COVID19 Vaccination

As you may be aware that the COVID vaccinations are currently being rolled out in New Zealand. 

We are getting a number of enquiries about this daily. 

Frequently Asked Questions:

Who will be eligible to have COVID-19 vaccines?

The Government has directed that anyone in New Zealand, whether they are eligible to publicly funded health services or not, will be eligible to COVID-19 vaccination until 31 December 2021. The timing of the vaccinations will depend upon the priority schedule and these vaccines will not be available to purchase privately. For more information on eligibility, click here.

Are COVID-19 vaccines going to be compulsory in New Zealand?

No. The New Zealand Government has stated that COVID-19 vaccination WILL NOT be compulsory. 

Which COVID-19 vaccines are likely to be available for New Zealanders?

Currently, one COVID-19 vaccine (Comirnaty™, an mRNA vaccine by Pfizer/BioNTech) is available in New Zealand. Work is ongoing to procure further safe and effective vaccines.

As of December 2020, the New Zealand Government has Advanced Purchasing Agreements (APA) with Pfizer/BioNTech, Janssen, AstraZeneca/Oxford and Novavax. This means there is an arrangement to buy a pre-planned number of doses of vaccines from these companies if their vaccines are proven to be safe and effective. Also, as part of a global collaboration called COVAX, New Zealand will have access to additional vaccines. For more information about COVAX, please click here.

When are COVID-19 vaccines going to be available in New Zealand?

The first vaccinations against COVID-19 have already begun using the mRNA COVID-19 vaccine, Comirnaty™ (from Pfizer/BioNTech) to be given to those at highest risk of exposure to SARS-CoV-2, the virus that causes COVID-19. The exact date when other vaccines will be available in New Zealand is unknown.

Their arrival depends on

a) data being available to review, particularly in relation to safety and effectiveness,

b) when Medsafe approval is granted and c) when the vaccine can arrive in New Zealand. To obtain approval for use in New Zealand, each vaccine needs to meet strictly defined safety and efficacy criteria.

Who will be first in line to receive a COVID-19 vaccine when it is available in New Zealand?

The New Zealand Vaccine Strategy includes a priority schedule for COVID-19 vaccines. This aims to make sure those who are at highest risk of exposure are vaccinated first, followed by those at highest risk of severe disease. The Ministry of Health has recently released the planned order of the roll out of COVID-19 vaccines. The priorities may change depending on who is most at risk from infection, in the case of a widespread community outbreak. For more information, please click here.

Will we still need other COVID-19 prevention measures such as social distancing if a COVID-19 vaccine is available?

As not all New Zealanders will be able to be vaccinated at once, the current public health measures, including social distancing, mask usage, rapid contact tracing and managing cluster outbreaks, will continue for some time. With an effective vaccine programme, it is anticipated these control measures can be reduced, albeit slowly. This will rely on a high proportion of the population (estimated to be at least 8 out of 10 people) being immunised.

Who can administer COVID-19 vaccines in New Zealand and how are they trained?

Staff administering COVID-19 vaccines must be authorised vaccinators or qualified medical staff. The criteria for nurses to become authorised vaccinators is set out in Appendix 4 of the Immunisation Handbook. Training for administering the COVID-19 vaccines is in addition to this criteria, therefore all vaccinators are already qualified and experienced.

What is the process New Zealand vaccinators are following to administer COVID-19 vaccines?

Vaccinators are following normal best practice in drawing up and administering the Pfizer/BioNTech vaccine. This is consistent with standard immunisation guidelines. Some nurses are finding they can sometimes get up to six doses out of the vial, consistent with what Pfizer has indicated.

What types of vaccines are researchers developing?

Multiple types of vaccines are being developed around the world. We are familiar with some of the vaccine types, such as the protein subunit candidates, like those used in Hepatitis B and whooping cough vaccines; however, other vaccines are using newer technologies such as mRNA and viral vector vaccines. For further information on the types of vaccines that are being developed, please click here.

