from Hacker News

Germany pauses AstraZeneca vaccinations as a 'precaution'

by mpsq on 3/15/21, 3:20 PM with 543 comments

by fab1an on 3/15/21, 4:25 PM
Looks like this may be a bit more relevant than many of the snarky comments would suggest - the relevant German authority on this said that they have seen a unexpected increase in a specific type of blood clotting issue that usually is very rare: https://www.pei.de/DE/newsroom/hp-meldungen/2021/210315-voru...
by giantandroids on 3/15/21, 3:44 PM
You do have to wonder if some of this is politically driven. Germany are losing hundreds of life's a day, while in the meantime the UK has administrated 23 million doses (not sure the ratio of those that were AstraZeneca) and not recorded a single fatality or adverse reaction and are seeing infection rates / deaths drop. I can understand caution under normal circumstances, but nothing is normal right now.
by yread on 3/15/21, 4:17 PM
I've mentioned it in a comment in the previous thread but it's not completely unexpected and with no causal link. Adenovirus induced blood coagulation problems are known:
Adenovirus-induced thrombocytopenia: the role of von Willebrand factor and P-selectin in mediating accelerated platelet clearance
https://www.sciencedirect.com/science/article/pii/S000649712...
You can see the number of reported cases across Europe in the EUDRA Vigilance database (if you manage to get through the Oracle BI interface and if it doesn't error out)
https://www.ema.europa.eu/en/human-regulatory/research-devel...
I don't understand why AstraZeneca doesn't just say: yeah blood clots are a risk, incidence 1/100,000 and everyone can move on. Why does everything needs to be so politicized with this vaccine.
by fasteddie31003 on 3/15/21, 3:45 PM
The pandemic has made me believe we need to be greater consiquentalists in our polices. It's pretty obvious that on the whole the AstraZeneca vax will save more people than are killed from the side effects. We don't not live in a 0 risk existence.
by jedberg on 3/15/21, 9:41 PM
Three weeks ago I was debating someone here on HN, defending the FDAs choice to deny approval of the AZ vaccine. I pointed out that while the FDA can be conservative compared to the EU, they have a strong track record of being right.
Thalidomide is the most well known example, but there are many others:
https://en.wikipedia.org/wiki/Lumiracoxib -- Approved in Europe, not the USA. Withdrawn from sales due to side effects.
https://en.wikipedia.org/wiki/Zimelidine -- Same.
https://en.wikipedia.org/wiki/Tolrestat -- Approved in Europe, failed stage 3 clinical in the USA
https://en.wikipedia.org/wiki/Rimonabant -- Approved in Europe, failed in the USA, withdrawn worldwide because the side effects were so bad.
by temp-dude-87844 on 3/15/21, 3:59 PM
Given that some amount of alternate vaccines are available, governments are doing the right thing by "deferring" deployment of this vaccine for a short while, because this move has the highest chance avoiding direct harm to people from medicine (which is often perceived worse than harm that would have befallen people without medicine) and highest chance of avoiding an increase of brand-agnostic vaccine mistrust from the public.
As news about some countries pausing its deployment spread, the pressure rises on other countries to follow suit, as they weigh the risk of public mistrust.
If in the near future, public mistrust about this brand of vaccine climbs higher but confidence in other vaccines does not drop as much, then governments will benefit from having deferred deployment of this vaccine, and they may benefit further by suspending deployment of this vaccine entirely, even if the vaccine is entirely vindicated to be safe.
This outcome would be unfair for the manufacturer, but it would sacrifice this brand to preserve public trust. Public trust is a key factor in healthcare policy in societies where some healthcare participation is voluntary and elections can significantly influence policy priorities.
by GhostVII on 3/15/21, 11:30 PM
Sounds like a real world case of the trolly problem. Either take no action (by giving out no vaccine) and let hundreds die each day, or give out the vaccine and kill a few people each day (assuming the vaccine is causing the deaths, which likely isn't the case anyways).
by jonplackett on 3/15/21, 3:41 PM
Maybe AZ should have charged €3 per shot instead of €2 and spent the extra € on a PR agency. They just seem to be constantly taking a hammering in the press, unfairly I’d say.
by whyenot on 3/15/21, 10:58 PM
Vaccine skepticism is already very high in many European countries, including Germany. Vaccination doesn't work if 1/3 to 1/2 the population doesn't want to get the vaccine because they are afraid of the side effects. There may be some value in governments showing citizens how cautious they are being, even if it is not necessarily warranted based on the number of adverse reactions.
by 5cents on 3/15/21, 3:54 PM
In Norway, two health care workers are receiving intensive care for isolated low platelets and blood clotting. A third was also admitted but died from a cerebral catastrophe. These are all young (<50 years) and previously healthy. Of course this is serious and needs proper investigation.
