Like many other Melbourne residents, Grant has been watching in horror as the state’s Delta outbreak picks up speed.
But unlike his fellow lockdown-weary neighbours, the 51-year-old — who declined to use his last name — has another pressing concern: he isn’t sure if he’ll be able to be vaccinated against the virus, despite his best efforts.
“I’ve been listening to the press conferences that have been happening, and I don’t criticise them for saying this, but they’re saying that it will become a pandemic for the unvaccinated,” he says. “Prior to last week, my worry was, well I’ll be one of those unvaccinated.”
That’s because years earlier during a medical procedure he had a serious allergic reaction to a compound called polyethylene glycol, otherwise known as PEG — one of the ingredients in Pfizer and Moderna, two of the three COVID-19 vaccines currently approved for use in Australia.
Grant says he first sought out vaccination advice from his doctor in April and was informed that both vaccines available at the time could cause him to have an anaphylactic attack, due to his allergy to PEG and potential reactions to polysorbate, an ingredient in the AstraZeneca jab.
He was immediately referred to an immunology and allergy specialist, but when he followed up in July he says he was told it could be anywhere from another three to 12 months before he was able to undergo testing.
“I was saying to them, I’m a little bit concerned about that time frame because by that stage I have a feeling the vaccinations would have rolled out quite a bit and I’m going to be of higher risk if I’m not vaccinated,” he says.
After going back to his GP, who pushed for his appointment to be moved up, he’s now scheduled to be tested for a polysorbate allergy by the end of the month — and, if all goes well, set to receive his first dose of a vaccine on the same day.
Experts say medical conditions that preclude people from ever getting any of the available COVID-19 vaccines are very rare. Professor Tony Cunningham, director of the Centre for Virus Research, says that’s because the mRNA vaccines — Pfizer and Moderna — are quite different to AstraZeneca.
But, he says, there is a risk of an anaphylaxis allergic reaction to different components in both the mRNA and Astra Zeneca vaccines.
Conditions that increase vaccine risk
Professor Cunningham says there are two “completely different” ingredients in the vaccines available in Australia that can cause severe allergic reactions: PEG in the mRNA vaccines and polysorbate in AstraZeneca. These ingredients are relatively unique to COVID-19 vaccines, he says, meaning a reaction to a past vaccine is not reason in itself to avoid the jab.
“There’s not much overlap, I couldn’t find any, between PEG and polysorbate and other common vaccines,” he says.
People who have recently been diagnosed with other conditions, such as pericarditis and myocarditis, or COVID-19 should wait six months before their first dose, he adds, while patients being treated for cancer or undergoing other “fairly severe” immune compromising treatment should consider holding off until it’s completed.
There are also various rare blood clotting disorders, such as thrombosis with thrombocytopenia syndrome, or TTS, which preclude people from having the AstraZeneca jab.
“It’s a pretty rare bunch of conditions you’re dealing with, and it’s tailored to each individual vaccine,” Professor Cunningham says. He adds that in the rare case someone has a severe adverse reaction to their first jab, getting a second shot may not be advisable but they could swap to another available vaccine.
NSW Health has devised an exemption system that allows people who are either delayed or unable to get the COVID-19 vaccine for medical reasons to provide evidence as to why they’re unvaccinated as the state moves towards lifting restrictions for its inoculated residents. The form is only valid for a period of six months.
The federal government also has an immunisation medical exemption form that is used for all vaccines. The form needs to be signed by a doctor and outline why it has been sought. It can then be used in certain industries that have mandatory vaccination rules in place, such as teaching.
For anyone concerned about their medical conditions, Professor Cunningham advises talking to their GP or a clinical immunologist to “check things out and make sure they’re right to go”.
But as the vaccine rollout moves towards the 80 per cent threshold, with a different set of rules set to come into force, people with allergies say they are struggling to get an appointment.
The waiting game
Like Grant, Sydney resident Heather Jovevski says she’s so far been unable to get an appointment with her immunologist to get advice on whether she should get the COVID-19 vaccine because outpatient clinics have been closed.
The 47-year-old and her three children have a laundry list of allergies, ranging from anaesthetics, penicillin and macrolides medications to latex and adhesives, to name a few. In the past, she says, two of her children have suffered adverse reactions to ingredients in vaccines.
“So we have very sensitive bodies, I guess, for lack of a better word,” she says. “We have to keep ourselves healthy so we can avoid having to take medications, if we can, obviously sometimes we have to, and we have to deal with the repercussions of that.”
With restrictions set to lift for vaccinated Sydneysiders in weeks, and both her and her daughter’s industries mandating vaccination, Heather has sought out medical exemptions for her family but describes the process as an “uphill battle”.
So far, only one of her daughters has been granted a “Medical Contraindication form” — a certificate that states a person is unable to receive the first dose of the vaccines available in Australia — on the basis of a suspected allergy to polyethylene glycol (PEG), an ingredient in the Pfizer and Moderna vaccines, and concern around a potential reaction to AstraZeneca.
“We wear our masks, we wash our hands, we social distance, and not one person in our family has caught COVID,” Heather says. “Then all of a sudden, because we’re not vaccinated we’re a danger.”
Heather makes clear that she is not an “anti-vaxxer”, noting that all her children were vaccinated before she was made aware of the extent of their allergies. But because of her family’s medical history, she acknowledges that she’s particularly cautious when it comes to vaccinations.
Until she’s able to see her specialist, who is familiar with her medical history, she says she’s worried about getting the COVID-19 jab.
“I can’t even get in to see my specialist to even start the process of asking about these for myself,” she says, “and from what they’re saying, as of October 18 [or when NSW reaches 70 percent of adults vaccinated] we’re going to be completely excluded from society.”
Living with the virus
Across Australia, the vaccination rate is moving swiftly towards the 70 per cent threshold needed for the country to begin lifting COVID-19 restrictions, as set out in the Doherty modelling.
In NSW, which is currently experiencing the largest outbreak despite a months-long lockdown, health authorities have promised most restrictions will ease when the threshold is reached, likely sometime next month, but only for people who have received both jabs or have an exemption.
Meanwhile, in Melbourne and Ballarat, up to five adults from two households are now able to gather outdoors if they are fully vaccinated.
As a result, the President of the Royal Australian College of General Practitioners (RACGP), Dr Karen Price, told Sunrise this week that GPs had been inundated with people who do not want to be vaccinated “demanding” a medical exemption. “The guidelines are pretty clear, there are very, very, very few medical exemptions to vaccination,” she says. “What we could encourage people is not to come in and ask for an exemption certificate, but to come in and talk about what their fears and concerns are.”
Grant says he has already considered what he would do if he wasn’t able to get vaccinated by the time the lockdown in Melbourne lifts and decided he probably wouldn’t go into crowded environments, such as cinemas or restaurants — even if he was allowed.
“As an unvaccinated person I would have really struggled to go into society in any meaningful way,” he says, adding that he was frustrated by people who were able to get the jab publicly sharing their decision not to.
“I felt like it was a very ablest approach to take to this whole issue,” he says. “It was like ‘I’ve got this choice to make about whether or not I want to have a vaccine’, and I was in the position of essentially not being able to get the vaccine. So, I was frustrated by people not wanting to protect others who can’t get vaccinated.”