I don’t think the editors of the Washington Post quite appreciate the present situation with respect to the AstraZeneca vaccine:
More than a dozen countries, including Germany, France, Italy and Spain, temporarily suspended the AstraZeneca rollout after reports last week that some people in Denmark and Norway who got a dose had developed blood clots. There was no evidence that the shot caused them. The company says that out of 17 million doses given in Britain and Europe as of March 8, there were only 37 incidents of blood clots, less than what would be expected to occur naturally in a population of this size. German regulators, worried about seven cases of severe cerebral venous thrombosis that occurred within four to 16 days after the vaccine, including three persons who died, said the rate was above what would be expected.
I wonder how the editors think that evidence is accumulated or what constitutes proof in a medical setting? Offhand I’d case that you start with correlation and the Germans, French, etc. have that.
Let’s recap:
- Questions were raised about the AZ vaccines clinical testing.
- After receiving the vaccine some people experienced blood clots, in a few cases leading to death.
- Norway and Denmark suspended the use of the AZ vaccine.
- Then a few other countries like Bulgaria and Ireland did the same thing.
- Then all of the major European countries followed suit.
What’s wrong with that?
The editors conclude:
A lesson of this moment is that no medicine is 100 percent safe and effective. The flu vaccine must be reformulated every year to cope with mutations. Despite widespread use of the measles vaccine, outbreaks still occur.
Europe has an enormous job ahead to vaccinate tens of millions of people. Everyone should expect speed bumps, be vigilant for serious problems — but avoid panic.
Can’t the same lesson be learned from COVID-19 itself? There is no such thing as perfect safety. A year into the COVID-19 pandemic about 9% of the U. S. population has been diagnosed as having contracted the disease (estimates are higher) and of those 1.8% have died. Not to diminish the seriousness of the disease but that’s still a small risk. There may also be a small risk in getting the AZ vaccine. We’re confronted with the problem of comparing two small risks. Now add that there are other alternative vaccines (at this point Pfizer, Moderna, and Johnson & Johnson) none of which have comparable reports. The actions of France, Germany, etc. don’t seem that outrageous to me under the circumstances.
The actions of France, Germany, or the EU would be reasonable if you exclude their conduct over the last 4 months.
The Astra-Zeneca vaccine has been enveloped in the politics of Brexit, Irish border, and EU competency.
The EU went in a rage when Astra-Zeneca informed them they couldn’t hit their manufacturing targets in January, and caused a crisis by applying a “nuclear” Brexit treaty clause on the Irish border that angered both communities in Ireland. The EU has proclaimed multiple times without proof that the UK is stealing vaccines from the EU.
Then the Germans Health ministry created vaccine skepticism when they misread that > 65 were 8% of participants in the Astra-Zeneca trial as the vaccine was 8% effective in > 65. Macron repeated that as well. Meanwhile, the UK vaccination campaign is producing data that the vaccine is somewhere between 50-90% effective is > 65 year old. But of course, that is ignored because the UK left the EU and that means UK data is persona non-grata.
I hate to do a math exercise, but lets talk about absolute risk, relative risk, and societal cost.
In absolute terms, the chance of dying from COVID is ~1%, and the chance of catching it is 10% / year (until we reach herd immunity). So the chance of dying is 0.1% / per year. Meanwhile the chance of getting blood clots is 1 in million range, 0.0001%. If you assume herd immunity will be reached this year in the EU, then the absolute risk is 0.1% vs 0.0001%; both very low.
In relative terms, the risk of dying from COVID is 1000 times more likely developing blood clots from a vaccine.
In terms of societal costs — it adds up. Astra-Zeneca is still a substantial amount of the vaccine supply for the EU. The EU is reporting 3000 deaths / day from COVID. If the resulting delayed vaccination, vaccine hesitancy results in only 3% avoidable deaths, over 10 days that is 1000 avoidable deaths, etc etc.
If you can’t trust the EU vaccine regulator who says the vaccine is safe, what’s the point in being in the EU and centralizing regulatory capacity in its super-agencies?
I don’t think that’s quite the right risk comparison. Deaths without the vaccine are limited by social-distancing measures, which imposes its own economic and psychological cost that may not be maintainable.
Also, I don’t think the vaccines are widely available in the EU because they used their collective bargaining power to get a guaranteed cheapest price, but not guaranteed delivery at any point in time. At heart, its a trade bloc, only occasionally enlightened despot.
FWIW, I wrote this before reading CuriousOnlooker’s comments, with which I largely agree.
The 3000 deaths a day is taken from yesterday — but it looks like the 7 day average is 2000 deaths, while various forms of social distancing / lockdowns are present. Unless the EU suddenly learns to be South Korea, only vaccines can bring that number down.
One underestimated issue is the EU placed a lot of bets on EU vaccines from Sanofi, Curevac — Sanofi was a bust while Curevac will be available around Q3 this year. So the EU had bad luck — but as they say, beggars can’t be choosers and the EU doesn’t have alternatives to Astra-Zeneca if they want vaccines now instead of 6 months.
I am still not convinced that the numbers are any different for AZ than the other vaccines. I am not convinced that the numbers are any higher than would be expected in the normal, non-vaccinated population. I have seen reports that long with the clotting cases there were pretty abnormal platelet numbers, but have not seen that verified. I do think AZ is suffering because they had a very sloppy rollout/testing period and then they reported a lower efficacy than the first 2 vaccines. Both WHO and EMA are suggesting they keep giving other vaccine.
Steve