AstraZeneca
UK advises limiting AstraZeneca in under-30s amid clot worry
British authorities recommended Wednesday that the AstraZeneca COVID-19 vaccine not be given to adults under 30 where possible because of strengthening evidence that the shot may be linked to rare blood clots.
The recommendation came as regulators in the United Kingdom and the European Union emphasized that the benefits of receiving the vaccine continue to outweigh the risks for most people — even though the European Medicines Agency said it had found a “possible link” between the shot and the rare clots. British authorities recommended that people under 30 be offered alternatives to AstraZeneca. But the EMA advised no such age restrictions, leaving it up to its member-countries to decide whether to limit its use.
Also Read: EU agency: Rare clots possibly linked to AstraZeneca shot
Several countries have already imposed limits on who can receive the vaccine, and any restrictions are closely watched since the vaccine, which is cheaper and easier to store than many others, is critical to global immunization campaigns and is a pillar of the U.N.-backed program known as COVAX that aims to get vaccines to some of the world’s poorest countries.
“This is a course correction, there’s no question about that,” Jonathan Van-Tam, England’s deputy chief medical officer, said during a news briefing.
Van-Tam said the effect on Britain’s vaccination timetable — one of the speediest in the world — should be “zero or negligible,” assuming the National Health Service receives expected deliveries of other vaccines, including those produced by Pfizer-BioNTech and Moderna.
EU and U.K. regulators held simultaneous news conferences Wednesday to announce the results of investigations into reports of blood clots that sparked concern about the rollout of the AstraZeneca vaccine.
The EU agency described the clots as “very rare” side effects. Dr Sabine Straus, chair of its Safety Committee, said the best data was from Germany, where there was one report of the clots for every 100,000 doses given, although she noted far fewer reports in the U.K. Still, that’s less than the clot risk that healthy women face from birth control pills, noted another expert, Dr. Peter Arlett.
The agency said most of the cases reported were in women under 60 within two weeks of vaccination, though it was unable to identify specific risk factors based on current information. Experts reviewed several dozen cases that came mainly from Europe and the U.K., where around 25 million people have received the AstraZeneca vaccine.
“The risk of mortality from COVID is much greater than the risk of mortality from these side effects,” said Emer Cooke, the EMA’s executive director.
Arlett said there is no information suggesting an increased risk from the other major COVID-19 vaccines.
In a statement, AstraZeneca said both UK and EU regulators had requested their vaccine labels be updated to warn of these “extremely rare potential side effect(s).”
“Both of these reviews reaffirmed the vaccine offers a high-level of protection against all severities of COVID-19 and that these benefits continue to far outweigh the risks,” it said.
The EMA’s investigation focused on unusual types of blood clots that have occurred along with low blood platelets. One rare clot type appears in multiple blood vessels and the other in veins that drain blood from the brain.
“We are not advising a stop to any vaccination for any individual in any age group,” said Wei Shen Lim, who chairs Britain’s Joint Committee on Vaccination and Immunization. “We are advising a preference for one vaccine over another vaccine for a particular age group ... out of the utmost caution rather than because we have any serious safety concerns.”
In March, more than a dozen countries, mostly in Europe, suspended their use of AstraZeneca over the blood clot issue. Most restarted — some with age restrictions — after the EMA said countries should continue using the vaccine.
Britain, which relies heavily on AstraZeneca, however, continued to use it.
The suspensions were seen as particularly damaging for AstraZeneca because they came after repeated missteps in how the company reported data on the vaccine’s effectiveness and concerns over how well its shot worked in older people. That has led to frequently changing advice in some countries on who can take the vaccine, raising worries that AstraZeneca’s credibility could be permanently damaged, spurring more vaccine hesitancy and prolonging the pandemic.
Dr. Peter English, who formerly chaired the British Medical Association’s Public Health Medicine Committee, said the back-and-forth over the AstraZeneca vaccine could have serious consequences.
“We can’t afford not to use this vaccine if we are going to end the pandemic,” he said.
In some countries, authorities have already noted hesitancy toward the AstraZeneca shot.
“People come and they are reluctant to take the AstraZeneca vaccine, they ask us if we also use anything else,” said Florentina Nastase, a doctor and coordinator at a vaccination center in Bucharest, Romania. “There were cases in which people didn’t show up, there were cases when people came to the center and saw that we use only AstraZeneca and refused (to be inoculated).”
After the EMA announcement Wednesday, officials in Spain said AstraZeneca would be limited to people over 60 years of age, and Italy issued a similar recommendation.
