What are people asking their doctors about the COVID-19 vaccine? – Expert Briefing

The SMC led a briefing about what questions patients are bringing to their doctors about the jab.

Dr Maia Brewerton, Auckland-based clinical immunologist and allergist

The full briefing is available here and an excerpted and abridged transcript is below.

What questions are patients bringing to their doctors when they want to know more about the COVID-19 vaccine?

When I’m speaking one-on-one with a patient, the most common question I get asked is, they want to know if they should have it. It’s really about the individual I’m speaking to. The resounding answer from me is usually, “Yes.” That leads us into a discussion about the vaccine, and I guess what most people want is someone who can answer their questions, and that’s where I’m in a position to do that.

One of the most common questions that I know they’re interested in is how the vaccine itself works, because there’s a lot of different variations on how it’s been explained to people. It might be useful to hear how I explain it to many of my patients. I describe it, this mRNA, as like a recipe book. Our cells normally use mRNA and we produce mRNA as a recipe book to tell the cells what to do and what to make. Simply, all the vaccine does is supply this recipe book to our immune cells so that they can produce a small protein from the virus, which then means our immune system can learn how to fight the SARS-CoV-2 virus.

That leads me to one of the other concerns or questions that my patients have, and that’s whether or not they can catch the virus from the vaccine itself. But clearly they can’t, because they’re just getting a recipe book delivered to their cells, and it’s just one small part of the virus. We’re not giving your body the whole recipe.

That leads us into the fact that each patient just wants reassurance for their situation as to whether it’s the right choice for them.

It’s really important for people to understand how it works. I guess I get quite excited about it as an immunologist. I just think it’s very, very cool technology, and I guess for the future it’s going to open up a lot of opportunities in the vaccine space.

When discussing this with other colleagues, what kind of discussions are they having with their patients?

I think it’s actually the same. The main questions from patients are: should I have the vaccine? And, is it safe for me? People have heard that it’s safe, but when their talking to their clinician, they want to know, “Is it safe in the conditions that I have?”

As an immunologist, the sort of patients that come to see me in my clinic are patients where their immune system isn’t working properly. So I have a cohort of patients who have immuno-deficiencies, where their immune system is under-active, either because of genetic things that they were born with, or sometimes it’s been brought on by medications they’ve needed to treat other conditions. For that cohort of patients, it’s resoundingly, “Yes, you should have the vaccine.”

I think it’s important that people ask questions, and I love to be asked questions by my patients. So, I really encourage them – even if they think it’s something I might disagree with – I try to encourage them to ask questions. That I’m okay if they hold a different viewpoint to me, but that we should talk about it, because sometimes those viewpoints can come because they’ve had misinformation or they’ve applied things that perhaps aren’t necessarily the case for them.

Are you encouraging these kinds of conversations with people who are already “sold” on the vaccine?

Absolutely. I think for people who are sold on the vaccine – and I don’t think it’s a sell, I think it’s beautiful science is what I would say – they have a very powerful role to play too. We know from other literature in the influenza vaccine space that the most powerful thing to influence whether you will be vaccinated is the opinion of your family and friends. So, I encourage people who are keen to let people at work know, let people in their social circles know. And that not everyone has to agree, but that they are very powerful and they can help to spread the word far more than I can on a one-on-one.

I guess the other thing I try to do very much for my patients, and I encourage other clinicians as well, is to frame the conversation that vaccination is about community protection. I think in 2020, New Zealanders showed love and care through the way we behaved, and I think New Zealanders are inherently kind. I think that the act of vaccinating yourself – the reason I vaccinated myself primarily, was to protect my vulnerable patients, to protect my vulnerable grandfather, and to protect our community. I think when we are having these conversations, we all need to think about it in that framework, and less about that “it’s a selfish act just for me.” It’s much more important to think about it on a community level.

Have patients been asking about what reactions they should expect after getting their COVID-19 jab, in particular, the second jab?

Absolutely, they do ask. We expect patients to have some side effects. The most common side effects are headache, dizziness, nausea, and then pain at the injection site. Now, it is clear, from both personal experience and the data, that the second dose is more likely to elicit more of these symptoms.

I guess as an immunologist, it’s quite easy for me because I explain how excited I was when I got a fever and muscle aches after my second vaccine, because I thought about what an incredible immune system I had and what great work it was doing. I guess I frame side effects that yes, they may experience them, but to reframe it in a way that they understand that it’s a sign that your immune system is working.

As an allergist, I also always warn them that one of the severe and rare side effects is anaphalaxis, but that this is exceedingly rare. It happens in about one in 200,000 doses. I tend to steer clear of numbers for most patients because they can get bamboozled when I start talking about the figures, but some people really like it. I think that most people are trying to educate themselves on the topic, so I do tell them that that is a rare possibility, but that all of our clinic sites, the vaccinators who are trained to recognise anaphalaxis, and that we can treat it. So it is a severe allergic reaction, but it is very treatable.