MINISTERIAL ADVISORY COMMITTEE ON COVID-19 VACCINES (VMAC)
Q&A: Frequently asked questions of the COVID-19 vaccine rollout
Please note that these FAQs will be updated as more information becomes available.
Does being vaccinated mean that I can now dispense with COVID-19 precautions?
Unequivocally not. All COVID-19 precautionary measures must still be strictly adhered to, for several reasons. Firstly, the immune response elicited by the vaccines does not kick in immediately. For the J&J vaccine there is some response two weeks after vaccination but is really properly effective only after four weeks. The Pfizer vaccine should be regarded as effective two weeks after the second dose. Secondly, and very importantly, no vaccine is 100 per cent effective. Therefore, even vaccinated people are still at risk of infection and illness from mild to severe disease. And if a vaccinated person does become infected, we don’t know if the vaccine will prevent transmission of the virus to an uninfected person. We will only be able to return to our pre-COVID-19 life once herd immunity has been reached and the circulation of the virus has been controlled.
If I have had COVID-19 previously, do I still need to be vaccinated?
Yes. Because over 95 per cent of infections in South Africa are of the relatively immune-resistant
B.1.351 virus variant, which means that high levels of neutralising antibodies are needed for protection. Nearly everyone who recovers from COVID-19 has some degree of immunity which for most people will protect them against re-infection. But some people with a weaker immune response may become re- infected especially if their initial infection happened in South Africa’s first wave. In addition, we also don’t know how long natural immunity will last for. The COVID-19 vaccines currently being used in South Africa, (i.e., the Pfizer and Johnson & Johnson vaccines), have been cleverly engineered to boost the antibodies and T cells that were stimulated after natural infection. Therefore, vaccination is still recommended.
Why does the Pfizer vaccine require two doses while the Johnson & Johnson only requires one dose?
These two dosing strategies have been shown to be effective in their respective clinical trials. The Johnson & Johnson vaccine has been shown to elicit an immune response for many months after a single dose, while the strong immune response with Pfizer was seen after the second dose.
If I had a choice between the Pfizer or the Johnson & Johnson vaccine, which one should I choose?
Both vaccines provide good protection particularly against severe disease and hospitalisation. The best decision is to take the vaccine which is most immediately available and get vaccinated as soon as possible.
If I have been vaccinated and come onto contact with an infected person, do I need to be quarantined for 10 days?
Healthcare workers who regularly come onto contact with potentially infected patients must ensure that their PPE is satisfactory to avoid the need for quarantine.
Non-healthcare workers would need to quarantine even if they were vaccinated, especially if they have received only one dose of the Pfizer vaccine or within four weeks of receipt of vaccine.
If I am not feeling totally well should I still keep my vaccination appointment or postpone it until I’m feeling absolutely fine?
If your symptoms are suggestive of COVID-19, you should be tested rather than go for vaccination. However, if your symptoms are mild and not suggestive of COVID-19 there should be no reason to postpone a vaccination appointment.
If I have recovered from a bout of COVID-19, how long should I wait before being vaccinated?
The South African recommendation is at least four weeks.
The recommended interval between the first and second doses of Pfizer in the USA is three weeks. Why is South Africa recommending a six-week interval?
The clinical trials of the Pfizer vaccine were carried out with a three-week interval and consequently USA regulatory authorities have maintained that recommendation. However, the UK extended the interval to 12 weeks, primarily to vaccinate and provide some degree of protection to as many people as possible with at least one dose. An added advantage was that the longer interval produced a stronger immune response than the three-week interval, something observed with other COVID-19 vaccines. South Africa has taken a middle path, aligned with the World Health Organization, to delay the second dose for six weeks for an enhanced immune response and best coverage.
Should I do an antibody test after vaccination to confirm that I have immunity?
This is not recommended by the VMAC nor by other international bodies. Routine antibody tests are unreliable in establishing vaccine-mediated immunity (although they may have a role in determining whether someone has previously been infected). A negative antibody test after vaccination may not necessarily indicate a lack of immunity. In future, certain types of antibody tests might be used to indicate the need for repeat vaccination.
If I have had an antibody test which indicates that I have IgM and IgG antibodies would I still need to quarantine if I have been in contact with an infected person?