Belgium’s health minister, Frank Vandenbroucke, declared a four-week ban on administering the AstraZeneca vaccine to people under 56, but said that would have little impact on the vaccination campaign, since few from that age group are in line to get the shots this month.
Earlier Wednesday, South Korea had said it would temporarily suspend the use of AstraZeneca’s vaccine in people 60 and younger. In that age group, the country is only currently vaccinating health workers and people in long-term care settings.
“For the vast majority of people the benefits of the Oxford AZ vaccine far outweigh any extremely small risk,″ said Dr. Anthony Harnden, the deputy chair of Britain’s vaccination committee. “And the Oxford AZ vaccine will continue to save many from suffering the devastating effects that can result from a COVID infection.”
South African variant found in 81% Covid-19 samples since third week of March
The South African variant has accounted for 81% of the positive cases in Dhaka since the third week of March 2021.
A research study conducted by the icddr,b has revealed this information.
The research team at icddr,b analysed genomic sequence data of 57 samples of the SATS COV-2 virus in Covid-19 positive patients between March 18 and 24. Forty-six of those samples were found to be the same as the South African variant of novel coronavirus.
Also read: Bangladesh shatters its all-time records of daily Covid cases
This variant is said to have greater transmissibility and harbour new genetic changes, which may impact clinical manifestation and vaccine effectiveness.
Icddr,b identified the first UK variant on 6th January 2021; however, the SARS-CoV-2 sequence database at GISAID.ORG indicated that the UK variant was already circulating in December 2020 in the country. The UK variant gradually increased over time until the second week of March 2021, with the highest positivity rate (52%).
However, a dramatic change in the distribution of variants was observed when the South African variant appeared. It became the most prevalent variant during the third week of March 2021 by replacing other variants. Most remarkably, the South African variant occupied 81% of the variants in the fourth week of March 2021, according to icddr,b website.
Also read: New variant may be behind Covid surge in Bangladesh: Experts
In light of this finding, icddr,b urged all to abide by the restrictions recently announced by the Government of Bangladesh.
Vaccines may not work against variants
The head of the World Health Organization has expressed his concerns several times in the past that the vaccines developed so far might be less effective against the variant first detected in South Africa.
Tedros Adhanom Ghebreyesus said at a media briefing that South Africa’s decision to suspend its vaccination campaign using the AstraZeneca vaccine is “a reminder that we need to do everything we can to reduce the circulation of the virus with proven public health measures.”
Also read: UN: 'Concerning news' vaccines may not work against variants
South Africa has suspended plans to inoculate its front-line health care workers with the Oxford-AstraZeneca vaccine in February this year after a small clinical trial suggested that it isn’t effective in preventing mild to moderate illness from the variant dominant in the country.
Preliminary data from a small study suggested that the AstraZeneca vaccine offers only “minimal protection against mild-moderate disease” caused by the variant in South Africa. The variant appears more infectious and is driving a deadly resurgence of the disease.
Read How to strengthen your immune system to prevent COVID-19 infections?
EU agency: Rare clots possibly linked to AstraZeneca shot
The European Union’s drug regulator will announce the conclusions of its investigation into the possible connection between AstraZeneca’s coronavirus vaccine and rare blood clots later Wednesday, including recommendations that could have far-reaching effects on the use of the shot that is key to global efforts to end the pandemic.
Earlier this week, a senior official from the European Medicines Agency said there was a causal link between the AstraZeneca vaccine and the rare clots that have been seen in dozens of people worldwide, among the tens of millions who have received at least one dose of the shot.
Also Read: Canada pauses AstraZeneca vaccine for under 55
Marco Cavaleri, head of health threats and vaccine strategy at the Amsterdam-based agency, said in comments to Rome’s Il Messaggero newspaper on Tuesday that “it is becoming more and more difficult to affirm that there isn’t a cause-and-effect relationship between AstraZeneca vaccines and the very rare cases of blood clots associated with a low level of platelets.”
But Cavaleri acknowledged the agency hadn’t yet figured out how exactly the vaccine might be causing these rare side effects. The agency said its evaluation “has not yet reached a conclusion and the review is currently ongoing.”
The EMA is particularly focused on two types of rare blood clots: one that appears in multiple blood vessels and another that occurs in a vein that drains blood from the brain. It is also evaluating reports of people who had low levels of blood platelets, which puts them at risk of severe bleeding.
Also Read: UK regulator says AstraZeneca jab safe after 7 clot deaths
The EMA, the World Health Organization and numerous other health authorities have said repeatedly that the AstraZeneca vaccine is safe and effective and that the protection it offers against COVID-19 outweighs the small risks of rare blood clots.
