In retirement, Pat Alley’s life is incredibly busy. He is a councillor of the Auckland University of Technology and sits on their Research Ethics Committee. With many years’ experience of caring for doctors with health needs, he remains a willing member of the RACS Wellness group. 

He is a treatment injury advisor for New Zealand’s Accident Compensation Scheme and is assisting with the development of a digital record for New Zealand’s rich lode of medical history.

It was no surprise then, that when an appeal was made for additional resources to assist with COVID-19 vaccinations, that Dr Alley responded. He completed the 25 hours online course with the Immunisation Advisory Centre (IMAC) and in April, and began immunising healthcare staff at the North Shore Hospital, where he had worked for many years, being a founding member of the Department of General Surgery.

“I enjoyed seeing many of my old colleagues. After we finished, there were 92 per cent fully vaccinated, two per cent further waiting for their second vaccination, and a small minority who refused,” Dr Alley said.

Dr Alley answered another call to assist with community vaccinations, and from the end of April, has been working at a large vaccination centre twice a week. The clinic has completed more than 100,000 injections and on busy days, completes 1,600 to 1,700 injections a day.

The work has been no less interesting and rewarding for Dr Alley than his previous surgical work. “It’s still an interaction and a procedure. Vaccinations are a microcosm of a surgical procedure, still requiring a large supportive team, technology, patient consent, patient interaction and aftercare.”

Dr Alley said he enjoys educating the public about the necessities of being vaccinated, including talking to vaccine hesitant people, who often present due to family or work pressure. By the end of the conversation, he said, most are reassured and happier about receiving the vaccination.

Dr Alley explained that at full capacity, the clinic operates with approximately 70 people. “The public might not appreciate the whole process,” he said. “In addition to vaccinators, there are many staff directing people to the appropriate areas, administration and registration, aftercare and a large group making up the vaccines as the Pfizer vaccine needs careful handling and preparation.”

He enjoys this team approach. “At the beginning of the day, we review the previous day, cover any news, and listen to anecdotes and feedback. I’m moderately fluent in Te Reo Māori (Māori language), so I lead a karakia. Some people call it a prayer, but I regard karakia as a mission statement for the day. It acknowledges respecting and looking after each other, being inspired by our history and celebrating our successes.”

At the time of interview, the New Zealand population was just under 80 per cent first dose and around 50 per cent double dosed. To date, Dr Alley has administered more than 3,200 vaccinations and is looking forward to continuing to add to that number.

“I would encourage all retired surgeons to do the same,” he said. “Helping to vaccinate the New Zealand population has been immensely satisfying and rewarding. Furthermore, it relieves the nursing workforce who may be better utilised in specialist inpatient roles.”

Dr Ahmad Aly is a Specialist Upper Gastrointestinal Surgeon and the Head of Upper GI Surgery at the Austin Hospital in Melbourne. He has been educating and supporting local leaders in marginalised areas to encourage their communities get vaccinated against COVID-19.

Most COVID -19 patients requiring ICU beds at the Austin live in the City of Hume, north of the CBD. Hume has high rates of socioeconomic disadvantage, diverse cultural communities which include people from Turkey, India, Iraq and Lebanon, and many essential workers who work in trades like transport and labour.

Paul Johnson, Head of the North Eastern Public Health Unit, contacted Dr Aly to see if he had any ideas that could help to turn around low vaccination numbers. After speaking to community representatives, Dr Aly understood that people were not vaccinating due to a combination of several barriers. One barrier was a lack of vaccine delivery infrastructure, which meant people were relying on local doctors and pharmacies, many of which were becoming Tier One exposure sites and having to close.

Dr Aly decided to convene a meeting that brought together community leaders, governments, and health providers. The meetings, chaired by Dr Aly, helped form an integrated response between government and community workers. For example, the supply of Pfizer over Astra Zeneca was adjusted to maximise uptake, and vaccination clinics were set up in local locations like mosques and community centres. Health providers realised the message around the importance of vaccinating had to come directly from community leaders, who were trusted and respected.  “I was able to see the situation from a medical perspective and I could combine this with an understanding of the cultural issues,” Dr Aly said.

Dr Aly recorded a video of COVID-19 patients in the ICU with the help of Dr Stephen Warrillow, the Director of ICU at The Austin. The video was made to contextualise the issue emotively. It was a direct, tailored appeal and it worked. Many community leaders realised their community would continue to suffer if vaccination levels were not increased.

“At the time we made the video, the first dose vaccination rate was 39 per cent. Four weeks later, it was 90 per cent. What this shows is that these communities were not simply vaccine recalcitrant, we needed to implement a community-based strategy with appropriate government support. Not surprisingly, issues like COVID-19 affect marginalised and disadvantaged communities disproportionately. The key is local people and local actions and working with communities so they can help themselves.”

Orthopaedic spinal surgeon John Cunningham is another surgeon who has been assisting with the urgent drive to vaccinate the population. When elective surgeries in the public system were put on hold, Dr Cunningham and his colleagues discussed how they could contribute to addressing the issues surrounding COVID-19.

“David Love came up with the idea to do something positive and asked the question: why don’t we vaccinate? Especially since that’s the key to getting out of this: to help the population get vaccinated as quickly as possible.”

After completing the straightforward vaccination training, Dr Cunningham has been working at the clinic at the Royal Melbourne Hospital. He has been  vaccinating during the time he would otherwise spend doing elective surgery, which has been put on hold, in the public health system.

“It’s a way of ensuring resources aren’t wasted,” he said. “Why not put that time that would otherwise be wasted, for the greater good?”

He feels great satisfaction in the number of people he is helping. “In one session I can get through about 15-20 people. That is the number of people I have helped to take out of the equation of being unvaccinated. Every single vaccination is pushing us towards the end of this pandemic.”

Dr Cunningham has appreciated the opportunity to engage with a wide range of people in the vaccination booth. “Many people are quite knowledgeable about the benefits of the vaccine and the process around vaccination. They have read resources online and by the time they see me, they have answered most of the questions they would otherwise have had.”

Dr Cunningham said that for a procedure that is remarkably safe, it was disheartening that there was also fear surrounding it. This observation is familiar to Dr Cunningham, who was awarded an Order of Australia in 2016 for his services to medicine and his work around promoting the importance and benefits of immunisation. “There’s a basic human instinct to be frightened of new things—that is sensible. But in this instance, people need to ask themselves, am I being rational or am I listening to some primitive instinct?”

Dr Cunningham believes there will be other opportunities for surgeons like himself to continue to help. “As restrictions ease, the public are looking forward to enjoying life more normally, but we in the healthcare sector are bracing ourselves for a scenario where, if predictions are right, hospitals will be overwhelmed with patients,” he said.

Dr Cunningham has a message for his colleagues: “I would encourage all surgeons to think about ways they can continue to help while elective surgeries are furloughed. If there’s a time for us to think resourcefully about how we can contribute, this is the time.”

Dr Cunningham worked as general resident medical officer in a COVID-19 ward in a private hospital and hopes there will be an opportunity to do this again.
“I hope that in years to come surgeons like myself will look back and feel satisfied that we helped, in our small way, to navigate a way out of this.”