Wednesday 12 May 2021

The vaccine conundrum: Weighing the risks between benefits and a rare side effect

This column first appeared in Malta Today

The Malta Employers’ Association this week came out with the proposal that those employees who refuse to take the vaccine should have to accept regular mandatory swab tests at their own expense and should not be paid for any quarantine leave should they test positive. 

This controversial suggestion is obviously going to cause a furore, because it impinges on a person’s rights to refuse the vaccine, however the MEA’s argument is that employers also have the right to safeguard their workplace. While I can understand both points of view, I still cannot grasp why there is resistance to a vaccine which can perhaps get us back to life as we knew it, rather than waiting around for Covid to hit you, with who knows what type of consequences. 

Compared to other countries, the number of anti-vaxxers here is relatively low.  But those who are adamantly against being inoculated seem to make their presence felt very loudly, trolling every page and group on FB wherever this issue arises, while claiming that the rest of us are brainwashed and gullible.

With the news that globally there have been some very (very) rare cases of blood clots after taking the AstraZeneca vaccine, the already heightened anxiety took a new turn and those who were previously willing to be vaccinated were thrown into a tailspin.  In Malta there have been two incidents of blood clotting following inoculation reported to the Medicines Authority, but when questioned, Prof Gauci dismissed the claims that they were linked to any of the vaccines.  More disturbingly, however, is the news that a woman died three weeks after receiving AstraZeneca when she developed a blood clot and the case is now being investigated by Mater Dei’s Chief Medical officer.  Her husband insists she was perfectly healthy before being inoculated, while Minister Fearne said that no adverse reaction report had been relayed to the Malta Medicines Authority about this particular case.

For those who have been wary about AstraZeneca from the start, this has only served to deepen their scepticism.  Even after the European Medicines Authority pronounced itself that the risks of this rare side effect are far outweighed by the benefits, the prevailing feeling among many is one of growing mistrust.  So, should we believe the health authorities or not? But if we do not believe them, then whom should we believe? Are Governments simply pushing AstraZeneca because it has now been purchased in large quantities and there is no going back? Or is there a vaccine war going on between the manufacturers? The questions continue to swirl and there are no easy answers. The alternative of not being vaccinated, however, is not an enticing prospect either.  

Despite scientists and physicians trying to explain to the public that all medicines have probable side effects (including the most common over the counter ones), and even after pointing out that taking the contraceptive pill (1 in 2000) and taking a flight (1 in 1000, which increases in flights of more than 4 hours) have a higher probability of causing blood clots, the fear continues to prevail and it is going to be difficult to restore trust.  

The BBC News website illustrated the probabilities in an easy to understand way: 

Risk of serious harm from AstraZeneca?  It’s 11 in a million for a 25-year-old, and 4 in a million in a 55-year-old. 

Risk of dying from Covid? It’s 23 in a million for a 25-year-old and 800 in a million in a 55-year-old. 

And if we take the specific side effect of blood clots, a recent study has found that:

  • Pulmonary embolism, or clotting on the lungs, occurs in 7.8% of people who have COVID-19
  • Deep vein thrombosis (DVT), or clotting in the legs, occurs in 11.2% of people who have COVID-19
  • Of those who have COVID-19 and end up in an intensive therapy unit (ITU), 23% will have some form of clot
  • COVID-19 causes strokes in 1.6% of people
  • Up to 30% of people who have COVID-19 will get thrombocytopenia, which is a lowering of the platelet count 

Out of the 19 people who have died from blood clots in the UK after taking their first dose, 14 had CVST, while 4 had thrombosis. The Medicines and Healthcare products Regulatory Agency (MHRA) has pointed out that the risk of CVST, a type of rare blood clot that prevents blood from draining from the brain, is about four people in a million who receive the vaccine.  

The data is out there, which is why everyone offered any of the vaccines must inform themselves properly by referring to reliable sources, and consulting with their doctor to discuss their health issues and weigh their individual risks before taking a decision. On the one hand there is the rare possibility of a blood clot  and on the other, the risk of contracting Covid-19 or any of its variants with all the unpredictable ways it can wreak havoc on your body, possibly long-term.  With a simultaneous world-wide vaccination programme underway, and the pooling of data by scientists who are studying all of this in real time, we at least have the advantage of information at our fingertips, to help us decide.

Meanwhile, our own vaccination roll-out seems to have finally gathered pace. While up until the previous week I kept seeing constant complaints because those over 65 and those who are vulnerable had not yet received their appointment, a poll I carried out this week on the popular FB platform Is-Salott, told a different story. Only 48 people (from around 4300 views) replied that they or one of their relatives who fall within this cohort had not been contacted.  This was confirmed by friends and acquaintances who finally got their jab, so hopefully the delays in the roll-out have now been ironed now.  Despite the blood clot scare, there is a palpable feeling of relief in those who get the vaccine, because it represents one step closer to getting our lives back.

A further step forward was taken with the announcement that schools will be re-opened as from Monday.  While the re-opening plan is not perfect, at least there was an indication that this time the Prime Minister has listened to the health authorities by presenting us with a staggered approach and a timeline. Of course, this did not go down well with everyone but you can never get it right and had he opened everything at one go there would have been complaints as well. 

However, where the criticism was justified was in the fact that the timeline only focussed on a few sectors and those which were not mentioned and kept in the dark, such as restaurants and bars, the performing Arts, and organised sports, are frustrated and extremely disappointed at the dearth of information.  While I can understand the importance of giving education and the elderly the priority they deserve, leaving certain sectors out completely sent the flawed message that they were not important.  There could have been some indication of when they could open (like there was with tourism after all) even something as vague as “the beginning of May” with the proviso that the timeline could be brought forward if the numbers go down. 

To give credit where it’s due, Abela’s delivery during this press conference showed a marked improvement; he was more measured and sombre and the boasting ratio was kept to a minimum, although he was slightly tempted towards the end (he is still easily triggered by what he perceives as unfair criticism).  Where it went sideways was his announcement that there would be “direct contact” allowed with the elderly with the lifting of restrictions at care homes.  Those who have relatives in these homes understood this to mean that they could finally embrace their loved ones with physical contact, but their hopes which had been raised sky high were only dashed again when the protocols came out.  

The perspex would be removed but social distancing and masks would still be in place, and the meetings would be held in a designated room rather than the person’s own room, once a week for 25 minutes (rather than the previous twice a week for 15 minutes).  For those residents who are mobile there was an improvement as they would be allowed to move freely within the care home, but for others, not much has changed. While one can understand the need to keep shielding the elderly until more people are inoculated, Abela should not have given the impression that things were going back to the way they were before all this began.  It is crucial at this juncture to not get carried away by promising too much, and to communicate clearly so that there are no misunderstandings, especially when people have been separated and isolated from their parents or spouses for so long. 

And finally, in a parallel universe, somewhere in a villa, a young woman thought it would be a good idea to throw a party for her 21st birthday, because, you know, the rules don’t really apply to you when Daddy’s rich. We are told the Police are investigating this breach of Covid rules – apart from being slapped with the highest possible fines, I suggest that these party-goers should be sent to Mater Dei to spend a shift with the exhausted nurses and doctors caring for Covid patients.  

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