As recently as last week, the EMA said “there is no evidence that would support restricting the use of this vaccine in any population” — a response to several countries doing just that — though an expert said more brain clots were being reported than would be expected. To date, most of the cases have been reported in younger women, who are more susceptible to developing such rare clots anyway, making understanding what is causing the clots potentially more difficult.
“The problem is these clots are very unusual, and we don’t really know what the background rate of them is, so it’s very hard to know if the vaccine is contributing to this,” said Dr. Peter English, who formerly chaired the British Medical Association’s Public Health Medicine Committee.
A full investigation would likely take months, but English said given the urgency of the continuing pandemic, regulators would likely make a quick decision.
Also Read: What we know about AstraZeneca blood clot reports
“It’s very likely we will see a suspension of the vaccine’s use in certain groups while they do the further investigations to give us clearer answers,” English said.
In March, more than a dozen countries, mostly in Europe, suspended their use of AstraZeneca over the blood clot issue. Most restarted — some with age restrictions — after the EMA said countries should continue using the potentially life-saving vaccine.
The suspensions were seen as particularly damaging for AstraZeneca because they came after repeated missteps in how the company reported data on the vaccine’s effectiveness and concerns over how well its shot worked in older people. That has led to frequently changing advice in some countries on who can take the vaccine, raising worries that AstraZeneca’s credibility could be permanently damaged, spurring more vaccine hesitancy and prolonging the pandemic.
English said the back-and-forth over the AstraZeneca vaccine globally could have serious consequences.
“We can’t afford not to use this vaccine if we are going to end the pandemic,” he said.
That’s because the vaccine is cheaper and easier to store than many others, is critical to Europe’s immunization campaign and a pillar of the U.N.-backed program known as COVAX that aims to get vaccines to some of the world’s poorest countries. It has been endorsed for use in more than 50 countries, including by the 27-nation EU and WHO. U.S. authorities are still evaluating the vaccine.
The governor of Italy’s northern Veneto region said any decision to change the guidance on AstraZeneca would cause major disruptions to immunizations — at a time when Europe is already struggling to ramp them up — and could create more confusion about the shot.
“If they do like Germany, and allow Astra Zeneca only to people over 65, that would be absurd. Before it was only for people under 55. Put yourself in the place of citizens, it is hard to understand anything,” Luca Zaia told reporters on Wednesday.
The latest suspension of AstraZeneca came in Spain’s Castilla y León region, where health chief Verónica Casado said Wednesday that “the principle of prudence” drove her to put a temporary hold on the vaccine that she still backed as being both effective and necessary.
“If there are in fact individuals of a certain age group that could have a higher risk (of clotting) then we need to adjust its use,” Casado told Spanish public radio. “We are not questioning AstraZeneca. We need all the vaccines possible to reach the goal of 70% of the adult population.”
French health authorities said they, too, were awaiting EMA’s conclusions and would follow the agency’s recommendations, especially for the 500,000 people who have received a first dose of AstraZeneca.
Even officials in Asia said they were keen to hear the EMA’s decision. On Wednesday, South Korea said it would temporarily suspend the use of AstraZeneca’s vaccine in people 60 and younger. In that age group, the country is only currently vaccinating health workers and people in long-term care settings.
The Korea Disease Control and Prevention Agency said it would also pause a vaccine rollout to school nurses and teachers that was to begin on Thursday, while awaiting the outcome of the EMA’s review.
English, the former chair of the British drug regulator, said that even rare, serious side effects are seen with established vaccines and that policymakers often decide that bigger public health goals warrants their use, citing the polio vaccine as an example. For every million doses that are given of the oral polio vaccine, about one child is paralyzed from the live virus contained in the vaccine.
On Tuesday, AstraZeneca and Oxford University, which developed the vaccine, paused a study of the shot in children while the U.K. regulator evaluates the link between the shot and rare blood clots in adults.
UK regulator says AstraZeneca jab safe after 7 clot deaths
Britain’s medicines regulator is urging people to continue taking the AstraZeneca coronavirus vaccine, despite revealing that seven people in the U.K. have died from rare blood clots after getting the jab.
The Medicines and Healthcare Regulatory Agency, or MHRA, said it wasn't clear if the shots are causing the clots, and that its “rigorous review into the U.K. reports of rare and specific types of blood clots is ongoing.”
Also Read: Dutch temporarily halt AstraZeneca shots for under-60s
Though the agency said late Friday that seven people had died as a result of developing blood clots, it didn’t disclose any information about their ages or health conditions.
In total, MHRA said had identified 30 cases of rare blood clot events out of 18.1 million AstraZeneca doses administered up to and including March 24. The risk associated with this type of blood clot is “very small,” it added.
