Dangerous caution
Why is it better to resume the use of the AstraZeneca vaccine
Irina Yakutenko, Forbes, 03/18/2021
The decision of European politicians to suspend vaccination after reports of suspicious complications at first glance seems responsible and prudent. But in fact – just against the background of the beginning of a new wave of the pandemic – it deprives millions of people of the right to a vaccine, says molecular biologist and scientific journalist Irina Yakutenko.
The pandemic has been going on for more than a year, and there are no hints that the virus will go away in the near future. Half of the world is quarantined with varying degrees of severity, but despite this, the third wave of the disease is inevitably rising, and the speed of the vaccination campaign still causes bewilderment, sometimes turning into despair. Against this background, the suspension of vaccination by the largest European countries with a drug from AstraZeneca looks particularly impressive.
"We are not making this decision ourselves, but following the recommendations of the Paul Ehrlich Institute (the agency responsible for testing and permitting vaccines in Germany. – Forbes)" – this is how German Health Minister Jens Spahn explained the motives of his government. But now the reference to a respected research institution looks like an inappropriate excuse.
A pandemic is an emergency situation that has a devastating impact not only on people's health, but also on the economies of states. Such situations are the direct responsibility of politicians, and they should be resolved taking into account all available factors, not just scientific or medical considerations. And in the current circumstances, these factors certainly outweigh in favor of the decision to continue vaccination.
Exotic complication The concern of doctors monitoring the course of the vaccination campaign was caused by cases of a very rare thrombotic complication that developed within about two weeks after vaccination in combination with another rare pathology – a drop in the number of platelets, blood elements that ensure its coagulation. In other words, two opposite disorders appeared in people at the same time: one is associated with an increase in blood clotting, the other with a decrease. This sometimes happens in the late stages of diseases associated with the mass formation of blood clots: the body spends platelets on the formation of unnecessary blood clots. It is unlikely that the combination of complications found in those vaccinated with the AstraZeneca vaccine is accidental, most likely there is a connection between them.
Thrombosis of the sinuses of the dura mater – the so–called discovered rare complication - has been known for a long time. The frequency of this disorder, in which blood vessels diverting blood from the brain are blocked due to blood clots, in the European population is 3-4 cases per million people per year, that is, this is a very exotic condition. The reasons for it are unclear, but apparently, the triggers are not so much external influences as certain individual characteristics of patients, including a tendency to form blood clots, serious autoimmune inflammatory diseases like systemic lupus erythematosus, as well as female gender, recent childbirth and taking contraceptives. Some infections and head injuries can lead to blockage of blood vessels diverting blood from the brain, but in the absolute majority we are talking about a combination of several factors.
In other words, we are talking about a specific disorder that extremely rarely occurs in a certain category of people, primarily in young women. Six out of seven German patients who were found to have this pathology are women from 20 to 50 years old.
At the same time, among the 10.7 million vaccinated with the AstraZeneca vaccine in the UK, the frequency of any thrombotic complications was even lower than in the general population. The obvious contradiction is explained by the fact that the main vaccinated in the UK are elderly and very elderly people. Moderna BioNTech and Pfizer AstraZeneca vaccines were already reserved for the elderly, although older residents in continental Europe are also included in the first group in terms of vaccination priority, many countries vaccinated relatively young doctors with AstraZeneca vaccine more often. In addition, in a number of countries, for example in Norway, Denmark, the Netherlands, Spain and others, the vaccine has not managed to get permission for use in people over 65 years old, although the European Medical Agency has approved the drug for all age groups over 18 years.
Therefore, on the continent, the sample of those who received the vaccine from AstraZeneca differs markedly from the British one. These are relatively young people, mainly medical staff and employees of numerous European nursing homes, more than half of whom are women. In other words, in the EU countries, the vaccination was given to those groups of people for whom the risk of thrombosis of the dura mater sinuses is maximum. It is impossible to transfer the results obtained on this sample to the population as a whole. Moreover, they cannot be transferred to the elderly: for them, the risk of detected pathology is practically absent, but the risk of severe course and death from COVID-19 is huge.
Pause in favor of the virus By depriving these people of the opportunity to get their dose of the vaccine, politicians radically increase their chances of getting infected and dying. In addition, a pause in the vaccine campaign will inevitably lead to a tightening of the restrictions or a sharp increase in the number of new cases, including severe ones, due to premature release from quarantine. Both options will not only have an extremely negative impact on the economy, but will also result in a much greater number of deaths than from complications of thrombosis.
Any medications have undesirable side effects, including the most popular ones, such as aspirin or birth control pills. Their presence is not a reason to ban a particular drug. In medicine, in principle, there are no binary assessments in the spirit of "good" or "bad", it is always an assessment of the ratio between the possible risk and the intended benefit.
This approach does not mean that alarm messages should be ignored. Research is needed to find out the cause of such phenomena and, possibly, to optimize the scheme of drug use in such a way as to minimize the share of risk. In the case of the AstraZeneca vaccine, even if it turns out that it was its use that triggered the development of complications, the benefits outweigh the risks by many orders of magnitude, which remain extremely rare. To further reduce them, it is possible to revise the order of distribution of vaccines, vaccinating older people with this drug. Perhaps, in the process of studying, other factors will be found that increase the likelihood of developing this pathology, for example, some concomitant disease.
The decision to suspend vaccination, guided by reports of suspicious complications, at first glance seems responsible and prudent. But this is an incredibly simplistic and very dangerous view. In a reality in which Europe is confidently entering the third wave of the pandemic, hospitals are gradually filling up again with patients with complications of the coronavirus, and the economy and psyche of people can hardly withstand endless quarantines, depriving millions of people of vaccines on the basis of possible extremely rare complications is as irresponsible as possible.
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