If you had the virus and recovered, will you still be able to or need to get the vaccine?

Vaccination is being offered to people who have and have not had SARS-CoV-2 infection previously. Data from clinical trials and from countries with a lot of COVID-19 cases have shown the vaccines to be safe and effective in this group of people. It is expected that the vaccine will boost the immune response and provide good protection for those who have previously had SARS-CoV-2 infection. For more information, please click here.

If a person is vaccinated against COVID-19, will they still be able to spread the virus to susceptible people?

An ideal vaccine will stop everyone from carrying the infection as well as protecting them from becoming seriously ill. It is currently unclear whether the vaccine only protects against symptomatic and severe disease, or if it can also stop all infection, including asymptomatic infection (i.e. showing no symptoms). If the vaccine is only able to stop the symptoms of the disease, but unable to stop the virus from infecting us and reproducing, then the virus may still be able to be spread. Even in this case, by reducing the number of people with symptoms will help to reduce spread of the virus because fewer people will be coughing large quantities of virus on others. However, this possible limitation of the vaccine highlights the importance of continuing to follow public health advice such as hand washing and isolating if unwell, even post vaccination. For more information, please click here.

Recently published data from Israel showed that its mass COVID-19 vaccination campaign (using the Pfizer vaccine) was working well with two doses cutting symptomatic cases by 94% across all age groups.

If more than one vaccine becomes available, could taking two different vaccines boost the effectiveness?

We do not know the answer to this yet as it is still being investigated in clinical trials. For more information, please click here.

Will booster doses of a COVID-19 vaccine be needed?

Not enough time has passed since first vaccinations were given to be able to answer this question. People enrolled in clinical trials are being followed up closely, which will allow this question to be answered in due course. For more information, please click here.

How long will COVID-19 vaccine immunity (i.e. protection from the COVID-19 disease) last?

We would expect COVID-19 vaccines to provide protection for longer than 2 months, although exactly how long for, remains unknown at this stage. This is because not enough time has passed since the clinical trials started to be able to accurately answer this. We know that the Pfizer/BioNTech COVID-19 vaccine lasts for AT LEAST two months, because data supporting this has been reviewed by Medsafe. As part of the conditional approval of the Pfizer/BioNTech COVID-19 vaccine, more data is to be provided as it becomes available. It is anticipated that further data will be provided on durability of the immune response post vaccination in coming months.

Can we give a COVID-19 vaccine to a person who is sick with COVID-19?

Internationally, guidance states that people who are currently isolating or experiencing symptoms of COVID-19 should not be vaccinated until they have recovered and met the criteria to stop isolating.

Am I able to privately purchase a COVID-19 vaccine before I travel?

COVID-19 vaccines will be allocated according to a prioritisation schedule and will be available free of charge. This means it will not be possible to purchase a vaccine to be given earlier.

Is the AstraZeneca COVID-19 vaccine inferior to other COVID-19 vaccine candidates?

Despite reports to the contrary in the media, a press release from AstraZeneca on 3 February 2021, reported that its COVID-19 vaccine has shown high efficacy across three clinical trials: 100% efficacy against severe disease and hospitalisations, 76% efficacy against COVID-19 after the first dose and initial evidence that it may reduce SARS-CoV-2 transmission by 67%. Making comparisons between vaccine candidates is not straightforward due to differences in the way the clinical trials are conducted and analysed. For example, the definitions of the number and severity of COVID-19 cases in the trials differ, making direct efficacy comparisons problematic. Professor Peter McIntyre has written a great summary on this matter available here.

Can I have other vaccines if I have had a COVID-19 vaccine?

Currently Medsafe advice is only available for the mRNA vaccine from Pfizer/BioNTech (Comirnaty™) vaccine. A two-week gap is recommended between any influenza vaccine and the Pfizer COVID-19 vaccine and a four-week gap is recommended following MMR or any other vaccines. Please note that two doses of the mRNA vaccine are required, given at least 21-days apart. These recommendations are likely to be reviewed.

