Michael Clifford: Suspending vaccine down to fear of blame
Prof Karina Butler, chair of the National Immunisation Advisory Committee, with Health Minister Stephen Donnelly at a briefing earlier this year. File picture: Leah Farrell/RollingNews.ie
Character emerges when under pressure.
The good, the bad, and the ugly of what we are makes itself known when the chips are down. So it was last Sunday when a decision was taken to suspend the use of the AstraZeneca vaccine.
The decision was based on fear rather than science.
There had been four incidents of blood clots among people who had received the vaccine in Norway.
This information was enough for the National Immunisation Advisory Committee (NIAC) to announce that the vaccine would be suspended until further notice.
On Sunday, Professor Karina Butler, chair of the NIAC, laid out the reason for the decision. “The vaccine is proven to be very effective against severe Covid-19 disease, which is associated with a risk of clotting events… we have taken this step out of an abundance of caution.”
Why be so cautious? The World Health Organisation (WHO) wasn’t buying it. The WHO advised countries to keep using AstraZeneca until further investigation was completed.
The WHO is reported to be examining 37 cases in total, involving blood clotting in people who have received the vaccine.
That’s 37 out of around 17m doses administered, which is a rate of 0.007 per 1,000. During the week, one commentator noted that the contraceptive pill has been shown to cause clotting at a rate of 0.006 per 1,000.
The other issue arising for the suspension is the boost it provided for the anti-vaccine brigade.
Once the news got online, it would have quickly morphed into conclusive proof that if you took the vaccine you were in grave danger of a blood clot and near-certain death.
Then there is also the simple drain on confidence that is bound to occur among some people as a result of the scare.
By Thursday, the European Medicines Agency confirmed what it had stated earlier in the week.
“We are still firmly convinced that the benefits of the AstraZeneca vaccine in preventing Covid-19, with its associated risk of hospitalisation and death, outweigh the risk of side effects,” said the agency’s chief executive, Emer Cooke.
So why the “abundance of caution” from this country’s advisory body? Perhaps one factor feeding into the decision was an instinctive avoidance of anything that might involve the prospect of “blame” further down the line.
We have, in this country, evolved over the years into a society where the prospect of blame in general, and litigation in particular, are primary considerations in evaluating any initiative. Whatever you do, do nothing that might come back to haunt you.
This instinct has particular resonance in the medical world. One school of thought is that the blame culture is feeding into difficulty in retaining hospital consultants within the system.
Cliona Murphy, chair of the Institute of Obstetricians and Gynaecologists, raised this issue in 2019 in the context of a waiting list of 28,000 women.
She pointed out that the increased likelihood of having to fight a legal case deterred some from the speciality.
“We have a bit more of a blame culture in this industry, I think, than other countries,” she said. “Other countries have more no-fault compensation where families can be helped along with resources.”
In the wider health system, it is generally believed that one of the major organisational issues within the HSE is the “cover ass” culture.
This works to ensure that the main focus is on avoiding blame for any actions, even when the cost is ultimately borne by those using the service, who are often at a vulnerable station in life at the time of use.
The culture in question is not confined to medicine or litigation.
Mike Allen, director of advocacy at Focus Ireland, broached the subject recently on the podcast when discussing the failures in providing public housing.
“There is a really strong sense in all the public sector that people are overwhelmingly concerned with not being criticised for wasting money or making a bad decision,” he said.
“So people feel much more safe or comfortable in having to defend not having done something than to have done something and it not worked out perfectly.
“Rarely do you see a public figure roasted in front of a public committee for not having done something.”
The prevailing attitude, he pointed out, “is not counterbalanced with an encouraging sense of 'we want to help you get this done'.”
Of course one person’s ‘blame culture’ is another’s accountability. And it is true that accountability was missing in action for a long time in this country.
A hierarchical and deferential society ensured that those who acquired any measure of power or status rarely had to defend their actions.
Those days are long gone. There is an argument to be made that the balance has tipped way too much, in some respects, towards the pursuit of blame rather than observance of accountability. In such an environment, an abundance of caution is the only way to go.
Tackling this culture of caution is difficult. Take the public servant who appears before an Oireachtas committee defending an action taken.
The politicians would be required to judge where accountability ends and blame begins. This would be no easy task at the best of times and these are not the best of times in terms of responsible politics.
in an environment where a belief persists that there is political capital to be gained by grandstanding, who is going to consider society’s wider interests rather than their own instinct to reach out for a few stray votes?
This is the background in which an abundance of caution is instinctively applied in much of public life in this country, and may well have informed the decision to suspend the vaccine last week.
There is no suggestion that members of NIAC consciously acted on the basis of insulating themselves from any fallout.
They undoubtedly were acting in good faith to prioritise public health as they saw it. But decisions like that are not made in isolation from the prevailing culture.
That is the fallout from one aspect of the national character when it comes to public decision-making. And as always, those most ultimately impacted are likely to be the people who are at the furthest reaches from the centres of power.
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