection site, occurring within 24 hours of the vaccination and lasting just over one day.
Side effects from AZ appear to be worse after the first dose than after the second dose; in contrast, the side effects from Pfizer appear to be worse after the second dose than the first.
Does physical activity reduce the risk of severe disease?
Publication: Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients, by Sallis, R et al. on 13 April 2021, in the British Journal of Sports Medicine
People who consistently meet recommended physical activity guidelines are less likely to experience severe COVID-19 than those who are consistently inactive, a Californian-based study has found.
Researchers retrospectively analysed electronic health records of 48,440 patients of a Californian healthcare service who were 18 years or older, had three or more measures of self-reported exercise data in their healthcare records for the two years prior to March 2020, and had tested positive to COVID-19 between 1 January and 21 October 2020.
The self-reported exercise data was based on answers to two questions about exercise habits during the two months prior to an outpatient visit. These were used to calculate minutes per week of moderate-vigorous physical activity.
The average age of the study cohort was 47.5 years and 61.9 percent were female. Of the cohort, 8.6 percent were hospitalised, 2.4 percent admitted to intensive care unit (ICU) and 1.6 percent died due to COVID-19.
Six and a half percent of the cohort consistently met recommended physical activity guidelines, which is more than 150 minutes of moderate-vigorous physical activity each week; 14.4 percent were consistently inactive, which is between zero and ten minutes of moderate-vigorous physical activity each week; and the remainder of the cohort were somewhat active (between 11 and 149 minutes per week of moderate-vigorous physical activity).
The researchers found that those that were consistently inactive were about two times more likely to be hospitalised due to COVID-19 than those who consistently met physical activity guidelines.
The only other groups who had a higher risk of hospitalisation in this study cohort were those who were pregnant, older than 60 years, and those who had previously had an organ transplant.
Patients who were consistently inactive also had a greater risk of being admitted to ICU or dying due to COVID-19 than those who consistently met physical activity guidelines.
Due to its observational nature, the study does not determine causality and therefore, other factors may impact on the association found between low levels of physical activity and severe COVID-19. For example, those that have pre-existing medical conditions may lack the capability to incorporate physical activity into their daily routine, which may mean that it is the pre-existing medical condition causing the association and not the low physical activity levels.
The strengths of the study include its large population sample that was representative of the population in that area, and the ability for researchers to adjust data for age, sex and pre-existing medical conditions that may also be associated with severe COVID-19.
While this study has limitations, its findings indicate that regular physical activity may be a protective factor against severe COVID-19 and the authors suggest that, in addition to vaccination, physical distancing and mask use, physical activity should be promoted as a means of reducing the risk of severe outcomes from COVID-19.
In brief
Report: Dementia deaths during the COVID-19 pandemic in Australia, by the Australian Institute of Health and Welfare (AIHW), 22 April 2021
The rate of Australians who died with dementia was lower during the first ten months of 2020 than in the four years prior, likely due to infection control measures to prevent the spread of COVID-19, according to a report published by the AIHW.
Another key finding from the analysis of age-standardised mortality data from the Australian Bureau of Statistics (ABS) highlights that thirty percent of the 858 Australians who died due to COVID-19 during the same period also had dementia, which is likely due to outbreaks that occurred in residential aged care facilities.
The report was published on 22 April 2021 by the AIHW, with comparison of age-standardised mortality data of people with dementia recorded on their death certificate between 1 January and 27 October 2020 with the mortality rate for 2015-2019.
The full report and findings can be viewed here.
Resources
‘AstraZeneca Vaccine Decision Aid’
Ask Share Now GP Network, Australia
Ask Share Now Centre for Research Excellence is a collaboration between Bond University and The University of Sydney, who develop tools for sharing research evidence to GPs and their patients.
They have recently (27 April 2021) developed a ‘Vaccine Decision Aid’ for those hesitant about the AstraZeneca vaccine, which can be viewed here, and a supporting video here.
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‘Get your shot, Steady Pom Pi Pi’
Video by the Singapore Government developed to encourage Singaporeans to get their COVID-19 vaccines.
Also on the Singapore Government website, a host of Infographics and other videos about the COVID-19 vaccines.
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‘Ka kite, COVID – we’re getting immunity’
COVID-19 vaccine promotion video developed by the New Zealand Government. Their website also hosts a variety of vaccine-related resources, including resources translated into different languages.
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Led by Dr Emma Hodcroft, a researcher at the Institute of Social and Preventive Medicine, University of Bern, Switzerland, this website provides information about COVID-19 variants of concern, including where they are found and the impact they might have.
A variant of concern is one that appears to account for a significant number of COVID-19 cases in a region or country, spreading rapidly. The most common variants of concern include the B.1.1.7 and B.1.351 first identified in the UK and South Africa, respectively.
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.
See previous editions of the COVID wrap.
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