I am due an MMR vaccine but I am also due a COVID-19 vaccine. Which is the priority?

COVID-19 vaccine should be given priority over the MMR vaccine. It is recommended to complete the COVID-19 vaccine course (i.e. two doses, at least 21 days apart) before having the MMR vaccine. Please book to have your MMR four weeks after completion of your second COVID-19 vaccination so that the opportunity to be protected against measles is not lost.

The COVID-19 mRNA vaccine two-dose schedule should take priority over influenza (flu) vaccine. Patients are recommended to receive two doses of the COVID-19 vaccine given 21 days apart and then wait two weeks before receiving a flu vaccine. Please book to have your influenza vaccine two weeks after completion of your second COVID-19 vaccine so that the opportunity to be protected against influenza is not lost.

Safety

Will COVID-19 vaccines be safe?

COVID-19 vaccines are being held to the same high safety standards as all vaccines. They will not be given approval for use in New Zealand until sufficient data on both safety and on how well the vaccine works (efficacy) have been extensively reviewed. All clinical trials involve an independent safety monitoring committee that oversee safety and decide if it is safe to continue should adverse events arise, albeit coincidentally. Furthermore, internationally, tens of thousands of participants were enrolled in each Phase 3 trial and mass vaccination campaigns involving millions of people are currently underway. Safety information on those who have been vaccinated is being carefully collected and closely monitored. We can be confident that no shortcuts with regards to safety have been taken even though these vaccines have seemingly been produced quickly (see more below).

Is it true that they are skipping steps to make a vaccine more quickly?

No. It is true that COVID-19 vaccines have been produced faster than previous vaccines, but this is not because steps are being skipped. Instead, a combination of increased funding, international collaboration and removing barriers that usually slow progress (i.e. by doing some of the processes at the same time rather than one after the other) has sped up progress. Further information on this topic is available here.

Can mRNA vaccines change the DNA of a person?

No. RNA vaccines do not interact with a person’s genome as our genetic material is contained within the nucleus of our cells and mRNA cannot enter this area. Following injection with an mRNA vaccine, the mRNA is taken up locally by cells where the instructions to produce the immune system stimulant are followed. At this point, the RNA is broken down, ready to be recycled. For more information on RNA and DNA vaccines, please click here.

Can COVID-19 vaccines be safely given for frail and elderly people?

Following reports of deaths of frail, elderly adults in residential care facilities after COVID-19 vaccination, independent reviews by both the CDC and the WHO concluded, that the mortality rate in this population is high and a substantial number of deaths will occur coincidentally following vaccination. There are no safety concerns around giving COVID-19 vaccine to older and frail adults.

Can mRNA COVID-19 vaccine affect fertility or affect future babies?

There is no biologically plausible reason why this vaccine could have any effect on our genes or fertility. Upon injection, the lipid nanoparticle containing the mRNA is taken up by specialised cells (dendritic cells) at the injection site in the arm. These cells use the instructions from the vaccine mRNA to make only the SARS-CoV-2 spike protein and the mRNA degrades rapidly. The mRNA from the vaccine does not enter the nucleus of any cells. Furthermore, no components of the vaccine or the spike protein produced reach the ovaries or the testes. More information about how this concern arose can be found here.

 

Manufacturing/vaccine content

What are the ingredients of COVID-19 vaccine available in New Zealand?

Vaccine ingredients depend on the type of vaccine. As vaccines are approved for use, the contents and presentation of each vaccine is published by Medsafe as a data sheet and consumer medicine information. These form part of the information that companies submit during the approval process. See below vaccine ingredients from two vaccine candidates which are being used in COVID-19 vaccination programmes internationally.

