The New Zealand Government has directed that anyone in New Zealand, whether they are eligible for publicly funded health services or not, will be eligible to receive COVID-19 vaccination until 31 December 2021. The timing of the vaccinations will depend upon a priority schedule and COVID  vaccines will not be available for private purchase.

The New Zealand Government has stated that COVID-19 vaccination will not be mandatory.

FAQ

What is the process New Zealand vaccinators are following to administer COVID-19 vaccines?

Vaccinators are following normal best practice in drawing up and administering the Pfizer/BioNTech vaccine. This is consistent with standard immunisation guidelines.

Some nurses are finding they can sometimes get up to six doses out of the vial, consistent with information from the vaccine manufacturer.

Who can administer COVID-19 vaccines in New Zealand and how are they trained?

Staff administering COVID-19 vaccines must be authorised vaccinators or qualified medical staff.

The criteria for nurses to become authorised vaccinators is set out in appendix 4 of the Immunisation Handbook. Training for administering the COVID-19 vaccines is in addition to this criteria, therefore all vaccinators are already qualified and experienced. 

Training for the first cohort of vaccinators administering the Pfizer/BioNTech vaccine takes the form of online learning and webinars. This training includes detailed disease and vaccine-specific information, vaccination process information, paperwork and record-keeping, vaccine research and a review of the positive safety profile for this vaccine. They also cover responding to common concerns and where staff can go to access further support and clinical advice. This is followed by additional webinars to ask further questions and a clinical support line for vaccinators. Training will continue to expand and support more vaccinators to become authorised and complete the COVID course.  

If more than one vaccine becomes available, could taking two different vaccines boost the effectiveness?

We do not know the answer to this yet as it is still being investigated in clinical trials. Currently, the COVID-19 vaccines are not interchangeable.

There is no data available on the interchangeability between COVID‑19 vaccines, such that, where possible other vaccines should not be substituted to complete the course. So far, the only COVID-19 vaccine available for use in New Zealand is Comirnaty (Pfizer/BioNTech). Other vaccines are undergoing the Medsafe approval process.

To be fully immunised with Comirnaty, two doses are required, to be given at least 21 days apart. There is no maximum duration between doses, so it is not necessary to restart the course or give a third dose if it has been longer than 21 days since dose one.

For more information, please click here.

What is the guidance around receiving a COVID-19 vaccine and having a general anaesthetic?

Based on first principles and our experience with other vaccines, there is no expectation that an anaesthetic would affect the safety or immunogenicity of the mRNA COVID-19 vaccine.

The general recommendation when planning vaccination with any vaccine is explained in Section 3.1.3 in the Immunisation Handbook 2020

What is the acceptable timeframe between the first and second doses of the Comirnaty vaccine?

To be fully immunised with Comirnaty requires two doses given at least 21 days apart.

Vaccinators are advised not to give the second dose earlier than this, and while longer spacing is acceptable, the recommended spacing is for the second dose to be given as close after 21 days as possible.

Will booster doses of a COVID-19 vaccine be needed?

Not enough time has passed since first vaccinations were given to be able to answer this question.

People enrolled in clinical trials are being followed up closely, which will allow this question to be answered in due course. For more information, please click here.

It is expected that small adjustments may be made to the vaccine if the COVID-19 virus changes so much that vaccine loses effectiveness. In this case booster doses will be required to better match the virus variants in circulation, like for the influenza vaccine. How frequently these changes will need to be made is unknown. A major advantage of mRNA vaccine technology is that these changes can be made very quickly (new batches available within a few months compared with more than 6 months for seasonal flu vaccines).

Can other vaccines be administered with a COVID-19 vaccine?

Currently Medsafe advice is only available for the mRNA vaccine from Pfizer/BioNTech (Comirnaty™) vaccine.

