Alison O'Connor: Our leaders must lead to restore trust in AstraZeneca vaccine

Members of the British science and medical community responded with scepticism to the AstraZeneca suspension decision. Picture: AP Photo/Christophe Ena

This week last year, people were wondering whether the Cheltenham Racing Festival would ever recover from the PR hammering it was receiving.

A year is a long time in a pandemic. This year Cheltenham went ahead without the punters and our concerns, rather more crucially, centre around the reputation of a life-saving Covid vaccine. The stakes are far higher here.

Personally, I would take an AstraZeneca (AZ) shot in the morning if it was offered to me. However, I totally understand why acting chief medical officer Ronan Glynn, national immunisation advisory committee head Professor Karina Butler and others decided late last Saturday night to recommend suspending its use here pending further investigation.

A meeting had been quickly convened following news that a cluster of four people, in younger age groups, had suffered clots in Norway. The HSE had been just about to begin administering the vaccine to younger people in high-risk categories.

More than a dozen EU countries have decided to halt its use, including Germany, Italy, France and Sweden.

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This was not — nor could it ever be — a decision taken in isolation. 

There has been a growing toxicity to the image of the AZ jab — the troubled child of the Covid vaccine world. From the numerous reports of piles of it lying around unused in EU countries, to people refusing to take it and requesting one of the other vaccines, there is no end to the angles. 

The politics that surround it operate at a very base and visceral level. Who imagined that, when the Brexit vote took place almost five years ago, part of the fallout would surround a vaccine for a virus that had caused global devastation.

AstraZeneca was founded through the merger of a British and Swedish firm. Have you noticed that, when you see the Pfizer/BioNTech, Moderna or Johnson & Johnson vaccines mentioned, there are no add ons. However, AZ frequently has “the British vaccine” attached to it. It works both ways. 

Here’s just one headline of many in the British media this week, from the Daily Express: “EU is exaggerating AstraZeneca concerns because they’re losing to the UK”. 

Members of the British science and medical community responded with scepticism to the suspension decision, querying the motivations behind it. A member of the joint committee on vaccination and immunisation, Professor Jeremy Brown, said it was “not logical” and “not sensible”.

A consultant in respiratory medicine, Prof Brown said he was worried the decision could drive up the number of people who are hesitant about booking their vaccine.

The vaccine has been given to around 11m people in the UK “and there’s been no serious side-effects” reported in this country, he added.

“It is confusing to understand why so many countries have decided to stop using the vaccine.

“Many of those countries are going through a third wave, and by stopping using the vaccine they’re actually literally causing more problems.” 

However, Professor Klaus Cichutek, head of the German government body that recommended suspending the vaccine, said its decision was based on science. He told the media there had been six cases of sinus vein thrombosis in women between the ages of around 20 and 50 years. Of those, two were fatal. There was another case of cerebral haemorrhage with thrombosis in a man.

The analysis found that the number of these cases was above average in the population without vaccination, he said.

“I think the citizens want to be able to trust that the vaccines we offer are safe and efficient,” Prof Cichutek said.

Elsewhere is the equally fraught issue of AZ delivery to the EU. Commission president Ursula von der Leyen said on Wednesday that the company had “under produced and under delivered”. It promised to deliver 90m doses in the first quarter of 2021, which ended up being reduced to 30m. The 180m doses promised in the second quarter, would now only be 70m.

Tied up in the politics and the angst has been the super success of the British vaccination rollout, where nearly 25m people across the UK had received their first dose of a vaccine by Tuesday. In the UK, 38 doses for every 100 people have been administered, with 32 in the US and just a miserly 11 doses in the European Union.

However, even that has hit difficulties, with news of a vaccine shortage hitting this week — believed to be due to a delay in an AZ delivery from India. Boris Johnson, the British prime minister, had said the aim was to vaccinate all UK adults by the end of July, but clearly this must now be in some doubt — especially with the threat of a block on the export of EU doses.

Even prior to its approval, there were initial issues about how effective this jab was and concerns about its use. On January 29, the day the European Medicines Agency (EMA) approved its use without age limitations, Emmanuel Macron, the French president, claimed that, for people over 65, it was “quasi ineffective”. 

This was a loaded and inaccurate statement. There was an issue, but it related to a lack of trial data on this age group. In early February, the World Health Organization recommended the use of AZ in all adults, “without an upper age limit”. 

However, from the time it was first approved, Ireland and other countries decided not to give it to those over the age of 65, against EMA advice.

On Tuesday Emer Cooke, the Irish woman who is the executive director of the EMA, said the investigation into the latest issue of blood clotting was ongoing, but “we are still firmly convinced that the benefits of the AstraZeneca vaccine in preventing Covid-19… outweigh the risks of these side effects”. 

It was relatively easy to see which way the wind was blowing for the EMA.

Last weekend, just after the decision was taken, Dr Glynn admitted that maybe they were being uber careful and that there was no evidence of “cause and effect” at the point the decision was taken. 

"It may be nothing, we may be overreacting, and I sincerely hope that, in a week's time, we are accused of being overcautious," he said.

However, putting yourself in their shoes at 11pm last Saturday night, it’s easy to understand their thought process.

Ms Cooke stressed that trust in the safety and efficacy of vaccines that the EMA had authorised is of paramount importance. 

“We are worried there may be an effect on the trust of the vaccines,” she said. 

There can be no doubt but the sum of all of the issues that have surrounded the AZ vaccine has caused considerable damage. However, it is a very valuable tool to fight Covid and one that we desperately need. Real effort needs to be made to attempt to repair its reputation and the trust of people.

Jean Castex, the French prime minister, said he intended to get an AZ vaccine once the EMA confirmed it was safe. This would be a good idea on the double for Taoiseach Micheál Martin and other senior politicians. They could get vaccinated with the AZ jab — it is ridiculous they have not got their jab already — while at the same time showing the public their trust in this vaccine.