It’s not enough to cross our fingers and hope Australians get vaccinated. We have to go where people are
Dr Sarah Simons (St Vincent’s Hospital Melbourne) - Guardian Australia 16 Oct 2021
After a rocky start to the vaccination rollout, Australians are finally and fortunately catching up to the rest of the world and getting immunised.
Although the end of lockdown is in sight, there’s still a way to go, especially given lower vaccination rates among marginalised and poorer communities who are not only more likely to get Covid-19 but are also at an increased risk of a bad outcome and death if they are infected by the virus.
As healthcare professionals we’ve learned to ask, relentlessly and repeatedly, about vaccination – when, which, how many – because despite a number of emerging treatments, it’s still the most effective weapon we have in our arsenal against Covid-19.
At St Vincent’s hospital Melbourne, we started opportunistically vaccinating people against Covid-19 in our emergency department after recognising that many of our more vulnerable patients had not been jabbed.
As a Melbourne emergency doctor during the Delta wave, I can only function in survival mode for so long
We found that vaccination rates among people who frequently attend hospital were more than 20% lower than the general population of Victoria, so we started offering vaccines on the spot in the ED. We prioritise Indigenous Australians, people experiencing homelessness or insecure housing, people dealing with family violence or addiction issues, as well as refugees and asylum seekers, as part of our pandemic response.
The vast majority of our eligible patients have rolled up their sleeves, grateful and keen for a vaccine.
We seize any opportunity to talk to any and every patient about why immunisation will save their life. Sometimes we’ll sit together on the steps outside the ED as the patient grabs some fresh air – clinician still replete in gown, goggles and mask – and we’ll talk about the fact you’re more than twice as likely to get struck by lightning than develop a blood clot after a vaccine.
We build trust, ask for consent and then give a dose of Pfizer, a cup of coffee and a couple of biscuits (shortbread), stat.
Vaccine scarcity has been redressed nationally and aside from a disproportionately vocal minority, vaccine hesitancy has abated.
The reasons for not yet being vaccinated are inevitably similar; two in five Australians are functionally illiterate, which makes negotiating booking systems daunting and difficult and competing priorities are rife. If you don’t know where you’ll sleep safely tonight, if you can’t afford to feed your family next week, if you don’t know if you’ll survive the next round of violent assaults from a partner or simply don’t have a smartphone with data and a reliable battery, how can you make and commit to a vaccination appointment in a fortnight’s time and then again three weeks after that?
In order to bring this pandemic to a safe and sustained close, we need to redouble our efforts to address the concerns and needs of unvaccinated people, particularly those who are more vulnerable.
Time is of the essence with Delta, especially as immunity only peaks a couple of weeks after the second vaccine. We can’t afford to keep our fingers crossed and hope that everyone who is unvaccinated will show up to a vaccination centre soon.
Instead, we need to prioritise meeting unvaccinated people where they are, like the emergency department, not just where we hope they’ll be. The comfort and psychological safety inferred from a vaccination offered by a friendly face and a mother tongue on familiar turf is not to be underestimated – the unequivocal success of mobile clinics and community vaccine vans across Australia stand testament to this.
Even when we hit the magical 80% double vaccination landmark nationally, a fifth of Australians will still be inadequately protected against Covid-19 and there’s evidence that the immunity conferred by two doses of vaccine wanes over time.
Once lockdowns ease, the novelty of a cold beer with mates in the sun is likely to be more favourable than several hours queuing outside an exhibition centre for a third jab, so vaccination efforts need to be appealing and accessible to keep us all safe.
Success stories from overseas illustrate the power of opportunistic vaccination in community centres, places of worship, sports games, shopping precincts, supermarkets and nightclubs, with the latter offering at least two different kinds of shots.
For our team in ED, vaccinating people against Covid-19 is cathartic. We thank our patients for protecting us, for protecting their loved ones and for protecting people they’ve never met.
Mostly, though, we are grateful they won’t meet the same fate as the critically ill unvaccinated person wheeled past the cubicle just a couple of minutes earlier, with beeping breathing tubes and a devastated, terrified family who are likely to also test positive in the days to come.
Instead, the daily successes of opportunistic vaccination are a gentle but persistent reminder that better days are coming.
Covid-19 case numbers have rocketed in the last couple of weeks in Victoria. We can’t just provide vaccines where we want or hope people will be; we have to take vaccines to where people are, on their terms, to protect all of us and our health system.
Opportunistic vaccination is undoubtedly saving lives, and in the words of the World Health Organization, “no one is safe until everyone is safe”. We can’t afford to wait.