A two-week gap is generally recommended after any non-live vaccine, including influenza, and the Comirnaty mRNA COVID-19 vaccine. If a live vaccine, such as MMR, varicella and zoster vaccine has been given, then a four-week gap is generally recommended before Comirnaty. If Comirnaty, is given first, then maintain a two week gap before any other vaccines. Do not delay if a gap between these vaccines is not practicable.

Please note that two doses of the mRNA vaccine are required, given at least 21-days apart. These recommendations are continually being reviewed.

How should we space MMR, influenza and COVID-19 vaccination?

Please continue to allow a four-week gap when giving the MMR vaccine before the COVID-19 vaccine where possible. However, the gap can be reduced to two weeks when giving the MMR vaccine after the second dose of the COVID-19 vaccine. Complete both doses of the COVID-19 vaccine, 21 days apart, before giving another vaccine.

Please continue to allow a two-week gap between the COVID-19 vaccine and influenza vaccine where possible, regardless of the order they’re given.

Having a gap between the different types of vaccinations makes it easier to judge which vaccine may be responsible for any side effects. Note that there are no clinical safety concerns should the gap between vaccines be less than the recommendations above. Do not delay vaccination if such a gap is not possible.

The MMR and influenza vaccines can be given at the same time.

The Ministry of Health has put together a flowchart for healthcare providers managing MMR and influenza vaccinations around COVID-19.

What is the priority - an influenza vaccine or a COVID-19 vaccine?

The COVID-19 mRNA vaccine two-dose schedule should take priority over influenza (flu) vaccine.

The flu vaccine can be administered two weeks after the second dose of COVID-19 vaccine, which is given at least 21 days after the first dose. 

Can I delay receiving my second dose of Comirnaty?

It is recommended to have the second dose of Comirnaty™ at least 21 days after the first dose. A delay for longer than 21 days is not considered to be a problem in terms of how you will respond to the second dose.

It is not yet known, for how long the first dose provides protection. If you are at risk of exposure to SARS-CoV-2, it is advisable to have the second dose when recommended. During clinical trials, the vaccine efficacy against symptomatic COVID-19 between the first and second doses was around 50% compared with 90% within 2 days of the second dose increasing to 95% after a week. Recent real-world data has shown that protected against SARS-CoV-2 infection was around 62 to 91% from 14 days after dose one and 68 to 97 % from 14 days after dose two in frontline workers. 

Can COVID-19 vaccines be safely given to frail and elderly people?

There are no safety concerns around giving COVID-19 vaccine to older and frail adults. Multiple COVID-19 vaccine candidates have shown to protect against severe disease in older age groups.

A single dose of COVID-19 vaccine substantially reduced (over 70%) the risk of COVID-19-related hospitalisation in elderly, frail patients with extensive co-existing conditions in the UK. By 2 weeks after the second dose effectiveness against symptomatic COVID-19 in adults aged over 70 years was 85-93%. This is important, as increasing age is a risk factor for severe COVID-19.

Following reports of deaths of frail, elderly adults in residential care facilities after COVID-19 vaccination, independent reviews by both the CDC and the WHO concluded that the mortality rate in this population is typically high and a substantial number of deaths will occur coincidentally following vaccination. For further information, click here.

COVID-19 vaccines in pregnancy and breastfeeding

Pregnant people are encouraged to be vaccinated against COVID-19 at any stage of pregnancy.

In pregnancy, the risk of severe COVID-19 complications is much higher than in people who are not pregnant. The updated recommendation aligns with recommendations in other countries and is based on international evidence from a large number of people who have already received mRNA COVID vaccines when pregnant and no additional safety concerns have been shown. There is also increasing evidence that antibodies made by the mother after vaccination are shared with the baby in the cord blood that are likely to also protect her newborn baby against COVID-19.

As with all vaccines on the New Zealand Immunisation Schedule, there are no safety concerns about giving mRNA COVID-19 vaccine to women who are breastfeeding and by being vaccinated, mothers can provide some protection against COVID-19 for their babies in breastmilk.

Please refer to the Immunisation Advisory Centre's COVID-19 vaccination in pregnancy fact sheet for more information.

