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COVID-19 vaccines: what’s next?

COVID-19 vaccines: what’s next?

Summary:
Professor Julie Leask shares her insights on the complexities of the COVID-19 vaccination program and trust promoting measures to improve vaccination uptake. View the video or read the transcript below.

GPsPatient communicationVideos
23 / 11 / 2021

Today we are interviewing Julie Leask. Julie is a social scientist and professor in the Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney. Julie is a visiting fellow at the National Centre for Immunisation Research and Surveillance. She has qualifications in public health, nursing and midwifery and has studied what people think, feel and do about vaccination for 24 years. She currently chairs the WHO Behavioural and Social Drivers of Vaccination working group. In 2019, Julie won the 'Australian Financial Review 100 Women of Influence' award. 

Listen to the full interview

Read the transcript

Hello and welcome in the spirit of reconciliation. The Avant Foundation acknowledges the traditional custodians of the country throughout Australia and their connections to land, sea and community. We pay our respect to their elders past, present and emerging and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

Hello, I'm Penny Browne, I'm the chief medical officer at Avant and I'm a GP in Sydney. Like many of you, I've been living, breathing and constantly adapting to the COVID pandemic for the last two years. This year, though, it has all been about the vaccines and the vaccination program.

So today I have the pleasure of interviewing Julie Leask. Many of you will already know her, Julie is a visiting fellow at the National Centre for Immunisation Research and Surveillance. She has qualifications in public health, nursing and midwifery, and has studied what people think, feel and do about vaccination for 24 years.

She currently chairs the World Health Organization behavioural and Social Drivers of Vaccination Working Group, and in 2019, Julie won The Australian Financial Review 100 Women of Influence Award. Welcome, Julie. Really has been an extraordinary couple of years, and for somebody like you who has lived and breathed vaccinations, I can't imagine what the last couple of years have been like for you?

I really wanted to start by just saying, really, from your perspective, this is quite unique. What have been for you personally and professionally the greatest challenges over the last year?

Julie: Well, hi, Penny, and thanks very much for the lovely introduction, and I want to pay my respects to the Darrag people, the country, and their elders past, present and future and any Aboriginal and Torres Strait Islander people who are listening.  I think for me, the biggest some of the biggest challenges have been the challenge of communication, and I think we've all experienced this in different ways. For me, it's been a sudden, huge ramp up in having to communicate with the mass public through the mass media.

And I've done now I think about 300 and over 370 separate interviews with the mainstream media around the topic of COVID 19, particularly the behavioural and social aspects, but also public health aspects. Because I'm trained in public health and infectious diseases and also, of course, vaccination and how we get high vaccine uptake.

And that's seen us go through so many different sorts of almost crises in a way, such as when we had the issue with the AstraZeneca vaccine and rare serious side effect of thrombosis with thrombocytopenia syndrome. And also, I guess, you know, when we've had issues like different, you know, debates about the efficacy of different vaccines and why concerns about what that might mean for public confidence. Now I guess the big challenge is communicating are the nuances around vaccination mandates, which are affecting people so greatly right now and also sort of copying, you know, feedback from the public, whether it be somebody who thinks on to pro-vaccine or somehow someone who thinks I'm a bit much too or too much of a sympathiser for the so-called anti-vaxxers.

So yeah, it's been a pretty wild ride for me, but also a huge privilege to be able to bring that knowledge to bear on helping Australians navigate their way through this incredibly challenging time.

It certainly has been a challenging time and a massive learning curve for us all. What do you think then are the lessons for us as a community, as a community in relation to the vaccination programs from this last year?

So I think what we've learned is that Australians are a pretty cooperative bunch and you know, we've seen that with lockdowns and with doing all the things we've needed to control COVID and where we if there's a fair bit of solidarity there or might shoot there as well and we are able as a country also to get very high vaccination rates. That has been not surprising because we knew we had the capacity. We have huge strengths within general practice, community health, aboriginal, community-controlled sector, many different sectors where there are all these existing strengths in delivering adult vaccines and of course, child vaccines.