YES. As mentioned under question 8 the usual routine tests for antibodies are not reliable indicators of protective immunity. You could still get infected, especially if you were in contact with an infected person within four weeks after receiving your vaccination.
What side effects can I expect from the vaccine?
Most people will not experience any side effects. Some people may experience tenderness or a rash at the injection site. Occasionally, for a day or two and rarely longer, there may be some headache, feeling out of sorts, muscle pain or even a slight fever, which could be controlled with something like paracetamol. However, if you are concerned about any adverse event you should report it to a health facility, where you will receive treatment for the adverse event and the event will be reported.
Recipients should be aware of the possible association and seek immediate care for signs and symptoms suggestive of thrombocytopenia or thrombotic complications:
– unremitting, severe headache, occurring during this time frame
– focal neurologic symptoms such as weakness in legs, blurred vision and new onset seizures
– new onset, persistent and unexplained abdominal pain
– chest pain, shortness of breath and/or leg pains
All serious adverse events reported to the national Department of Health (NDoH) will be shared with the South African Health Products Regulatory Authority (SAHPRA) and will be presented at the National Immunisation Safety Expert Committee (NISEC) for causality assessment. Alternatively, South Africa is using the “MedSafety” App which health workers are encouraged to use to report adverse events rather than using paper-based reporting. This data is shared with SAHPRA and the NDoH.
If I have had allergic reactions in the past (e.g., allergic reactions to previous vaccination or medication, foods, pets, grass, etc.) should I get vaccinated?
Severe allergic reactions (anaphylaxis) with the Pfizer vaccine have been reported, but these have been extremely rare – calculated at 11 per 1 million doses. Some three quarters of these have occurred within 15 minutes of vaccination. It would therefore be important for such individuals to alert the staff doing vaccinations about their allergy history, and one should wait in the clinic for 30 minutes instead of the usual 15 minutes after vaccination. The risk of blood clots after the Johnson & Johnson vaccine is less than one per million doses and has not, to date, been reported after receiving the Pfizer vaccine.
A frequent question about vaccination comes from patients with various chronic underlying medical conditions.
In the first instance, this should be discussed with the attending doctor. In broadly general terms, COVID-19 vaccine can be given, and in most of these cases should be given to persons with underlying medical conditions, especially where the immune system may be suppressed by illness or chemotherapy. Such individuals are often at increased risk of severe COVID-19. But this must be discussed with the attending doctor.
If I have had the influenza vaccine, or any other vaccine, how long after should I wait before getting the COVID-19 vaccine?
A waiting period of a couple of days is recommended.
Can I have the COVID-19 vaccine if I am planning to become pregnant?
Once this younger age group of women is included in those who can access vaccines, the answer is yes and this is encouraged. We now know that pregnant women are at higher risk of severe COVID-19 disease and of preterm delivery, and for this reason it is good to be protected against COVID-19 before becoming pregnant.
Can I have the COVID-19 vaccine if I am pregnant or if I am breastfeeding?
Once this younger age group of women is included in those who can access vaccines, COVID- 19 vaccines using the Pfizer or the J&J vaccine should be offered to all pregnant women based on benefit risk. Pregnant women with co-morbidities such as obesity, diabetes and hypertension in pregnancy should be prioritized for vaccination and can be offered a vaccine if they have co-morbidity that is in a priority group for vaccination. Health care workers are encouraged to discuss the risks and benefits of the COVID-19 vaccination with their patients. These discussions should include currently limited but reassuring safety data for the vaccines in pregnant and breastfeeding women, the strong immune response conferred to mothers following vaccination and the benefits of immune transfer to the neonate.
Conclusion
In conclusion, it remains to reiterate that both vaccines, Pfizer or Johnson & Johnson, are both safe and effective yet not perfect. Having been vaccinated does not allow abandoning precautionary measures. The VMACs advice is to take whichever vaccine is offered to you in order to be vaccinated as soon as possible. Advice and recommendations will change from time to time as more is learnt about COVID-19 and the vaccines. Importantly, advice must always be sought from reputable sources.
Contact e-mail for further enquiries: SAEDP@health.gov.za