Reference

Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. 2021 DOI: 10.1056/NEJMoa21049

If you had the virus and recovered, will you still be able to or need to get the vaccine?

Vaccination is being offered to people who have and have not had SARS-CoV-2 infection previously.

Data from clinical trials and from countries with a lot of COVID-19 cases have shown the vaccines to be safe and effective in this group of people. It is expected that the vaccine will boost the immune response and provide good protection for those who have previously had SARS-CoV-2 infection. Start your vaccination course at least 4 weeks after you have recovered. For more information, please click here.

Can a person who is currently sick with COVID-19 receive a vaccine?

Internationally, guidance states that people who are currently isolating or experiencing symptoms of COVID-19 should not be vaccinated until they have recovered and met the criteria to stop isolating.

Will children receive a COVID-19 vaccination?

Medsafe has not approved a COVID-19 vaccine for use in children under the age of 16 as yet.

Further research with vaccine trials enrolling children is underway overseas. Initial data in 12-15 year-olds looks promising, with excellent efficacy and a similar safety profile to that seen in adults. Read this Stuff article with IMAC’s Dr Emma Best offering some helpful ideas on how to approach the topic of COVID-19 and vaccines with children.

Is the Comirnaty vaccine safe and effective for people living with HIV?

The vaccine has been through rigorous testing to ensure safety and efficacy and is now being used widely overseas without any serious concerns appearing. People with HIV were included in clinical trials though efficacy and safety data specific to this group are not yet available.

With some vaccines people living with HIV can produce a weaker immune response. People living with HIV are encouraged to be vaccinated. People with HIV were included in clinical trials for the Pfizer vaccine, although the data specific to this group is not yet available there are no safety concerns.

Based on what we know about people living with HIV and their response to other vaccines:

  • those with a suppressed viral load are likely to have some protection from the COVID-19 vaccine
  • they may have a weaker response to some vaccines, including the COVID-19 vaccine

For people who are newly diagnosed and starting HIV treatment are advised to take advice from their specialist about the timing of their vaccination. Any medication being taken for HIV is not expected to change how effectiveness of the COVID-19 vaccine. The vaccine will not affect HIV medications.​

Can I have a COVID-19 vaccination before a CT scan?

It is important to advise your oncologist or radiographer if you have received the COVID-19 vaccine recently. This is because the vaccine can cause the lymph nodes in your armpit and neck to swell which can be detected by CT scans used to diagnose and monitor cancers.

This is particularly detected by FDG PET/CT scans, in which you are given a contrast medium containing a type of radioactive sugar that is taken up by active cells. When an immune response to a vaccine takes place, the cells in the lymph nodes near the injection site become very active and take up a lot of this sugar. Depending on the type of cancer, you may be able to request the injection on the opposite side to your tumour. If possible, have the vaccination at least 2 weeks before a scheduled scan or as soon as you can afterwards. Do not delay any treatment.

COVID-19 vaccine may cause swelling of local lymph nodes. Does this affect mammogram results?

When you attend a mammogram, it is recommended that you mention to your doctor or radiographer that you have had a COVID-19 vaccination recently.

This is because occasionally the vaccine can cause swelling of the lymph nodes in the arm pit near to the injection-site. This usually settles after a few days after vaccination but may be detectable on a mammogram for up to a few weeks. In this case, it is advised to monitor such lymph node changes for at least 6 weeks after vaccination. You do not need to delay your vaccination or your mammogram.

Click this link for further information from BreastScreen Aotearoa.

How many doses of COVID-19 vaccine should I have? I already received a COVID-19 vaccination overseas.

If you were partially vaccinated overseas with one dose of Comirnaty (Pfizer/BioNTech) vaccine, you will need to have another dose at least 21 days after your previous dose. There is no maximum time limit between doses, so you do not need to repeat the first dose or receive a third dose.