Once we're able to tap into those, we were able to get high coverage. But not only that, with Delta around, we've had huge motivation, particularly in New South Wales, Victoria and the act from the community and from community groups to really get on board.

So I think, you know, people are amazing and haven't we shown that through the way we've responded to this pandemic as a nation, throughout all the trials and tribulations, throughout all the disease and suffering that has happened, but we have managed to control this relatively well on the world stage and now we've got very high vaccination rates so, we're getting there. We've still got some areas where we need to work, but I think that's the sort of inspiring things, you know, the things that give you a bit of a chill when you talk about them because they're such huge achievements and they are so important for us navigating our path forward as well.

I can't remember who said it wasn't a race, but boy, have we raced to the finish line and we're close. We have got extraordinary coverage. I think now in Australia, but there are still some pockets as you've already called out, there's some pockets of resistance and we are as GP's and as doctors that are dealing with our patients on a day to day basis, trying to help get those lost people over the line. What tips and strategies would you have for us in helping us do that?

Well, first, all credit to GP's and all the people that you work with, your practice nurses, your people at the front desk who face their own unique challenges in their practices, and many of the other physicians who are engaged with the program in different ways. It has been very challenging in some respects in terms of navigating all the new announcements from government and trying to put all the different bits of information together.

Sometimes information it's not easy to access or that is extremely long and technical in its content and accessing that information making sense of it rapidly. Keeping up with the changes in recommendations, dosing intervals, vaccine preferences for different age groups, etc. and then trying to then help patient’s kind of turn around and say, OK, now we want you to have this vaccine. It's very important and trying to build that confidence, having had so many sorts of fits and starts with the program. So, look, a lot of our work has been in addressing concerns about vaccination and helping primary care providers deal with vaccine hesitancy.

And we've come upon a very simple approach, but quite helpful, which is to think about the person in front of you as someone who's either ready to vaccinate, who's hesitant or is planning to not vaccinate. And then they're often there for another reason, or they're there for a medical exemption.

And we recommend that when someone's ready to vaccinate you, make sure that there's good process so that their positive clinical experience will be shared with others and they'll be inspired. And that's, you know, one person's experience is an experience for many others, often because they do share those experiences being very knowledgeable about the vaccines giving  correct advice, reassuring people who are very, very hesitant in ways that adults, you're most skilled communication because you're going to need that. I'm so sorry. That's the first group they're ready to vaccinate consent processes. Valid consent is important.

And the second group is the very hesitant and they're you thinking about where they're at, asking a few questions, getting them to talk a bit more at the start of the consultation so that once you set your agenda for what you want to tell them, you have a really good sense of what they might want to know and you're more likely to meet their needs and make them where they're at. And that can be difficult because somebody might come out with a piece of wrong information that you want to lay in straight away and correct.

We recommend just holding off and eliciting all those concerns and questions saturation, maybe prioritising them if there's not much time and focusing on the most important ones. So that's a brief agenda setting and then addressing the concerns with validation and respect for the person with quality information and a recommendation to vaccinate.

And the same would go for people who are not willing to vaccinate. So that's the third group. And that said, great for the people who are planning to decline vaccination and they might be thinking about what's what they're understanding, where they're coming from, why they're planning that, whether they've had any doubts about their decision, what their plans are for the future, how they're going to manage risk, maybe even finding out if they might have some motivation for protection against COVID and whether they'd be willing to reconsider in future. But just keeping that bridge there so that they can walk back along, that if they change their minds, that's important.

Thanks, Julie, and all of that is very time consuming, but it really helps if you know the patient and know where they're coming from prior. So, you can, as you say, pitch things to their needs and where they're at.

We've done an interesting thing when we started on this journey with the COVID vaccination, that it was very much about encouraging and selling the benefits. And we've moved quite strongly really over the last few months into a mandatory vaccination.