Also Read:What we know about AstraZeneca blood clot reports
“The benefits of COVID-19 vaccine AstraZeneca in preventing COVID-19 infection and its complications continue to outweigh any risks and the public should continue to get their vaccine when invited to do so,” said Dr. June Raine, the agency’s chief executive.
Concerns over the AstraZeneca vaccine has already prompted some countries including Canada, France, Germany and the Netherlands to restrict its use to older people. The U.K., which has rolled out coronavirus vaccines faster than other European nations, is particularly reliant on the AstraZeneca vaccine, which was developed by scientists at the University of Oxford.
MHRA's view about the relative benefits of the vaccine is shared by the European Medicines Agency. It has said a causal link between unusual blood clots in people who have had the vaccine is “not proven, but is possible," and that the benefits of the vaccine outweigh the risks of side effects. The World Health Organization has also urged countries to continue using the jab.
Also Read: Africa CDC says India vaccine woes could be 'catastrophic'
Adam Finn, a professor of pediatrics at the University of Bristol, said the “extreme rarity” of the blood-clotting events in the context of the millions of jabs administered in the U.K. makes the decision facing people very straightforward.
“Receiving the vaccine is by far the safest choice in terms of minimizing individual risk of serious illness or death,” he said.
A more detailed look at the MHRA’s findings show that of the 30 cases, 22 related to cerebral venous sinus thrombosis, which stops blood draining from the brain properly, and eight were connected with other thrombosis events with low platelets.
It said there were no reports of any blood-clotting events around the Pfizer/BioNTech vaccine, which has also been widely rolled out in the U.K.
Dutch temporarily halt AstraZeneca shots for under-60s
The Dutch government said Friday it is temporarily halting AstraZeneca coronavirus vaccinations for people under 60 following reports of very small number of people suffering unusual blood clots after receiving the shot.
The Dutch decision comes three days after authorities in Germany also stopped using the AstraZeneca’s vaccine in the under-60s, citing fresh concerns over unusual blood clots reported in a tiny number of those who received the shots.
Earlier Friday, a Dutch organization that monitors vaccine side effects said it had received five reports of blood clots with low blood plate counts following vaccinations. All the cases occurred between seven and 10 days after the vaccinations and all the people affected were women aged between 25 and 65 years.
The organization said in the period when the five cases were reported, some 400,000 people were vaccinated in the Netherlands with the AstraZeneca shot.
Health Minister Hugo de Jonge says the temporary halt is a precautionary measure.
“I think it is very important that the Dutch reports are also properly investigated,” De Jonge said. “We must err on the side of caution.”
Also read: What we know about AstraZeneca blood clot reports
The news is another setback for the AstraZeneca vaccine, which is critical to Europe’s immunization campaign and a linchpin in the global strategy to get shots to poorer countries, for it is cheaper and easier to use than rival vaccines from Pfizer and Moderna. It comes two weeks after the EU drug regulator said the vaccine does not increase the overall incidence of blood clots following a similar scare.
The European Medicines Agency said at the time that the benefits of vaccination outweigh the risks, but it could not rule out a link between the shot and some unusual kinds of clots, and recommended adding a warning about possible rare side effects.
Also read: German cities suspend AstraZeneca vaccine use for under-60s
Most European Union countries, including Germany, resumed using the AstraZeneca vaccine on March 19.
De Jonge said the Dutch pause comes ahead of an update next week from the EU medicines agency on the AstraZeneca vaccine.
Africa CDC says India vaccine woes could be 'catastrophic'
Africa is unlikely to meet its targets for vaccinating the continent against COVID-19 if supply delays from a key Indian manufacturer continue, the director of the Africa Centers for Disease Control and Prevention warned Thursday.
Dr. John Nkengasong told a press briefing that officials hope the problems at the Serum Institute of India will only be temporary otherwise “it would definitely impact our ability to continuously vaccinate people.”
"I really want to deliberately hope that it is a delay — not a ban — because that would be catastrophic,” he said.
Also read: German cities suspend AstraZeneca vaccine use for under-60s
More than half of the 29.1 million vaccine doses received by African nations so far have come through the global COVAX initiative, which aims to ensure that low- and middle-income countries have fair access to vaccines. COVAX has largely relied on distributing the AstraZeneca vaccine, because it is cheaper and only requires ordinary refrigeration.
But the Serum Institute of India recently announced that as many as 90 million doses of the AstraZeneca vaccine destined for COVAX worldwide will be delayed through the end of April as India’s government grapples with a spike in infections among the country's 1.4 billion people.
Nkengasong said it is not yet known what impact the uncertainty might have for scheduling second doses of the AstraZeneca vaccine in African countries.