If you received one dose of different vaccine (for example, COVID-19 vaccine AstraZenaca/Vaxzevria/Covishield or the Moderna mRNA COVID-19 vaccine), the current recommendation is to have one dose of the Comirnaty vaccine when it becomes available for your priority group at least 4 weeks after your first vaccine. These vaccines are not interchangeable, but you are likely to have a good response to just one dose. If you received one dose of the Janssen/Johnson & Johnson vaccine, you are considered fully immunised and do not require any further doses of COVID-19 vaccine.

Can I have the COVID-19 vaccine if I am allergic to latex?

Comirnaty™ is latex-free. The vial stopper is made with synthetic rubber (bromobutyl), not natural rubber latex.

Can I receive the COVID-19 vaccine even though I have a compromised immune system or am receiving treatment for cancer?

Many people take medication that suppresses their immune system, especially for the treatment of cancer, severe asthma, autoimmune diseases or following organ transplantation, or have medical conditions that can affect the immune system, such as HIV infection or kidney failure.

These conditions put you at increased risk from COVID-19, and although you may not respond as strongly to the vaccine as someone with a fully functioning immune system, it is safe for you received COVID-19 vaccine and it will provide some protection against COVID-19, particularly against severe and life-threatening disease.

It is important and safe for those receiving active treatment with immunosuppressive medications to have the COVID-19 vaccine. If you are severely immunocompromised, it is recommended to talk to your GP or specialist to discuss the optimal timing for vaccination before the vaccine appointment. Ideally, vaccination should be conducted prior to any planned immunosuppression.

It is also important for the people around you, in your household, to have the vaccine when it is offered to them to widen your protection.


For information about Cancer care and COVID-19 vaccine see Te Aho o Te Kahu (Cancer Control Agency) information here.

What side effects may be expected after vaccination?

The most common responses to the COVID-19 vaccine are injection-site reactions (sore arm for example) and general symptoms such as ‘flu-like’ illness, headache, chills, tiredness, nausea, fever, dizziness, weakness or aching muscles.

Generally, these potential responses happen within a day or two after the vaccination and are not associated with more serious or lasting illness. These types of reactions reflect the normal immune response to this vaccine. Not everyone experiences this type of response. They are more likely after the second dose and tend to resolve within a day or two. Pain relief, such as paracetamol or ibuprofen, is not recommended to be taken before having the vaccine but can be used after it if required. 

In addition, as with any vaccine or medicine, there is a risk of allergic reactions shortly after the vaccinations. Because of this people should wait at a vaccination centre as instructed after having their vaccine. Those with previous allergic reactions or anaphylaxis should tell their vaccinator before going ahead.  

For more information about what to expect after the vaccination see the Ministry of Health's website. 

Monitoring for adverse reactions and side effects is being conducted in New Zealand and worldwide. Vaccine recipients and their health care providers are encouraged to report possible side effects to CARM (Centre for Adverse Reactions Monitoring). See here for the latest Adverse Events following Immunisation report from Medsafe on Comirnaty 
 

Will other COVID-19 prevention measures such as social distancing be needed if a COVID-19 vaccine is available?

As not all New Zealanders are be able to be vaccinated at once, the current public health measures, including social distancing, mask usage, rapid contact tracing and managing cluster outbreaks, will continue for some time.

With an effective vaccine programme, it is anticipated these control measures can be reduced. This will require a high proportion of the population (estimated to be at least 8 out of 10 people) being immunised.

Even when we have a high proportion of population vaccinated, we will still need to maintain a level of public health measures particularly when we can travel more freely. See this infographic to explain why.

If a person is vaccinated against COVID-19, will they still be able to spread the virus to susceptible people?

An ideal vaccine stops everyone from carrying and passing on the infection as well as protecting them from becoming seriously ill. It is currently unclear whether COVID-19 vaccines only protect against symptomatic and severe disease, or if they can also stop all infection, including asymptomatic infection (i.e. showing no symptoms).