And that's in several settings for work, people, for work and to get on with their lives and the limits on their social restrictions. So is that we've got essentially a mandatory vaccination and in fact, I've had health care workers in tears not wanting to give up their job but being forced to because of the mandatory vaccination to work. I'm just interested in your views on mandatory vaccinations and how successful do you think this approach has been both for this program? But also, then what impact that might have on future vaccination programs?

Mandatory vaccination can work. You've got to be very clear about what you're trying to achieve and whether you really need to mandate vaccination. And in some settings, you will need to, for example, certain health care settings where we don't want to see patients who are vulnerable to severe COVID get COVID from their health care workers.

In an environment where there is a lot of COVID and not a lot of population immunity, that might be the same for aged care or fly in, fly out workers going to Aboriginal communities, for example. But there are other settings where we might be thinking about mandates is just a way to get higher vaccination rates, and that's usually not warranted unless you really, really must resort to those in New South Wales hasn't so much been about mandatory vaccination but having vaccination as an exemption from lockdowns. So, as we are coming out of that lockdown towards the end of September, knowing that the vaccinated could circulate around while we were taking the time to get higher population immunity and letting other communities in the state where coverage was lower, get their high coverage to some mandates can work, but it's better to use voluntary approaches first, because mandates have very significant downsides. As you've mentioned, Penny with the people that you've encountered who are at risk of losing their jobs because they're not going to vaccinate. And so, you only bring them in when you really need to, but you try all the other measures. first, you must make sure that there's good access supply, of course, access convenient services and use other methods such as reminders, talking people through their concerns, incentives to full time appointments.

There are all sorts of behavioural strategies that can increase vaccination uptake, and if there is a community-based mandate, only keep it in for as long as it's necessary. Because the people who don't vaccinate, for example, in some states, are essentially going to be in lockdown for the next year, according to some of the political announcements.

In an environment where those states may end up having 95% two dose coverage if they're lucky. And it's certainly looking that way, for example, in New South Wales, at least for one dose. And that will be the case in Victoria and possibly Queensland and WA.

And that is a very significant level of hardship for people who are simply trying to go about their everyday lives, to purchase clothing, to go to the hairdresser, to take their kids to the hairdresser, for example, in Victoria.

Because these extended lockouts, the unvaccinated applied to the twelve to 16-year olds as well. So yeah, there are some real ethical issues around them. And we explored those in a paper in the Medical Journal of Australia recently, and listeners can get a preprint online, and I think it's about to be properly published as well.

Well, thanks. I'll be looking forward to reading that. It's interesting. We're getting a lot of calls. We get calls from doctors who ring our medical legal advice line. And one of the things they're really struggling with, we're getting a lot of calls about is as a result of the mandate, mandatory vaccination in several works, several work settings. People are seeking exemption certificates and they come to their doctor is one of the few people that can write those certificates. And doctors are really struggling with how to cover that people. There's several what I would say, peripheral reasons that people raise reasons to get their exemptions. I was just wondering what advice you would have for those doctors that are struggling with that.

Yeah, absolutely. This is as soon as we saw these widespread requirements in place for certain workers or commute people in just in the community. We knew that this was going to be a real pinch point for doctors in dealing with these requests, which mostly they cannot meet because there are very, very, as you know, pretty, very few genuine medical country indications and a limited number of precautions as well.

So here we're thinking about a permanent or temporary exemption, and very few people will be eligible for them. So, we put together some guidance based on our sky sharing knowledge about immunisation package that that is already available publicly.

And it's sort of a discussion guide for medical exemptions. And we recommend setting an agenda to start with. So, making it clear that if this is a request for an exemption, here's how this discussion usually goes and making it clear that I, as a doctor, a separate to the rules.

But I do have to say I have a legal responsibility to enforce them, so I will take a history from you. I'll make a determination. And if you're not eligible so you're priming, people will talk about what you know, what your path forward might be.

And so, you take your history. You make your determination. You see resources available to you to do that and then hear them out. Because as you know, there may be a bit of a response to an angry reaction, a protest debate about the person believing they should have an exemption and just give them a little annoyed.