“We are tracking that very, very closely,” he said Thursday. “I’m sure countries are still trying to finish vaccinating their first round of the vaccines that were received.”
Also read: Johnson & Johnson COVID-19 vaccine batch fails quality check
Nkengasong remained optimistic, though, that a deal announced on Monday for African countries to acquire the single-dose Johnson & Johnson vaccine remains “an historic moment and a game-changer.”
The agreement with the African Union's African Vaccine Acquisition Trust calls for 220 million doses to be delivered by the third quarter of this year, with an option to acquire an additional 180 million doses through 2022.
If those 400 million people receive the Johnson & Johnson vaccine, it would represent more than half the continent's goal of 750 million, Nkengasong said.
Africa has confirmed more than 4.2 million cases and 112,000 deaths, but since most countries on the continent lack the means to track mortality data, it is not clear how many excess deaths have occurred since the pandemic began.
Also read: African expert warns of 'vaccine war' over access to jabs
Covid-19: Bangladesh records highest-ever daily cases, 59 deaths
For the third time in four days, Bangladesh recorded its highest daily coronavirus cases as the health authorities confirmed 6,469 new infections on Thursday afternoon.
The infection rate jumped to 22.94 percent from 19.9 of Wednesday’s when the country recorded 5,358 cases, the highest in months.
On Tuesday, 5,042 cases were recorded and the number was 5,181 on Monday.
Also read: Avoid public gatherings, wear masks to fight Covid surge, PM urges all
Bangladesh had seen a sharp decline in cases and the daily infection rate dropped below 5 percent but the sudden spurt appears to have caught the health sector unawares. There is hardly any bed available at hospitals treating coronavirus patients.
The country’s covid caseload soared to 617,764 after it recorded its highest-ever single day case count, according to a handout issued by the Directorate General of Health Services (DGHS).
During the 24-hour period until Thursday morning, 2,539 coronavirus patients recovered, taking the number of recoveries to 544,938.
Bangladesh reported its first cases on March 8 last year and confirmed the first death from the virus 10 days later.
The country has so far tested 4,698,774 samples, including 28,198 in the last 24 hours, the DGHS said.
Dhaka sees highest deaths
Meanwhile, the fatalities reached 9,105 with 59 new deaths. The mortality rate slipped slightly to 1.47 percent.
Coronavirus claimed 568 lives in January this year, 281 in February and 638 in March.
Among the latest victims, 40 people died in Dhaka division, five in Chattogram, two each in Rajshahi and Rangpur, four in Khulna, one in Barishal and five in Sylhet division.
So far, 5,192 coronavirus patients died in Dhaka division, 1,645 in Chattogram, 506 in Rajshahi, 586 in Khulna, 274 in Barishal, 325 in Sylhet, 376 in Rangpur and 201 in Mymensingh divisions.
So far 6,847 men (75.20) and 2,258 women (24.80) died of the virus.
Also read: New variant may be behind Covid surge in Bangladesh: Experts
Govt strengthens protective steps
The daily surge prompted the Prime Minister’s Office (PMO) to issue an 18-point directive on Monday to prevent the virus’ transmission.
On the same day, the Health Ministry proposed strict measures like partial lockdowns for some places with higher Covid-19 transmission rates.
Other recommendations made by the ministry include closure of amusement centres, picnic spots, religious gatherings, limiting wedding ceremonies, strengthening quarantine systems, limiting passengers in public transports, and limiting attendance in offices.
It also suggested strong enforcement of the ‘no mask no service’ policy, increasing numbers of mobile courts and slapping fines on health guideline violators.
The administrations in various districts have shut down the amusement centres and are urging people to mask up. But a large number of people are still reluctant to follow covid health guidelines, putting themselves and others around them at risk.
Vaccination drive
The government launched a countrywide vaccination campaign on February 7 with doses received from the Serum Institute of India.
Bangladesh inked an agreement with Serum in December last year for 30 million doses of the Oxford-AstraZeneca vaccine. Serum is supposed to supply the doses between January and June this year – 5 million each month.
Also read: Covid surge in Bangladesh: Experts for tightening the grip with nighttime curfew
Global situation
Coronavirus cases were first reported in China in December 2019. Since then, countries around the world have reported 128.8 million cases and 2.8 million deaths so far, according to data compiled by Johns Hopkins University.
A number of vaccines have been developed to fight the virus. Most notable of them are those made by Pfizer-BioNTech, Moderna and Oxford-AstraZeneca.
What we know about AstraZeneca blood clot reports
German officials have decided to limit the use of AstraZeneca’s coronavirus vaccine in people under 60 after more unusual blood clots were reported in a small number of people who received the shots.