If the vaccine is only able to stop the symptoms of the disease, but unable to stop the virus from infecting us and reproducing, then the virus may still be able to be spread. Even in this case, by reducing the number of people with symptoms will help to reduce spread of the virus because fewer people will be coughing large quantities of virus on others. However, this possible limitation of the vaccine highlights the importance of continuing to follow public health advice such as hand washing and isolating if unwell, even post vaccination. For more information, please click here.

Recently published data from Israel showed that its mass COVID-19 vaccination campaign (using the Pfizer vaccine) was working well with two doses cutting symptomatic cases by 94% across all age groups. Data reported by the CDC in the US has also shown that mRNA COVID-19 vaccines were 90% effective in health care workers against SARS-CoV-2 infection (with and without symptoms).

How long will COVID-19 vaccine immunity (i.e. protection from the COVID-19 disease) last?

We would expect COVID-19 vaccines to provide protection for longer than 2 months, although exactly how long for, remains unknown at this stage. This is because not enough time has passed since the clinical trials started to be able to accurately answer this.

We know that the Pfizer/BioNTech COVID-19 vaccine lasts for AT LEAST two months, because data supporting this has been reviewed by Medsafe. As part of the conditional approval of the Pfizer/BioNTech COVID-19 vaccine, more data is to be provided as it becomes available. It is anticipated that further data will be provided on durability of the immune response post vaccination in coming months.

Will the vaccine make a person test positive on COVID-19 tests?

No. The vaccine makes a person produce antibodies against the virus spike protein but the nasal swab looks for particles of virus.

The spike protein that is made in your body in response vaccine does not travel far and does not reach your nose.

Can mRNA COVID-19 vaccine affect fertility or affect future babies?

There is no biologically plausible reason why this vaccine could have any effect on our genes or fertility.

Upon injection, the lipid nanoparticle containing the mRNA is taken up by specialised cells (dendritic cells) at the injection site in the arm. These cells use the instructions from the vaccine mRNA to make only the SARS-CoV-2 spike protein and the mRNA degrades rapidly. The mRNA from the vaccine does not enter the nucleus of any cells. Furthermore, no components of the vaccine or the spike protein produced reach the ovaries or the testes. More information about how this concern arose can be found here.

Will ACC provide cover for COVID-19 vaccination injuries?

ACC can provide treatment and support for injuries caused by COVID-19 vaccination if the criteria for treatment injury are met. This means there’s a physical injury caused by the vaccination, that’s not a necessary part or ordinary consequence of the treatment.

For example, inflammation around the site of the injection is common with COVID-19 vaccination (an ordinary consequence) and is unlikely to be covered. Infections (such as cellulitis or septic arthritis) due to the vaccination, and anaphylaxis resulting in injury, are not ordinary consequences and are likely to be covered. 
 
To make a treatment injury claim for a patient please complete an ACC2152 treatment injury claim form as well as an electronic or manual ACC45 injury claim form.
 
To help with reporting, ACC needs to know the COVID-19 vaccine brand name and vaccination dose number (i.e. dose one or two). This can be noted: 

  • on the ACC45: please tick the treatment injury box, identify this as an adverse event in the drop-down menu and then enter the COVID-19 vaccine brand name and vaccination dose number in the open comments section
  • on the ACC2152: in Section 3 - Treatment claimed to have caused the injury.

 
More information about lodging a treatment injury claim is available on the ACC website and in the treatment injury claim lodgement guide.
 
To find out more please contact ACC on 0800 222 070 or email [email protected]
 

COVID-19 vaccine may cause swelling of local lymph nodes. Does this affect mammogram results?

When you attend a mammogram, it is recommended that you mention to your doctor or radiographer that you have had a COVID-19 vaccination recently.

This is because occasionally the vaccine can cause swelling of the lymph nodes in the arm pit near to the injection-site. This usually settles after a few days after vaccination but may be detectable on a mammogram for up to a few weeks. In this case, it is advised to monitor such lymph node changes for at least 6 weeks after vaccination. You do not need to delay your vaccination or your mammogram.

Click this link for further information from BreastScreen Aotearoa.