Comirnaty ™, manufactured by Pfizer/BioNTech

The Pfizer/BioNTech mRNA vaccine (Comirnaty™; also known as BNT162b2) contains:

  • Active ingredient

    • 30µg of a nucleoside modified messenger RNA encoding the viral spike (S) glycoprotein of SARS-CoV-2

  • Fats (these ingredients make up the lipid nanoparticle which is the transport mechanism for the active ingredient to make it inside a cell without being broken down)

    • 0.43 mg (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate)

    • 0.05 mg 2[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide

    • 0.09 mg 1,2-distearoyl-sn-glycero-3- phosphocholine

    • 0.2 mg cholesterol

  • Salts (these ingredients help ensure the vaccine pH is close to that of human cells)

    • 0.01 mg potassium chloride

    • 0.01 mg monobasic potassium phosphate

    • 0.36 mg sodium chloride

    • 0.07 mg dibasic sodium phosphate dihydrate

  • Sugar (this ingredient protects the lipid nanoparticle at the very cold temperatures (-80 degrees C that the vaccine is stored at)

    • 6mg sucrose

Do COVID-19 vaccines contain fetal cells?

Human cell lines are sometimes used in vaccine manufacturing as this is known to be a safe and efficient way to produce vaccines. Both the Janssen and Oxford/AstraZeneca COVID-19 vaccine candidates used cell lines. NO cells from the manufacturing process remain in the vaccine because purification removes all the cell culture material and each batch undergoes thorough quality control checks. The Catholic Church has issued a formal statement saying it is ‘morally acceptable’ to take vaccines that use cell lines from aborted foetuses. For further information on fetal cells and COVID19 vaccines, click here.

How are vaccines authorised in New Zealand?

All medicines approved for use in New Zealand, including vaccines, go through strict review by Medsafe to make sure they meet local and international safety and efficacy guidelines. Once Medsafe has reviewed all available data, it will make a recommendation to the NZ Government as to whether a medicine can be granted approval in NZ. More comprehensive information on this process is available on the Medsafe website. For further information on vaccine approvals in New Zealand, click this video link here.

What does provisional approval mean in New Zealand?

The mRNA COVID-19 vaccine by Pfizer/BioNTech was granted ‘provisional’ approval for use in New Zealand on 3 February 2021. This means that it has been approved for use in a defined group and on the condition that Medsafe continues to receive and review further data about this vaccine’s safety and effectiveness. Click here to find out more.

This approval differs from that granted in other countries, such as the US, UK and in Europe, in which these vaccines were granted ‘emergency-use approval’ based on early data and an urgent need to start vaccinating soon as safely possible. New Zealand has been fortunate to be able to wait, while receiving the most current clinical trial and post-licensure data, to make the decision to approve the use of this vaccine. Once sufficient data as been obtained, it is likely that Medsafe will convert the provisional consent to full consent in due course.

 

COVID-19 vaccines in special groups

COVID-19 vaccines in pregnancy and breast feeding

Pregnancy is a precaution for vaccination with the mRNA COVID vaccine, Comirnaty™ because initial clinical studies have not investigated the mRNA vaccine given in pregnancy – a phase 2/3 clinical trial is now underway in the US in pregnant women. Based on how the vaccine works, it is unlikely to pose a specific risk when given to pregnant women. Whereas COVID-19 in pregnancy can be very severe in pregnant women and can lead to premature births or miscarriage.

It is recommended to delay vaccination until after delivery if the pregnant woman is at low risk of exposure, but for those at high risk of exposure to SARS-CoV-2, vaccination can be offered with informed consent. While lactating women were not included in the initial phase 3 studies, as with all vaccines on the New Zealand Immunisation Schedule, there are no safety concerns about giving mRNA COVID-19 vaccine to women who are breastfeeding.

COVID-19 vaccines in older age groups

This is important as we know increasing age is a risk factor for severe COVID-19. Currently, multiple COVID-19 vaccine candidates have shown to protect against severe disease in older age groups. For further information, click here.