In response, Europe’s drug regulator reiterated Wednesday that “there is no evidence that would support restricting the use of this vaccine in any population,” though an expert said more brain clots were being reported than would be expected, and it continues to investigate.
Earlier in March, more than a dozen countries, including Germany, suspended their use of AstraZeneca over the blood clot issue. Most restarted — some with the kinds of restrictions Germany imposed Tuesday — after the European Medicines Agency said the benefits of the vaccine outweighed the risks of not inoculating people against COVID-19.
But the seesawing back and forth in some countries on who can take the vaccine has raised concerns that its credibility could be permanently damaged. Here’s a look at what we know — and what we don’t.
WHAT HAPPENED IN GERMANY?
Earlier this week, Germany’s medical regulator released new data showing a rise in reported cases of unusual kinds of blood clots in people who recently got a dose of the AstraZeneca vaccine. In response, Health Minister Jens Spahn and state officials agreed to only give the vaccine to people aged 60 or older, unless they are at high risk of developing serious complications from COVID-19 and have agreed to take the shot.
“It’s about weighing the risk of a side effect that is statistically small, but needs to be taken seriously, and the risk of falling ill with corona,” Spahn said.
Also read: German cities suspend AstraZeneca vaccine use for under-60s
Germany’s medical regulator said its tally of the rare blood clots reported by March 29 had increased to 31. Some 2.7 million doses of AstraZeneca have been administered in Germany so far. Nine of the people died and all but two of the cases involved women, who were aged 20 to 63, the Paul Ehrlich Institute said.
Some clots have also been reported elsewhere, among the tens of millions of people who have received the AstraZeneca vaccine.
WHAT HAVE PREVIOUS INVESTIGATIONS FOUND?
The EMA’s initial investigation concluded the AstraZeneca shot did not raise the overall risk of blood clots but could not rule out a link to rare clots and recommended a new warning be added to the vaccine’s leaflet. The shot is authorized for people 18 and over.
The EMA is continuing to look closely at two rare types of blood clots, including one that affects the brain, reported in people who got at least one dose of the AstraZeneca vaccine and could update its recommendations for the vaccine next week.
On Wednesday, Dr. Peter Arlett of the EMA said that the agency is seeing “more cases of (brain clots) than we would expect to see,” and noted that more younger women have been affected — but it wasn’t clear if that was significant since younger women were also more likely to receive the AstraZeneca vaccine in Europe. He did not say how many of these kinds of clots would typically show up in the general population.
Also read: Canada pauses AstraZeneca vaccine for under 55
Emer Cooke, the agency’s executive director, said its experts had not been able to identify specific risk factors for those who might be at higher risk for the rare clots.
The World Health Organization’s expert committee also evaluated available data for the AstraZeneca vaccine and said the shot was safe and effective. On Wednesday, Dr. Kate O’Brien, who heads WHO’s vaccines department, said they were continuing to review the situation.
It’s normal to continue to look for side effects as new vaccines are rolled out since they are typically tested in tens of thousands of people, but some rare problems might only occur once millions receive the shot.
HOW CAN SCIENTISTS FIGURE OUT IF THE VACCINE IS RESPONSIBLE FOR THE RARE BLOOD CLOTS?
“The way to tell if cases are caused by vaccination is to look to see if there is an excess of cases in people who have been vaccinated,” said Dr. Peter English, past chair of the British Medical Association’s Public Health Medicine Committee.
That will take some time. It took about a year, for instance, before scientists were able to conclude that a swine flu vaccine was responsible for some cases of narcolepsy in Europe.
Adam Finn, a professor of pediatrics at the University of Bristol, said there was no compelling evidence yet that the vaccine is to blame for the rare clots.
Also read: AstraZeneca confirms strong vaccine protection after US rift
“The mechanism by which these blood clotting abnormalities come about, and why they affect this very small proportion of individuals, has still not been properly worked out,” he said in a statement.
In a statement, AstraZeneca said it was analyzing the tens of millions of records for people who received its vaccine “to understand whether these very rare cases of blood clots ... occur any more commonly than would be expected naturally population of millions of people.”
WHAT DOES THIS MEAN FOR COVID-19 VACCINATIONS?
It’s bad news. Health officials worry the repeated suspensions and restrictions for the AstraZeneca vaccine could undermine confidence in a shot that is key to global efforts to stamp out the pandemic since it’s cheaper and easier to store than some others.
In Norway, which recently extended its suspension of the AstraZeneca vaccine for three weeks, officials say the confusion is prompting a wave of vaccine hesitancy.