Time is short here but give them a little bit of space to express those emotions, acknowledge them and maybe even reflect. I can say this is hard for you. But then in sometimes that may require conflict management, and there's some very good de-escalation and guidance on de-escalation and management of abuse in primary care that the College of GPs has provided, and it's been updated for COVID. This is quite useful and it's a whole of practice approach. But if you don't have to manage abuse here, then the next step would be to help the patient consider their options.

So, your options are to reconsider your vaccination decision and we can talk you through that. Talk you through your concerns or to not vaccinate for now. And let's help you figure out what that might mean for you. After that happened, it might.

You might be able to, in that process, hear that there is maybe a glimmer of hope that this person might reconsider vaccination. So, can we have can we book another appointment in a week's time when you've had a chance to process all this?

But I think it's safe to say that a recommendation is always appropriate. And by this stage, you've built up a level of empathy and rapport, and you probably know your patient anyway that it's OK to recommend vaccinations. So, look, the last option for you is vaccinating today.

I'd like to see you vaccinated to protect you and those around you. Would you be willing? So, would you be willing? Is a powerful question. Would you be willing to consider having a vaccination today? Or can we park this and think about it for another week or two weeks?

Can I see you again in when on a on Wednesday in two weeks’ time? So, you're keeping someone there because they will face a fair bit of hardship sustaining their decision to not vaccinate and that's not good for them.

Look, I think that's helpful advice could have done with some of that. But I think one of the keys is leaving the door open for having further conversations. And making them feel like they're not rejected as a patient because remembering as a general practitioner, we're seeing them in the range of medical problems, not just to their vaccinations. So, I think that's useful.

The other thing we've also published guidance. We have written this guidance. It's available at the Melbourne Vaccine Education Centre website. And if your listeners just Google discussion guide exemptions in VEC, they'll probably find it.

That's helpful. The other little tip that I've found quite helpful is when I make the point of going through what are the only reasons, we can give the exemption off on using a form? A pro forma takes me out as being the middle.

I'm just following the rules in a way, so I take it turn analysing it, which makes it less about me deciding. So that's just one strategy that I use as well. I wish we'd had your advice when we were running.

That's a running document so that you can add that in the New South Wales exemption forms quite good because it's quite specific. I find the one on the Australian Immunisation Register a little bit more general and therefore less useful for this strategy.

Look, I guess I want to change shift a little bit. We all know, of course, that the COVID vaccination program has done well, but it's not over yet, and the pandemic is not over yet. We only must look to what's happening to our neighbours overseas. And I guess, you know, the experience tells us that the vaccines wane over time and the number of countries, of course, are now rolling out a booster program. And in fact, was they starting to look at? And I know the United States has started vaccinating the children under the age of twelve.

We've got some hurdles to overcome. And that's, of course, not even considering the emerging nations, which are really struggling to vaccinate their populations because of issues of supply, distribution, administration and education. So, there's, you know, globally, we've got a long way to go.

Yet, I guess, really, I wanted to take us in our conversation into what's happening in Australia and what are the things that we see are coming up that you see are coming up over the next six months in relation to boosters and children and where the new variants are going to sit and so on.

So I've just I want to just before we get on to boosters, just mop up the end of it and just talk about the I think there's about 50,000 odd people that have had their first dose and haven't come back for their second dose. And have you got any tips and strategies for practitioners for those group?

Yeah. Look, I think your listeners will know that it's always going to be this group who don't follow up for a second dose. We see it with HPV vaccine, most other vaccines and fit for the GP's, for example.

And to some extent, all doctors, it's about reminding people. So even, you know, if you're working in emergency department, check the record, see if they're not up to date. If they're not recommend strongly, they do get up today and tell them where they can make their appointment, maybe even help them make the appointment.

But in general practice, I think calling your patients, writing a letter, sending us SMS and a little bit of messaging in there, that's you're not fully, you know, you're not as well protected as against COVID with just one dose.

