AstraZeneca’s blood clot risk is incredibly small. Australia shouldn’t follow the UK’s lead of offering under 30s another vaccine


Nathan Bartlett, University of NewcastleAuthorities in the United Kingdom overnight recommended people under 30 be offered an alternative COVID vaccine to the AstraZeneca/Oxford shot.

The recommendation came after the European Medicines Agency (EMA) found a “possible link” between the vaccine and blood clots. The EMA also said blood clots should be listed as a “very rare” side effect of the vaccine.

It’s important to note there’s still no conclusive evidence the vaccine is causing the clots, as so few have been reported. However, evidence there is a link is increasing, which has prompted more focused monitoring.

The benefits of getting a COVID vaccine still far outweigh the risks. I would still be encouraging everyone to be vaccinated with the AstraZeneca vaccine.

Prime Minister Scott Morrison said this morning “there’s nothing to suggest at this stage that there would be any change” to Australia’s current rollout strategy. The Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation are currently reviewing the data and latest advice from Europe and the UK.

What’s causing these clots?

Blood clotting events linked to vaccination are being called “vaccine-induced prothrombotic immune thrombocytopenia” (VIPIT).

In these rare instances, clots are forming in a patient’s blood, and not just in veins but in arteries and other rare locations like the brain and abdomen. This is also paired with low platelet counts (cells needed for the blood to clot).




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What is thrombocytopenia, the rare blood condition possibly linked to the AstraZeneca vaccine?


It appears, in these instances, the body’s response to the vaccine is triggering an “off target” immune response that is attacking platelets. Limited data that is yet to be peer reviewed suggests antibodies targeting platelets cause them to become activated and trigger clotting. This autoimmune response also targets the platelets for destruction, reducing their level in the blood. So platelets are either tied up in clots or are eliminated. Both processes contribute to “thrombocytopenia” (low blood platelet count).

Like infections, vaccines trigger an immune response, so when receiving any shot that stimulates a robust immune response there’s a small but real risk your immune system will generate “off target” effects. In these rare instances, these effects can lead to autoimmunity, which is an immune response that attacks your own cells.

All vaccines and medications come with small risks

The numbers of clots reported after the AstraZeneca are very small, so we don’t exactly know how common they are. But they appear to occur at a rate between one in 25,000 and one in 500,000.

The UK’s vaccine advisory board said there were 79 cases of blood clotting issues among more than 20 million people given the AstraZeneca vaccine. That’s a chance of about 0.0004%, or one in 250,000.

Researchers haven’t yet identified any specific risk factors so far for the development of blood clots following COVID vaccination. We need to understand as quickly as possible what these are if indeed a causal link is established.

Some have suggested there could be a link with women taking the contraceptive pill having a higher risk of blood clots after receiving the AstraZeneca vaccine. But there’s no evidence for this at all. As far as I know, information on whether women receiving the vaccine are taking the contraceptive pill isn’t captured. Perhaps it’s something to consider going forward.

Young people don’t appear to be at particularly higher risk of blood clots linked to the vaccine. The publicised cases of blood clots have occurred in mostly women under 60 years of age.

Australia shouldn’t follow the UK’s new recommendation

One reason the UK is able to advise younger people to receive other vaccines is because it has other vaccine options, including the Pfizer and Moderna shots. Offering the under 30s an alternative vaccine isn’t really going to hinder the rollout, which is going very well in the UK.

But this isn’t the case in Australia. The AstraZeneca shot is the only one we have guaranteed supply of, given CSL is producing it in Melbourne.

It’s important to remember the AstraZeneca vaccine is a very safe and effective vaccine. It’s also easier to store and distribute than the Pfizer vaccine.

The priority is vaccinating as many people as possible and quickly

It’s important to note we’re in uncharted territory. This is the first time in modern history we’ve been in a situation where we’ve needed to roll out a vaccine to deal with a pandemic.

We’re also using new vaccine technologies that we’ve had to expedite to try and get on top of this virus as soon as possible. These new technologies, including AstraZeneca’s, have never been tested at this immense scale until now.

There are a lot of unknowns, but certainly the scale in which were doing this means we’re going to see very rare adverse events linked to these vaccines.

At this stage the priority is still to vaccinate as many people as possible, as quickly as possible.

My primary concern is ongoing high levels of transmission across the world. The more cases there are, and longer we delay vaccinating people, the higher the likelihood is of new variants of the virus emerging.




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UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic


Even though we have very low COVID-19 case numbers in Australia currently, we’ve seen regular outbreaks stemming from hotel quarantine. We can’t predict what’s going to happen in the future. The longer the virus is waiting at our doorstep, the greater the risk we’ll have another outbreak and end up in lockdown and much worse — and nobody wants that.The Conversation

Nathan Bartlett, Associate Professor, School of Biomedical Sciences and Pharmacy, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As Britain passes 100,000 COVID deaths, Boris Johnson is in a crisis of his own making


Rob Manwaring, Flinders University

Two slippery and elusive phantoms seem to be escaping UK Prime Minister Boris Johnson and his Conservative government. The first is the fiendishly viral and deadly COVID-19 pandemic.