The leader of the Norwegian Association for General Practice, Marte Kvittum Tangen, told broadcaster NRK that resuming the vaccination with AstraZeneca “will be very difficult if we want the greatest possible vaccination coverage in the population in the long run.”
Finn, of the University of Bristol, said the biggest health threat to the world is currently COVID-19 and that any doubts about the effectiveness of authorized coronavirus vaccines is problematic.
“We need to stay focused on the need to prevent (COVID-19) taking millions more human lives before it is brought under control, and the only effective way to do that is through vaccination,” he said.
Canada pauses AstraZeneca vaccine for under 55
Canada on Monday suspended the use of the Oxford-AstraZeneca coronavirus vaccine for people under age 55 following concerns it might be linked to rare blood clots.
The National Advisory Committee on Immunization had recommended the pause for safety reasons and the Canadian provinces, which administer health in the country, announced the suspension Monday.
“There is substantial uncertainty about the benefit of providing AstraZeneca Covid-19 vaccines to adults under 55 given the potential risks,” said Dr. Shelley Deeks, vice chair of the National Advisory Committee on Immunization.
Also read: AstraZeneca: US data shows vaccine effective for all adults
Deeks said the updated recommendations come amid new data from Europe that suggests the risk of blood clots is now potentially as high as one in 100,000, much higher than the one in one million risk believed before.
She said most of the patients in Europe who developed a rare blood clot after vaccination with AstraZeneca were women under age 55, and the fatality rate among those who develop clots is as high as 40%.
Dr. Joss Reimer of Manitoba’s Vaccine Implementation Task Force said despite the finding that there was no increase risk of blood clots overall related to AstraZeneca in Europe, a rare but very serious side effect has been seen primarily in young women in Europe.
Reimer said the rare type of blood clot typically happens between four and 20 days after getting the shot and the symptoms can mirror a stroke or a heart attack.
“While we still believe the benefits for all ages outweigh the risks I’m not comfortable with probably. I want to see more data coming out of Europe so I know exactly what this risk benefit analysis is,” Reimer said.
The AstraZeneca shot, which has been authorized in more than 70 countries, is a pillar of a U.N.-backed project known as COVAX that aims to get COVID-19 vaccines to poorer countries. It has also become a key tool in European countries’ efforts to boost their sluggish vaccine rollouts. That makes doubts about the shots especially worrying.
Also read: AstraZeneca confirms strong vaccine protection after US rift
“This vaccine has had all the ups and downs. It looks like a roller coaster,” said Dr. Caroline Quach-Thanh, the chair of the National Advisory Committee on Immunization, when asked if the latest news will lead to further vaccine hesitancy.
Health Canada said it has not received any reports of blood clots in Canada, and the department’s chief medical adviser, Dr. Supriya Sharma, said she still believes the vaccine’s benefits outweigh the risks.
Last week, the department changed its label on the vaccine to warn about the rare risk of blood clots.
Only those 60 and above have received AstraZeneca in Ontario, Canada's most populous province.
“We have no concerns with those who have received it so far,” said Dr. David Williams, Ontario's chief medical officer.
Mark Mendelson, a 63-year-old Toronto man who has had heart surgery, said that he has no regrets about getting his first AstraZeneca dose two weeks ago and that he will get the second.
“Get what you can,” Mendelson said. “I had no ill effects at all from the AstraZeneca. I am in a better position than those who don’t have any vaccine at all. If you are betting person you would take those odds any day of the week. I’m quite prepared to roll the dice.”
Several European countries that had suspended using the vaccine over concerns it could cause blood clots have resumed administering it after the EU’s drug regulator said the vaccine was safe.
The vaccine is used widely in Britain, across the European continent and in other countries, but its rollout was troubled by inconsistent study reports about its effectiveness, and then more recently the scare about clots that had some countries temporarily pausing inoculations.
Canada is expected to receive 1.5 million doses of AstraZeneca from the U.S. on Wednesday.
“The messaging has been brutal overall. I am fearful it is toast. It shouldn't be," said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network.
Morris thinks those who are at a high risk for a bad COVID-19 outcome and over the age of 55 should get AstraZeneca if the other vaccines are not available to them, especially during a third wave of coronavirus infections.
Canadian regulators approved the Pfizer, Moderna, AstraZeneca and Johnson & Johnson vaccines. Canada has placed bigger bets on Pfizer and Moderna, ordering up to 76 million doses of Pfizer and up to 44 million of Moderna, compared with up to 20 million of AstraZeneca. It's not known when Canada will receive its first shipment of Johnson & Johnson.
