by Dr. Nell Thomas


Dr. Mike Ryan from the World Health Organization was quoted as saying, “Everything about COVID-19 pandemic is about trust. Innovation is needed in behavioural science on how we, as communities and [as] individuals, understand epidemics and behave during them, process information and advice, build trust. That is as scientific as building vaccines.”

I started writing COVID CORNER because I sought to provide a trusted resource that was fact-based, up-todate, reliable and evidence-based. I was disappointed with some of the journalists’ and media presentation of provocative and inflammatory stories that were emotionally exhausting and contributing to news fatigue.

This week I have seen a number of articles suggesting that the CDC’s decision to pause and reconsider the Johnson and Johnson vaccine (Janssen) because of safety concerns might be harmful, as this pause could deliver a message to the public that vaccines in general are to be avoided. They suggest that announcing to the public when a medical intervention needs further safety review might invite mistrust in the medical community.

Really?

I would hope that thoughtful caution, pausing and reviewing safety data, builds trust and instills confidence rather that feeds mistrust and scepticism. We know that vaccines are reducing infection, hospitalizations and death from COVID-19. That is not for one moment in question; the data abound to demonstrate this. But we have discovered that two viral vector vaccines, Astra Zeneca and Janssen, have an associated very serious risk in certain populations (specifically, premenopausal women who test positive for platelet factor 4 (PF4)–heparin antibodies and have low platelets).

All six patients in the USA who developed clots with Janssen’s vaccine were women between the ages 18-48. One has died. There were more than 6.8 million Janssen vaccine doses given in the United States as of April 12. A review of 11 patients (nine women) in Austria and Germany who received Astra Zeneca and developed clots shows they are between ages 22-49 and developed symptoms five to 16 days from their vaccination. Of these patients, six died. This is from a pool of roughly 20 million individuals who received the vaccine.

Does benefit outweigh risk? What factors do you consider? No end of articles cite mathematical “odds” and statistical fun facts. For example, a “risk” of a blood clot is four in one million if you get the Astra Zeneca vaccine. According to one resource, clot risk is 500 to 1,200 in one million if you are on the birth control pill. It is 1,793 in one million if you smoke. It is 165,000 in one million if you get COVID.

Does the fact that another activity has a higher risk associated make this risk acceptable? Only you know what “risk” you are prepared to take.

We are being asked by our public health officials to weigh personal risk into our decisions for vaccine choice. Reasonable. Are you a premenopausal female? Can you stay home and isolate? Are you in a “hot spot,” a zone with high case numbers of COVID infections? Is there an adequate supply of vaccines? Are you housebound? Unable to travel to receive an mRNA vaccine that is not stable enough to be transported to you the way Astra Zeneca can?

We cannot afford to lose confidence in our guides who are using the best data we have at any given moment to make the best decision possible. Guidelines will change when more information is known, or when circumstances change. If one treatment (or vaccine) is in short supply but is known to be safe, and an alternative is available with some risk, then we may change our risk assessment. Circumstances and factors are personal.

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