The number of covid-related deaths in the UK has passed 100,000, making it the first nation in Europe to pass this milestone. The UK now has the fifth-highest death toll in the world. The Johnson government has struggled to manage the crisis, and the human cost is higher than the total civilian casualties the UK experienced during the second world war.

As elusive for Johnson, who for so long has played arch-buffoon and joker, is political capital. The concept of “political capital” feels intuitive – popular politicians seem to have a lot of it, and unpopular ones seem to have none of it. Yet, political science has long wrestled with trying to define and understand it.

The notable sociologist Pierre Bourdieu was one of the first to grapple with the idea. The academic Kimberly Casey argues that political capital is analogous to a cake – it requires a number of ingredients and, crucially, not all of them were initially made by the baker. Richard French suggests political capital is made of up of:

[…] mostly intangible assets which politicians use to induce compliance from other power holders [such as business leaders].

After his emphatic 2019 election win, Johnson seemed to have stacks of it. He won a landslide majority of 80 seats and notably broke into Labour’s “red wall” (although the starkly majoritarian electoral system skewed Johnson’s victory margin).

A rampaging virus has meant a bleak winter in the UK, which has just passed 100,000 COVID deaths.
Facundo Arrizabalaga/EPA/AAP

Johnson has made a number of serious political misjudgements in responding to the pandemic. First, his government has repeatedly been slow off the mark to deal with the crisis. At the outset of the first wave, it played down the risks. In March 2020 he was arguing the UK would “turn the tide” in 12 weeks.

Johnson’s government was slow to handle the second wave, attempting a relaxation of restrictions over the Christmas period. The government’s chief medical officer, Sir Patrick Vallance, asserted an earlier lockdown could have made a difference. More striking was this claim relating to the first wave by one of the scientists advising the government, Professor Neil Ferguson:

Had we introduced lockdown a week earlier we’d have reduced the final death toll by at least half.

Johnson also made of habit of either marginalising or just ignoring scientific advice. In tandem with handling the pandemic, Johnson was under immense pressure to deliver a Brexit deal while also dealing with the “economic emergency” of the crisis.

More damningly, there appears to be no overarching and clear strategy to deal with the COVID-19 crisis. Johnson’s government has had to make numerous and predictable policy U-turns on a range of issues.

Poor communication has also been a hallmark of the period. The government’s “stay alert” campaign last May was met with public bemusement. The belated introduction of a tier system in October also seemed to cause confusion and was followed by further England-wide lockdowns.

Johnson’s approach has been bedevilled by trying to meet the health challenges while simultaneously trying to rebuild the economy and manage the spiralling costs of the pandemic. The government’s “eat out to help out” scheme proved disastrous, with evidence it appears to have contributed to the devastating second wave.

Worse still were the complacency and apparent hypocrisy that are part of Johnson’s political calculus – not least his handling of the damaging trip made by his then-top aide Dominic Cummings to “test his vision”. Johnson’s own father Stanley has seemingly flouted lockdown rules, all while his government hectors the public. The double standards in Johnson’s approach give an impression of “one rule for us” and serve as a reminder of the levels of inequality in the UK.




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As a second wave of COVID looms in the UK, Australia is watching closely


There are systemic factors, beyond Johnson’s leadership, that help explain the flailing response to the pandemic in the UK. In a considered essay, Ferdinand Mount brutally reminds us of the systemic dismantling of the NHS and neo-liberal reforms under both Conservative and Labour governments, and the austerity measures that have left the system struggling. Mount’s judgment is:

The malign combination of an over-centralised system and a hopelessly narcissistic prime minister has been fatal.

Will Johnson be able to remake his political capital? If he manages to ride out the current crisis, he has a number of available strategies and systemic advantages.

First, he stuffed his cabinet full of loyalists, many owing their political careers to his backing – even when they break ministerial codes. Johnson is now trying to get on the front foot, expressing “deep sorrow” for the mounting death toll, and a change in advisers is resetting his political strategy. He is adept at downplaying criticisms with the “benefit of hindsight” argument.

The vaccine roll-out in the UK has also been hailed as a great success, and the government is still performing relatively well in the polls.

Crucially, the UK is not scheduled to head to the polls until 2024. If the vaccine strategy works, Johnson knows future elections are not often decided by a government’s record in the early part of a term.




Read more:
As COVID rampages through Europe, it will test not just health systems but social cohesion


The Conversation


Rob Manwaring, Senior Lecturer, Politics and Public Policy, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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