Canada received its first shipment of AstraZeneca this month — 500,000 doses from India. Of the 194,500 doses that Ontario received, about 10,000 remain. They expire April 2.
Also read: AstraZeneca vaccinations resume in Europe after clot scare
Canada has lagged on vaccinating its population because it lacks the ability to manufacture the vaccine and has had to rely on the global supply chain for the lifesaving shots, like many other countries.
With no domestic supply, Prime Minister Justin Trudeau’s government bet on seven different vaccines manufactured elsewhere and secured advance purchase agreements — enough to get 10 doses for each of Canada’s 38 million people. While acquiring them has proven difficult, deliveries have ramped up this month. Canada expects to have more than 36.5 million doses by July and officials hope to get at least one dose into all adults who want one by the end of June.
The National Advisory Committee on Immunization earlier recommended a four-month delay between doses after data from the U.K. and Quebec showed a good level of protection offered by the first shot. The U.K. has instituted a similar delay.
African expert warns of 'vaccine war' over access to jabs
The head of the Africa Centers for Disease Control and Prevention warned against a “vaccine war” among nations amid renewed fears vaccine shipments to the continent face delays.
John Nkengasong said in a briefing Thursday that he “truly feels helpless that this situation is going to significantly impact our ability to fight this virus," referring to reports that the Serum Institute of India is suspending major exports of the AstraZeneca COVID-19 vaccine in order to meet rising demand at home.
“Without ramping (up) access to vaccines we will be challenged, continue to be challenged. Lives will be lost,” Dr. Nkengasong said, noting that he remains hopeful "the power of humanity will prevail.”
Also read: Virus variants, vaccine inequity responsible for rising Covid caseload: WHO
He added: “There is absolutely no need, absolutely no need for us as humanity to go into a vaccine war to fight this pandemic. We will all be losers.”
The Serum Institute of India produces the AstraZeneca shots being shipped to Africa through the international COVAX initiative to ensure vaccine access for low- and middle-income countries. At least 28 of Africa's 54 countries have received over 16 million doses via COVAX as of Thursday.
Vaccine shipments through COVAX continue to arrive across Africa. South Sudan, for example, on Thursday received its first batch of 132,000 doses of the AstraZeneca vaccine in what WHO called “a giant step” toward equitable destruction of COVID-19 vaccines worldwide.
But COVAX has been facing delays related to the limited global supply of vaccine doses as well as logistical issues. That’s why some countries such as South Africa, the hardest-hit African nation, are also pursuing COVID-19 vaccines via bilateral deals and through the African Union’s bulk-purchasing program.
Also read: Leaders of "Quad" agree to aid vaccine delivery to developing nation
At least 10 African countries are yet to receive vaccines, according to the World Health Organization's regional office for Africa. Those countries include Tanzania, Burundi, Eritrea, Cameroon, and Chad.
The continent has "has received limited doses and much later than the rest of the world,” Dr. Richard Mihigo, a program coordinator in charge of immunization and vaccine development with WHO's Africa office, said in a briefing Thursday.
“We are concerned that while COVAX vaccinations have enabled many African countries to roll out vaccinations, the slow pace of vaccine supply we are now seeing risks widening the gap between the world's vaccinated and the unvaccinated populations,” he said, charging that it's unfair that some wealthy nations “are looking to vaccinate their entire populations” while Africa continues to lag behind.
There are ongoing discussions between WHO, the global vaccine alliance GAVI and Indian authorities aimed at ensuring COVAX shipments continue to be prioritized, the official said.
Africa hopes to vaccinate 60% of its 1.3 billion people by mid-2022 in order to achieve herd immunity, when enough people are protected through infection or vaccination to make it difficult for a virus to continue to spread. That amounts to about 1.5 billion vaccine doses.
That target almost certainly will not be met without widespread use of the AstraZeneca vaccine, which many experts see as key to the global strategy to stamp out the coronavirus pandemic. The vaccine from the Anglo-Swedish drugmaker is cheaper and easier to store than many others. It will make up nearly all of the doses shipped in the first half of the year via COVAX.
Experts have warned that until vaccination rates are high the world over, the virus remains a threat everywhere.
“We are all in this together. This is a global pandemic, and we need to solve it through global vaccination, global public health methods," said Anthony Costello, a professor of global health and sustainable development at University College London.
Also read: AstraZeneca confirms strong vaccine protection after US rift
Costello told the WHO briefing that while Africa, with its much younger population, is seeing lower death rates than other regions, "we must put pressure on wealthy countries to ensure that they offer the finance and the assistance to Africa to get the required number of vaccines.”
Africa has confirmed more than 4 million cases of COVID-19, including 110,000 deaths, according to the Africa CDC.