Benjamin Mueller reports in the New York Times that while "pausing" vaccines due to concerns over rare blood clots may have only a minor effect in rich countries, it's having a massive effect in poorer countries:
In Malawi, people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine. And in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.
....And even as American health officials stressed that they paused use of the Johnson & Johnson vaccine on Tuesday in “an abundance of caution,” they forced global health officials to begin crafting the difficult case that shots that might not be safe enough for the world’s rich were still suited to its poor.
“It’s sending vaccine confidence into a crater,” Ayoade Alakija, co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”
This isn't surprising, especially after the hit that vaccines took ten years ago when we learned that the CIA had been faking a vaccine campaign in Pakistan in order to obtain DNA from members of Osama bin Laden's family. We quickly forgot all about that, but the rest of the world didn't.
More broadly, it's not surprising that we don't have a good idea of how best to communicate about vaccine safety. We've never been faced with anything of this magnitude before and it's all virgin territory.
To state the obvious up front, nobody thinks that real problems with vaccines should be hushed up simply because they might reduce confidence in the vaccination program. But what's the right threshold for sounding an alarm? It sure seems as if a minuscule number of bad reactions is too low, but does anyone want to put a number on it? One death out of a million? Two? Three?
At the risk of suggesting something stupid, I wonder if a better idea is to be more transparent about side effects. Suppose we had something like a dashboard for each vaccine that showed every reported side effect more consequential than a sore arm. It would be updated daily and you could follow it in real time. Something like this might get people used to the idea that there are always a few rare reactions to vaccines and there's no preset limit where a vaccine suddenly goes from good to bad.
It's just a thought. Right now we have no nuance in the way we treat vaccines. They're either approved or halted. That's it. But that's not the way medicine works in the real world, and we might be better off educating people about that.
There should be some kind of method the help people develop an appreciation of context, as a general idea. When you say something is one in a million, a lot of people hear that and think, 'But I'm one in a million, that thing is just like me!', and so they go off to win the lottery or assume they're more likely to have a bad reaction to a vaccine than get the disease it would prevent.
One in a million rate of death is about the same rate of death as driving 100 miles.
Everybody understands driving and they have at least a vague idea of how dangerous it is.
South Africa stopped administering AZ-Oxford specifically because it performed very poorly -- just 10.4% efficacy -- against the dominant strain in South Africa, B.l.351.
Secondly, J&J has paused its own rollout in Europe. What are African nations to make of this -- are they supposed to continue to administer a vaccine that even its own manufacturer has stopped delivery of?
The NYT story is deeply misleading.
You know, I am outraged at the outrage. Pausing a vaccine to verify side-effects -- of a vaccine that was already supply-constrained and with lower efficacy -- is not that big of a deal. And this poor logic of suggesting that the rate of a very rare type of blood clot is just 1 in 1M? C'mon. Do you aggregate Coronary Artery Disease of all people and call it good, or do you disaggregate by race, age, and gender to see if risks are higher in certain groups, then try to figure out what's going on? Maybe the risk is 1 in 100M for most males, but what if they dig deeper and find that White women of child-bearing age with HPV have a risk of 1:130K?
Instead, people should be outraged at how few doses are being produced. At the current rate of production and administration, it'd take almost a year to reach global herd immunity through vaccines, and that's even before we hit logistical problems.
I wrote one year ago that Operation Warp Speed should be investing billions, even if a total waste, in production capacity in almost all of the candidates. Flash forward to 2021 and what do we have? Supply constraints. Sure, maybe not in the US, but FFS, is SARS-CoV-2 a provincial problem or a global one?
Reaching herd immunity in the US does not stop mutations in, for example, Brazil and the P.1 lineage from producing a mutant that causes widespread breakthrough infections in a 100% immunized US.
Why do people think provincially in a global pandemic?
The US alone is projected to have in excess of 300 million doses by the end of July. What more do you want. This stuff is _not_ magic you know.
There are 7.7B people on Earth.
Having extra doses in the US with contracts that prevent its exportation is useless.
The Biden administration is working on it.
You're right, the contracts signed with the Trump administration around Operation Warp Speed are a big bottleneck.
In the meantime, Biden is supporting COVAX with an initial $4B, and has 'loaned' Astra-Zeneca vaccine to Mexico and Canada.
I agree with D'ork on some of this. If you're going to brand the operation "Warp Speed", then "FFS" it ought to be damn fast.
Such a compendium of side effects exists already. Manufacturers of drugs are required by law to report side effects to the FDA where data are kept. The question would be: Is it a good idea to make that data public?
I think not. Such data is very preliminary. Even the data that stopped the J & J vaccine is preliminary at this point. The decision to pause in this case was due to the severity of the clots and the fact that the "natural" incidence of these particular clots is much lower than observed in the J & J population.
Yes, the data should be public. Data should be widely available. Just because some moron might look at the data and mis-understand it isn't sufficient reason to hide data.
How about polio or smallpox?
Communication about vaccine safety comes down to communication about probability and statistics. How much ProbStat is someone taught by the time she finishes high school?
Very, very little unfortunately. Doubly so since basic stat is, at worst, no harder than algebra. Your pardon, but lack of statistics education is something of a bugbear of mine.
It should be some experts' job to apply and revise standards so they can put a number on how many bad outcomes in a million should be cause to block a vaccination program. Unfortunately, some media and political figures will see it as their job to seize any opportunity to stimulate fear as a way to serve their own interests.
I would say that the new data related to the incidents of blood clot formation tell us that the authorized vaccines are just as safe, or even safer, than previously available data indicated. Because up until a few weeks ago, we didn't have data on millions of recipients. Now we do, and the number of adverse outcomes among those millions is extremely low.
> we don't have a good idea of how best to communicate about vaccine safety. We've never been faced with anything of this magnitude before and it's all virgin territory.
Yeah, no on anywhere in the world has ever been vaccinated before, especially in Africa and South America.
When giving a shot, give out a lottery ticket at the same time.