COVID is a very disruptive disease and can make people quite sick, including those who've had only one dose. So, it's very important that you have it. And please make an appointment or even make a default appointment for them.

They work in improving vaccination rates. Yeah, look, thank you, all of those strategies are going to be helpful, and I'm hoping we'll get a bit of a help as well from centrally from the federal people sending out reminders to people who haven't got a second dose registered in the and the Australian Immunization Register.

We'll keep our fingers crossed that because that will help as well. I think so. Back to the waning immunity we've got a target recommending. And I think Australia, it's quite an all-embracing policy that people over after six months should be having a better story.

You can call it a third dose, and I'm recommending this, although at this point it's not going to be part of the vaccination certificate. So, you'll be considered fully vaccinated after two doses. But we're strongly recommending people after six months to get a booster because we know that they’re their immunity will be waning.

I guess my question for you then is how do you think doctors are best going to communicate this need for boosters? Because I can see that there'll be a lot of people had to get vaccinated. It was mandatory and they're just not going to turn up or be interested in getting the stuff.

Yes, it's hard to communicate with the patient who doesn't turn up and again, sending a reminder remind us work. They improve vaccination rates, so try them. If there's one thing you can do, then however, whatever mechanism you have, remind your patients it's time for their deaths.

It would be a boost for those who are not severely immunocompromised. For this immunocompromised, it's a third dose to bring them up to the kinds of, you know, immunity levels that most of us would have with two doses.

So, reminders probably the best way for an individual provider. But this is also a population issue. It's a public health issue that requires government to coordinate its vaccination campaigns and make sure that people are aware of what's recommended, where and how they can get the vaccine.

And some of the delivery points where they previously got the vaccine and no longer available. I mean, that's the case for me. I had my AstraZeneca vaccine at the Hub at Olympic Park in Sydney, and that's not there anymore.

So, I'm going to have to think you're going to have to form a new habit and probably go to my GP. So, you know, helping people with the reminding awareness access, making sure that all people can access that information, including those from different language groups, from different communities who might not access to mainstream news conferences or whatever and making like if it's a workplace, for example, having on site vaccination, if you can manage it works. It also is effective in improving vaccination rates. And, you know, having all opportunistic vaccination.

So, every time you see somebody checks their third dose, I recommend they have it with their booster if they haven't already. Be aware of what the recommendations are. A reminder, though, about boosters. And this is the reason why a target actively recommended that they not be considered among mandates is that the there is good evidence that immunity against any infection wanes, particularly around that six month point, which is why we have that six months after the second dose for the booster recommendation. But also, there's not as much evidence about the effective whether you need a booster dose to prevent severe disease and that evidence is still coming. So here, working with boosters about what we kind of buy intensive disease protection and to health care workers.

This is an important thing because they want to have protection against any of it because they don't want to pass any COVID on to others. Of course, even a third dose. Is its perfect protection, as we know, but it's better than two?

But if people are concerned about severe disease, then two doses is still good, according to the evidence.

Yeah, and on that point of the evidence, one of the issues in this, which has fascinated me because I think of how many other vaccines I give out and nobody's ever asked me to the brand or for which vaccine I'm administering it in this. It's been all about which one and comparing the relative efficacy, which really has been way too much information. And the booster dose now is only recommended for the Pfizer or the culminating vaccine.

And I'm just interested as to how you would be recommending practitioners manage that limited recommendation.

Well, is it also Moderna possible for the booster?

I think it will be coming, but I believe that it's not there yet.

I think that still sitting. My understanding is it's still sitting with TGA, but I might be wrong. I might be a week late. Yeah, that's probably worth checking. It's best to check ATAGI on this. I thought it was possible. But but anyway, you know, it's hard to keep up with these recommendations to me included.

I suspect that brand choice won't be such an issue with Pfizer because Pfizer is being the desirable brand to have. And we've even heard accounts of people not wanting Moderna for their second dose because it's not Pfizer when Moderna is, you know, probably even more effective than Pfizer.

