I do not like the sound of “blood clots”. Many European leaders don’t like the sound of them either. Not nice, as my Granny used to say. It seems that some people who have received the AstraZeneca vaccination appear to have developed blood clots, 37 among 17 million people Europeans given the vaccine, so many European leaders have suspended vaccinations on the basis of “the precautionary principle”. I did not know this, but since 2005 this principle has been appended to the French Constitution. Slavish compliance with the precautionary principle is like ensuring your knife is correctly buttoned into its scabbard as you head off to a gunfight. European and international health agencies have told them not to stop vaccinating, so with their refusal we have another festival of confusion across the channel. Essentially, the Continent is cut off by fog, a fog of their own creation.
The back story is that there are blood clots and blood clots. Some happen in 1 in a thousand persons, and others so rarely that it is hard to calculate the base rates. Some account say that it was the latter sort which caused some countries to halt vaccinations. Whatever the reason, other countries followed suit. About a week later the advice came back that they should resume vaccinations. Not all have done so.
The French President had said that the AstraZeneca vaccine was “quasi-ineffective in over 65 year olds” and French health officials are now saying it should not be used on under 55 year olds. So, if official guidance is to be believed, this vaccine works for the 55 to 65 age group only. As Sir John Bell, Regius Chair of Medicine at the University of Oxford said, their policy is “crackers”.
In an attempt to raise all these rows to a war footing, the President of the European Commission, Ursula von der Leyen, is threatening to use an emergency clause in their constitution to justify embargoing the export of vaccines, which might result in AstraZeneca having to break its prior contract with the UK in order to fulfil a later contract with the EU. This is a mystifying plan of action, since at the moment the European factories don’t produce this vaccine, and 90% of it comes from England, and the last 10% from India. However, the European factory is due to come online soon, so the fuss is about who gets the big boost in production.
My impression of many national leaders is that they don’t really know much about industrial production processes, namely how long it takes to perfect a technique, and how widely across the world one has to search for all the ingredients and specialist equipment required for mass production of a new vaccine, at a scale never before achieved. All this threatening behaviour, just to be able to use a vaccine which is only available because the University of Oxford designed it, and because the University of Oxford partnered with AstraZeneca on the condition it was sold to everybody at cost, and because the United Kingdom then bankrolled it in advance, giving the company a guaranteed income flow in return for a pre-booked delivery schedule. The UK also pre-booked lots of other vaccine candidates very early in their development. The French seem to be particularly peeved because their own vaccine, put together by the Pasteur Institute and Sanofi, flopped, leading to lots of morose soul-searching.
To make a repellently absurd, petulant and posturing performance even worse, it turns out that the blood clot fiasco has resulted in 14 million doses of vaccine having been left unused, such that Europe is now facing a third wave of infection, and France has just locked down 21 million citizens, while they work out quite what to do with a population which were already vaccine hesitant, and are now vaccine bewildered and downright hostile. An English friend who lives and works in St Tropez got vaccinated last week. He said that the only people vaccinated while he was there (for about 40 minutes because it included the compulsory waiting time) was himself and another guy who was in a wheel chair. No other patients showed up. He had time to do his own little performance routine, saying he would only accept a vaccine if it was Russian, and then spent time chatting in English with the French medical staff, who said that all the available vaccines worked, if only people would take them.
Gerd Gigerenzer has made a great contribution to the understanding of risk in his 2002 book. What I most liked about his approach is that he designed a simple heuristic to make us smart, namely that when making decisions about risks, we should always draw out a frequency tree and put in actual numbers derived from population base rates. He also suggested that these “natural frequencies” were easier to understand than percentages, particularly when the percentages include decimal points. Only 0.01% of people get those right.
Plotting out the frequencies for all conceivable vaccination side effects, against the effects on those who get Covid would be a simple way of looking at costs and benefits. People with Covid often get blood clots. Recent data from the Netherlands and France suggest that 30-70% of coronavirus patient in intensive care units develop blood clots, one in four develop a pulmonary embolism, and are more likely to suffer a stroke. Not nice at all.
Since the virus kills mostly those above 65 years of age, as already described in my post on 3rd February:
For those between 65 and 75 year of age the risk is 2,500 in 100,000. For those between 75 and 85 years it is 6,000 per 100,000, and for those over 80 years it is 20,000 per 100,000. Individual choices will vary, but from 65 years onwards, a vaccination may look like a good bet.
Currently, the UK is vaccinating its population at a much higher rate than Europe.
Currently, the UK is experiencing fewer cases than most of Europe:
As a pointer for the future, as many more millions get vaccinated across the world, (currently 436 million and rising fast), the number of apparent side effects will rise in absolute numbers. The number of real side effects may also rise. The key issue is whether those side effects justify not being vaccinated and accepting the effects of getting Covid. Also, given that most national programs prioritize the elderly, there will be more and more people who will die shortly after being vaccinated for reasons of age alone. Some of those deaths will be of people who have rare diseases. As more and more millions get vaccinated, one day an elderly patient may die as they get vaccinated.
Saturday was a record day for UK coronavirus vaccinations, with 873,784 people inoculated. Those looking forward to a holiday in France have been told that they should wait before making bookings. No one wants returning tourists bringing back new variants from France. The entente is not so cordial.