Apparently, “AstraZeneca can now be seen for what it is, on the side of the angels”, at least according to Walter Ellis. This is regarding the company’s vaccine developed to protect from Covid-19, and now rolled out in various geographies, most notably the UK. The implication of Ellis’ piece is that President Macron is to blame for not having given the AZ vaccine a seal of approval earlier in the piece, and that the root cause of Europe’s ongoing vaccine travails can be traced back – at least in part – to France’s Jupitarian leader.
And while it is easy for us to doubt the Greek deities, what is unusual about these strange times is that we are expected to come down firmly on the side of ‘angels’, and against ‘devils’. I am not sure that life – with all its thorny complexities – is as simple as this. Not every relationship is linear and not every ratio is perfect; neither does a good model spit out good data if fed garbage. “Trust, then verify” is a useful maxim when navigating the treacherous waters of life.
Let us be clear: side effects are to be expected. Vaccines – like any medical intervention – will always carry the risk of adverse reactions. Imagine basic surgery – even the simplest of operations carries a small risk of infection. The overall risk of these complications is very small, but for those affected, the outcome can be very serious. This is accepted, because life has risks. We have the concept of ‘informed consent’, whereby a potential patient must be given the information relevant for them to give consent for the operation to proceed: “I understand the risks; please go ahead anyway, because for me the benefits outweigh the risks”. This can be extended to benefits for a population vs negligible side effects for an individual. But it does get harder when the side effects for the individual become non-trivial.
According to The Paul Ehrlich Institut, The German Federal Institute for Vaccines and Biomedicines, after the administration of 2.7 million doses of AstraZeneca’s ‘angelic’ vaccine, 31 cerebral venous thromboses have been diagnosed, 29 of which occurred in females between the ages of 20 and 63. In 19 of these cases, thrombocytopenia was also reported. 9 of these cases have resulted in death. As I outlined previous in a discussion of asymmetric risk and the balancing of benefit versus risk, what might be – on balance – good for the goose (those most at risk from Covid-19) might not be so good for the gander (those less at risk from Covid-19).
It is therefore entirely reasonable, logical and rational to pause vaccination for this ‘gander’ (i.e. anyone not at risk of Covid-19), as many countries have now done. Some might argue that we must press ahead regardless due to the apocalyptic threat of imminent catastrophe due to another Covid-19 epidemic… but (1) we know this is unlikely as the UK population has a high degree of resistance to the SARS-CoV2 virus and due to seasonality is unlikely to see a resurgence and (2) history tells us ignoring warning signs and that rushing vaccines out regardless is unwise, c.f. the 2009/2010 H1N1 vaccine that later was shown to cause narcolepsy in children.
As mentioned above, this risk/benefit analysis also extends from the individual to the overall population. On this basis – and if you assume that a vaccinated population is less likely to enable the spread of a future epidemic – it is worth considering vaccinating younger cohorts on the basis that the overall population benefits from the prevention of future epidemics. Using this logic, some are pushing for continuing the vaccination push to younger people, and even children. Well, why not?
Well… lots of reasons, actually:
- The vaccination programme was designed to ensure those ‘at risk’ could be offered protection, not to stop the spread of an endemic virus. One can justify the use of vaccines in an emergency situation for the former, but not for the latter.
- The risk/benefit analysis does not stack up for those who are not ‘at risk’, if those ‘at risk’ are protected from the vaccine. Only one of the following statements can be true: (1) the vaccine protects those who have it and (2) the unvaccinated must be jabbed to protect those who have already had the vaccine.
- The adverse effects of the various vaccines seem to be very serious. Risk is the product of likelihood of outcome multiplied by the severity of the outcome. Side effects such as a sniffle, aches & pains or a few days in bed are low severity, and associated with low risk. But death from a blood clot? This is high severity, and means the risk is higher. It is difficult to see how one can make a case for someone to take a vaccine if they are at zero risk from Covid-19, yet at higher risk from a vaccine adverse event.
- Our youngsters will hopefully be around to see in the 22nd century. This is a long time from now. They are essentially at zero risk from Covid-19. But we just don’t know what minor – or major – issues might crop up in a longitudinal study. The current crop of vaccines will not be fully approved until 2023. The precautionary principle applies, especially for children.
- Finally, wherever and whenever vaccination campaigns are started, there seems to have been an uptick in cases of Covid-19 – this lagged effect can be clearly seen in the main dashboards such as OurWorldInData. This may be purely an unfortunate temporal association, and there is – as yet – no indication that these are caused by the vaccine. But we know that Covid-19 has a seasonal element to it, and if it turns out that the delayed vaccination campaigns across the world trigger out-of-season Covid-19 spikes, then this is something that needs to be investigated further.
For all these reasons, we might well be advised to take stock once the ‘at risk’ population has been vaccinated. This has been a year of extraordinary measures, and we have barely had time to catch our breath in judging the effects of what has been done. Lockdowns caused death & destruction (known harms) while possibly reducing the spread of a respiratory disease (hoped for gains).
The likes of Florida, Sweden and Texas have demonstrated that focussed protection has been correlated with better outcomes than regions that have attempted to suppress the spread of the virus in the healthy young, as well as avoiding some of the worst effects from overblown restrictions. In fact, despite the radically different approaches taken to lockdowns, mask mandates, vaccination programmes and general restrictions between the UK and Sweden, it is extraordinary how similar their per capita mortality curves are. Meanwhile, hospitals are rammed in zero Covid New Zealand, just as they enter their autumn/winter season – hopefully their woes are not compounded by Covid-19.
With all these confusing signals around, perhaps now is the time to pause, reflect, gather more data and decide – carefully, in detailed consultation with the rest of our fellow inhabitants of these Islands – what the UK’s next move should be.
We currently do not have an epidemic in this country, and mortality is now way below normal average levels. We also have in place the processes and procedures needed to watch out for the next one.
In the meantime, let us roll back whatever restrictions remain, and put aside some of the crazy plans for blood passports and test certificates. There are very good reasons why we have avoided these things in the past.
Perhaps those angels are slightly harder to distinguish from the devils than we initially thought.
Dr Alex Starling (@alexstarling77) is an advisor to and non-executive director of various early-stage technology companies.