I don't think it's going to be a major issue, but you never know with the public. You can never really predict how people will respond, but it is what it is we can't do much about.

It's probably better that there's not a choice now because having a choice has created so much. So so much. Well, having a limited choice, I guess, has created so much difficulty. But it's funny, isn't it? We never had, you know, states that had Cervarix recommended in 2008 complaining that they didn't have Gardasil.

I know that's extraordinary. So just a slightly different tack. You know, it seemed from the Doherty modelling and certainly what's also been happening overseas that as we ease restrictions even in a community that's been highly vaccinated, we're likely to see a surge in numbers of cases.

So I just we also anticipate that that will not translate into hospitalizations and ICU admissions because of the vaccination program. And I'm just interested to hear from you how you see that unfolding in the Australian context. Yeah, we will have COVID around.

And if you look at the other countries where they've had waning immunity, they have seen COVID come back, particularly now we've got the winter period approaching in the northern hemisphere. So, I think we'll have a bit of a lull with COVID for now and we're doing well and Victoria's still seeing their cases come down.

They're still high. But New South Wales, where we're less than I think we thought in terms of cases that under 200 now a day, but. We will still see COVID circulating. Even with the very high coverage levels we have, just because it's so infectious and because vaccination isn't perfect protection, and we therefore case rates between 65 and 90% depending on the vaccine and the number of doses, et cetera, and the spacing, you know, it will still be possible to get a milder form of COVID even if you vaccinated and pass it on, potentially. So, the Doherty modelling did provide different scenarios under different control measures.

And one of those was assuming you only got to 80% and plus you started off at 80% with an outbreak of, I think, 300. Then over the next six months, you would have over 2100 ICU admissions and 948 deaths.

Now that's just one of the scenarios, and that's where you had. Okay. Test, trace, isolate and not a lot of lockdown. So, I think we'll probably do better than that. And it's possible that next winter will have what looks like a pretty bad flu season, but it will be COVID and probably a bit of flu back as well. And COVID sickness and death is not going to go away as it has not in any country. It's just that we will be able to much better control it and limit the burden on our health care systems.

OK, so let's talk a little bit about the vaccines for children. We know that in America, they've already started to vaccinate the five to eleven-year old’s, and I know it's under consideration now. So, what are your predictions about what's on the horizon here?

Because it's obviously going to make a big difference to how the poor children manage the in and out of school, which is happening now?

Yes, I think that's one of the biggest issues and one of the biggest drawcards for vaccinating that age group.

Because as your listeners will know, the burden of disease in children younger than eleven for COVID is much, much smaller. So, it's more likely to be experienced as a mild respiratory illness. The children who are more at risk of going to ICU and it's a very limited number of those with existing co-morbidities, such as lung disease, immunocompromised, et cetera. And that's, you know, one of the reasons why we saw that initial recommendation for the twelve to 16-year olds. Initially, it was those children who are at greater risk of severe COVID, and so they do stand to benefit from vaccination more than other children.

And that the same will be the case for the five to eleven-year olds. What's happening, right? So having the vaccine recommended by a target in Australia is not a fait accompli. We are yet to get that formal advice from a target, I suspect, and I don't know, I don't have any insider knowledge.

But I suspect it'll probably be recommended. But it is very important that they are doing what they're doing now, which is looking at the data from the trials and looking at the post licensure post rollout, data on safety of the safety surveillance in the US, where it's being rolled out in the five to eleven year olds in large numbers. Because what you want to do is go into any program like that with the benefit risk calculation is a little bit more marginal, with good knowledge of what the rare serious safety adverse events might be. So, you know what you're weighing up?

And that's precisely what they're doing right now. However, there are benefits beyond just disease prevention that I think are important when it comes to vaccination. And as we all know, one of those huge benefits is reducing COVID outbreaks in schools.

