‘I don’t know what my earliest memory is. I don’t think anyone really does. What I know is what I’ve been told – that I was born at King Edward Memorial Hospital in Perth and taken straight to St Joseph’s Orphanage.’
Dr Robert Francis Isaacs AM, OAM, PhD (Hon) has dedicated his life to breaking down cultural barriers and bridging the divide between black and white Australia. He was taken from his mother as a baby, raised as an orphan in institutions, unaware that he was Aboriginal. In this memoir, he writes of his life: raised to adulthood by the Christian Brothers, determined to find his own way once he left Clontarf.
Robert Isaacs was a member of the Stolen Generations and was unaware that he had a large extended family living nearby. A chance encounter, while surveying families in the slums of East Perth, changed his life:
‘Robert! We know you, we know you, you’re one of our people!’
Determined to embrace his culture and to build on both his religious faith and education, Robert Isaacs immersed himself in the world of Aboriginal health and housing, proving himself able to negotiate real and practical outcomes.
I kept reading, about quiet and positive achievements in education, home ownership, and justice. I kept reading, about a man who has found a place bridging a gap between two cultures with differing values.
‘We had elders, not leaders.’
This is a personal narrative, of the life of an inspirational Noongar figure, of a man who has worked within existing systems to make a positive difference. I read of his introduction of the rent warranty system, which saved Aboriginal tenants from eviction and of the purchase system which increased the available housing stock. In the early 1990s, Dr Isaacs became the first Aboriginal person elected to local government as a councillor for the City of Gosnells. I read of his other achievements, and I read of his heartbreak when he received a ‘phone call advising him that his mother (whom he had not met) had died and was to be buried later that same day. He never got to know his mother.
‘If I had one message for all the Aboriginal people in our community, it would be this. Your voice is important: use it to be a role model and to be influential, and use that influence for good.’
Dr Isaacs has retired now to Broome where his wife Teresa has extended family.
I finished this book full of admiration for Dr Isaacs and his achievements.
The change is based on the advisory group’s assessment of the risks of the clotting disorder, called thrombosis and thrombocytopenia syndrome or TTS, versus benefits of the AstraZeneca vaccine in protecting against COVID-19.
While the risk of TTS is still very low overall, it is more common in younger age groups. And younger people are less likely to die or become seriously ill from COVID-19.
What is the clotting disorder and how common is it?
Thrombosis with thrombocytopenia syndrome (TTS) is a rare clotting problem that can occur after vaccination with the AstraZeneca vaccine.
We don’t fully understand why TTS occurs, but we know it’s caused by an overactive immune response. This is a very different mechanism to clots people might get after travelling or being immobile for lengthy periods.
The condition involves blood clots as well as a depletion in blood clotting cells known as platelets. The clots associated with TTS can appear in parts of the body where we don’t normally see blood clots, like the brain or the abdomen.
Of the 12 recent cases, seven occurred in people aged between 50 and 59.
Sadly, two people have died.
The risk of TTS reduces with age. For people aged under 50, there are 3.1 cases of TTS per 100,000 doses. This reduces to 1.9 cases for those aged 80 and above:
As awareness of TTS grows, clinicians’ ability to detect and diagnose the condition has also improved. This means the risk of becoming severely ill and dying from this condition has fallen dramatically.
How does this compare to the chance of dying from COVID-19?
Globally, 177 million cases of COVID-19 have been reported, with around 3.83 million deaths, or just over 2%.
The risk of dying from COVID-19 increases with age. The rates depend on the country you live in and your sex. In China, for instance, the death rate was reportedly:
for under-50s, less than 1%
50 to 59 years, 1.3%
60 to 69 years, 3.6%
70 to 79 years, 8%
80 and above, 14.8%.
In terms of data from Australia, in 2020, for every 600 people with COVID-19 aged in their 50s, one person died and 18 required admission to a hospital intensive care unit (ICU).
For every 600 people aged in their 70s with COVID-19, 24 died and 42 were admitted to ICU.
So the benefits of vaccination to prevent severe COVID-19 are greater among older age groups.
If you’re aged 50 to 59 and have already had one dose, and didn’t have a significant reaction, the advice is for you to return for your second dose.
Relatively few Australians have received a second dose of the AstraZeneca vaccine. But data from the United Kingdom shows TTS appears much less commonly after second doses – 1.5 cases per million doses.
If you have concerns about the risk of TTS, talk to your doctor or vaccine provider.
In the future, as more evidence emerges and is assessed by Australia’s regulators, we may use other vaccines for follow-up doses. But this is not currently the recommendation.
ATAGI is a group of experts that closely monitors vaccines both in Australia and internationally for side effects, as well as how well they are working.
It also considers the amount of disease circulating that the vaccine is designed to protect from.
These factors are considered at the time of initial approval, and then monitored continuously. When some of these factors change, the way we use vaccines also needs to change.
Today’s change demonstrates the strength and robustness of the ongoing surveillance of adverse events of vaccines and our regulators’ commitment to ensure the safety of the community receiving these vaccines.
We’re fortunate to have excellent control of COVID-19 in Australia and low rates of severe disease. We’re also fortunate to have an alternate vaccine in the form of Pfizer, albeit still in relatively short supply.
Out of an abundance of caution and considering all of these and other factors, it makes sense to increase the age cut-off for the use of this vaccine in our country at present.
This may be subject to further changes in the future, in either direction, as the situation around us continues to evolve.