Surgeon and vaccinator Dr Pat Alley shares his insides about the Covid vaccine rollout. Photo / Supplied
"When Ed Hilary climbed Everest, he said the last 300 feet was the hardest and it's the same with vaccination," says Dr Patrick Alley, chairman of the Southern Cross Clinical Governance Committee and active vaccinator.
The trained surgeon has administered over 3500 jabs out of a vaccination clinic in Birkenhead and shares his insights into the current vaccine situation.
Alley said reaching the last few people with the vaccine was always going to be difficult – especially in isolated communities such as in Northland.
Having worked as a rural general practitioner on the West Coast, Alley understands the difficulties entailed with reaching these communities.
He said while Northland District Health Board and Māori health providers were doing "pretty well" by sending mobile vaccination clinics out to isolated communities, he urged them to double-down on their efforts.
"We are way past the days of having a big clinic in town and expecting people to come there.
"The main thing is a face that you trust. Yes, it's expensive and it's logistically difficult. But the cost of not doing it is greater than the cost of setting it up."
Alley said "we need to get on with it" because "we don't have the luxury of time".
"We've got a real risk of setting up little pockets of Covid in rural communities that smoulder on producing case after case unless we do our damnedest to get in there and immunise."
Alley doesn't believe that living isolated provides sufficient protection against the Delta variant because the disease is "just too infectious".
"Everyone is going to become immune to Covid. There is a hard way and there is an easy way. The hard way is to get the disease. The easy way is to have a vaccination."
He said he wouldn't wish the disease on anybody because it is "horrible".
Alley has had several conversations with people in the rural sector who said they will hunker down as long as Covid spreads but Alley said it was a "bad thing to do".
"The mental health issues that face the rural sector are profound enough without stopping people from communicating with each other. Engagement of people in isolated communities is really important."
Restricted communication can also increase doubt in people who are still vaccine-hesitant.
Because anti-vaxxers have mixed with people who oppose vaccine mandates or other restrictions imposed by the Government, it was difficult to read the messages of the recent protests, Alley said.
"One of the problems about the rural sector is that they don't get a steady flow of good information. It tends to drive people into a conservative frame of mind."
A potential threat for unvaccinated communities could be the Government's promise to let Aucklanders travel for Christmas and enter Northland.
Alley called it a "real dilemma".
Financially stricken businesses in the North had a commercial interest in customers from Auckland but the rising number of cases coming out of the city could be cause for concern.
"The answer is to get the vaccination rates up.
"It's wearing a bit thin but we are a team of five million, and we've got to see both sides of the equation."
Meanwhile, some New Zealanders who refuse the Pfizer vaccine have demanded a new vaccine, Novavax, to be approved.
A petition to Parliament that has so far received nearly 4000 signatures states: "We are more comfortable with the Novavax vaccine and would like to have the option to vaccinate with Novavax."
The drug was developed in the States and could be made available by March.
Alley believed there was a level of reservation because the US haven't approved it yet.
So far, only Indonesia has given its green light with India and the Philippines expected to follow soon.
Novavax has also applied for approval in Australia, Canada and Europe.
Alley said Novavax wasn't "super better" than Pfizer. "It's just another type of vaccine."
He questioned why people would want a different kind of vaccine if the immune results weren't different.
"People say they don't trust the mRNA technology. But if we had Novavax from the start, people would say 'no, we want to try Pfizer now'.
Addressing concerns that vaccines such as Pfizer were rushed and not safe, he explained that the process was accelerated because drug developers didn't have to scramble for funding to do their research and there was also no shortage of people to do clinical trials on.
He said allegations that clinical trials were not conducted properly were "absolutely not true".
Medsafe has granted Pfizer provisional approval for use in New Zealand, meaning it's been formally approved, but Pfizer must give Medsafe ongoing data and reporting to show that it meets international standards.
Medsafe has also granted provisional approval for the Janssen (Johnson & Johnson) and the AstraZeneca.
It is up to Cabinet to decide whether a different vaccine will be rolled out.
What kind of vaccine will be used for booster shots and at what time they are recommended is still not clear.
"A double-vaxxed person has three biological weapons against Covid. One is in your blood – they are called humoral antibodies. Then it has got special cells in the immune system, B and T cells.
"They both have the ability to recognise the next invasion of something like Covid or another antigen coming in the form of a vaccine," Alley said.
"What we don't know is what that cellular immunity is like. Your immunity doesn't drop off suddenly, it declines over time.
"The statistics I have seen say the effectiveness reduces by 60 per cent every 100 days.
"The current data from Pfizer is that 11 months from your second dose is the optimum time to have a booster. But it's still under development."
Pfizer have got a group of about 10,000 people who got vaccinated in February-March this year and whose antibodies are being watched.
Alley believed New Zealand's conservative health jurisdiction will be inclined to recommend the booster before 11 months.
Lastly, Alley reiterated that the Pfizer vaccine was safe for women during pregnancy.
"Pregnant women are very susceptible to Covid."
To those who worry about harming their baby, Alley said: "The mRNA doesn't go anywhere near the nucleus of the cell. It won't change your baby's genetic make-up in any way shape or form. It is impossible to do that."
Instead, antibodies will cross the placenta and give the baby immunity. That immunity can also be transferred from mother to child through breastmilk.
"There is no increase in the risk of pregnancy loss as a result of the vaccination. That has been looked at quite closely."
About Dr Patrick Alley
Dr Pat Alley worked as a surgeon across New Zealand hospitals and is currently the chairman of the Southern Cross National Clinical Governance Committee.
In 1984, he was one of four general surgeons who developed general surgical services at North Shore Hospital.
Dr Alley retired from active surgical practice in 2012, carrying on as the director of clinical training for Waitematā DHB. He is now mostly involved in educational and medical governance enterprises.
Dr Alley is a member of AUT University Council and serves on their Research Ethics Committee.
He is an external clinical adviser to ACC on treatment injury and chairs the Southern Cross National Clinical Governance Committee.
In addition to his medical qualifications, he has formal degrees in professional ethics and has served on several institutional and research ethics committees.
He has had numerous awards from the RACS (Royal Australasian College of Surgeons) for his work as an educator, in medico-legal matters and for the advocacy for better health outcomes for Māori.
In 2016 he was awarded membership of The Order of New Zealand for his services to surgery.
Dr Alley has personally delivered over 3500 vaccines to people in the Birkenhead community.
Post-season monitoring recorded 50 individual tara iti, up from 33 last year.