So, we don't see schooling disruption, which is so severely affected our kids and the and all sorts of facets of the children's life, sometimes their even their nutrition intake, because that's where they get a decent breakfast or lunch at school.

So, all those things are important, and I don't think we can discount that, and it's not being discounted. So, you know, limitations on educational disruption as an additional indirect benefit from the vaccination program and to some extent, also the incredible anxiety for parents of those younger kids who, even though COVID is less burdensome in younger kids, are still worried about it. Because we've socialised people to be very worried about COVID and being worried about your kids and anxious and stressed is not a great way to be. So, I I personally think that that is also part of a legitimate set of legitimate reasons to bring in vaccination.

But we need to have that safety data and we need to look at other costs, opportunity costs, program delivery issues, et cetera. one of the other costs is also the fact that if we keep getting vaccination, giving vaccination to our populations, we, you know, like all the nations that are doing this, have less vaccine to share with countries that that don't have good access. And that global equity of access issue is important because we want all people everywhere to be fully vaccinated with their initial doses, particularly in the older age groups in. Lower- and middle-income countries, and we also want to be able to reduce the risk that we'll see new variants arise because of very extensive epidemics in countries without enough protection. You think of the African continent with two dose coverage is only around 10%. So, there's a long way to go there. And I don't think it's easy to weigh up, say things like, does a politician say, sorry, we're not going to vaccinate kids and we're not going to give boosters because we're going to give you the vaccines to Africa. I think politically that would be suicide, but it's actually a very important question that is about being good neighbours and good global citizens, as well as securing our future protection against new variants of COVID.

Exactly the new variants is an element you could actually bring it back to the people who look at themselves think that is a really tricky area and where we go with this, both looking at our situation nationally and internationally is really a very interesting and difficult conundrum for us.

So, one of the things that we've been advocating for very strongly at Avant, and I know when we are not Robinson Crusoe on this has been to the COVID vaccine, no fault indemnity scheme. And I know that you've also advocated more broadly for a no-fault vaccine indemnity scheme to cover off all public health supported vaccines.

I guess I want to know how important do you think that this milestone that we've reached with this vaccine indemnity scheme is going to be in in trying to actually realize that desire to actually bring in a broader scheme for all vaccinations?

It's very important, but let me preface that by saying thank you for your advocacy as well, I think took quite a lot of us have been quietly advocating about these schemes with government for many years, and I know that my particular efforts in leading letters to government that brought in several organizations have been going since 2016. But before that, people like Heath Kelly, Nick Wood, Christine McCartney, all people who have been advocating for no fault vaccine injury compensation. Because as you as your listeners know, vaccine injury that needs compensation, it's rare. But it does happen.

And it's the right thing to do because we ask people to do to vaccinate themselves for the benefit of themselves, but the wider community. So, we were thrilled to see Minister Hunt announce that he was going to bring in this indemnity scheme not just for providers, but for the patients themselves who had suffered serious adverse events and the specific ones that they plan to compensate from thrombosis with thrombosis, cytokine syndrome and myocarditis pericarditis after the mRNA vaccines. And so that's fantastic. But it's right and fair also to make sure that there is compensation for other serious vaccine injuries because it's not just limited to the COVID vaccines.

There are other children, adolescents and adults who may have serious adverse event where there's a loss of income. There are ongoing medical costs where it is fair and right. And just to be ensuring that those people are looked after because they're, you know, depending on what's happened, they're often not eligible for NDIS scheme.

So, having a no-fault vaccine injury compensation will be good for everybody, for other vaccines and may well increase confidence in our vaccination system. Certainly, I think it would among providers, and I hope that the government will develop some strong self-efficacy around this scheme that right now they're working very hard to establish.

I know, you know, a big credit to pay people in the health department and other areas of government and the health minister for bringing this in. But let's think about what we could do for other vaccines in future as well.

We'll be there supporting you, and I agree, I think this is sort of a window of opportunity to broaden that scheme. So, Julie, look, that brings us to the end of our formal interview. I just want to say thank you.