Maybe the risk for some specific groups justify giving them another vaccine?
by ssully on 3/15/21, 3:51 PM
Just announced that France is also suspending use of the vaccine [1]
[1]: https://apnews.com/article/germany-suspends-astrazeneca-vacc...
by motohagiography on 3/15/21, 4:44 PM
There is an availability bias, where stories about people dying after vaccinations are amplified in fringe media, and conversely, the numbers of people who died in nursing homes of actual covid were suppressed by mainstream authorities. There's uncertainty on every part of the issue. Interpreting the general uncertainty we live with as evidence for a hidden agenda on the part of authorities is it's own self fulfilling bias, but when I read about these vaccine risks, I'm looking for a plausible model of the options.
I would (and did) jump out of planes with a parachute recreationally, but if untrustworthy people started advocating it, proposing it should be mandatory, and unstable people dressed up in double flight suits in the streets started shaming others into doing it, I would definitely not jump out of planes anymore.
If it were true that the probability of complications/death from covid are heavily skewed to people over 75 and some obvious co-morbidities, we could vaccinate everyone in that risk group in a matter of weeks. What is the case for anyone who isn't a medical worker outside the real at-risk cohort to take on the endogenous risk of a vaccine? I could make one, but I'm more interested in what more knowledgeable people have to say about it, and judging by rising popular skepticism, we're going to need one.
When covid started last year, as someone young'ish and healthy I signed up to volunteer for human challenge trials and started to organize a convalescent plasma drive, because that's what I thought being civic minded meant. I have living family members who were affected by polio before widespread vaccinations were available, and recognize the importance of vaccines on herd immunity. After a year of hall of mirrors bullshit about masks and politics, I'm struggling with the case for why a low-risk healthy person would take a vaccine with non-trivial side effect risks for a virus that is less dangerous than their normal activities, when the vulnerable people who get vaccinated (for whom the risk/reward is clearer) are no longer vulnerable.
Is there a conversation to be had on the model for this, or does it come down to "conspiracy theorists who put us at risk," vs. "normal people" and there's no point in engaging it? Is the best argument just a matter of, "we live in a society and part of that is accepting the jab?"
by unanswered on 3/16/21, 1:54 AM
This was always going to happen. Make it political/religious that the vaccine is 1000% safe and anyone who says otherwise is antiscience and probably a white nationalist. Then discover there may be some issues with the vaccine after all. Now the train has no fucking brakes, so you've got to derail it instead.
Meanwhile we "anti-science" folks who have been blowing the whistle all along that the vaccines were not and could not even theoretically have been adequately tested (9 women can't make a baby in one month!) will just get shat on some more for some reason.
by ptaipale on 3/16/21, 10:52 AM
At the moment, the decision-making looks like a trolley-problem. You've set the trolley to move on the "let's vaccinate" track. You have a risk that there might be a person who suffers down those tracks. If you pull the lever to stop vaccinating, on its path on the other track, the covid trolley will smash into 20 people.
Because you will be held accountable for vaccination but not for progression of covid, you pull the lever to change tracks.
As one person draws it in Twitter: https://twitter.com/MiettinenTopi/status/1371702220174016520
by calhoun137 on 3/15/21, 3:54 PM
Since these vaccines got emergency use authorization, that means they did not follow the standard procedure for clinical trials.
Therefore, precautionary measures which respond dynamically to trends detected in newly available data, is the logical, ethical, and scientifically correct thing to do, imo.
by sampo on 3/15/21, 4:53 PM
I have seen 2 similar cases of immune thrombocytopenia in the news in US, one related to the Moderna vaccine, and one related to the Pfizer-BioNTech vaccine:
https://www.nytimes.com/2021/02/08/health/immune-thrombocyto... (alternative link: https://archive.is/RisZF)
https://www.seattletimes.com/nation-world/doctors-death-afte...
by agd on 3/15/21, 5:20 PM
Let’s see if any new data comes out, but from what’s public right now I can only see this pause costing many lives across Europe.
We’ve had millions of doses in the UK without serious side effects, so unless there were faulty batches I think any risk must be minuscule, and certainly lower than the known risks of covid deaths for unvaccinated people.
This is a case where a cautious ‘first do no harm’ approach will likely cost many lives.
by pixiemaster on 3/15/21, 3:36 PM
with ~300 deaths per day in germany, how many people will this kill?
by rossdavidh on 3/15/21, 4:52 PM
So, does anyone know why Astra/Zeneca is not approved in the U.S.? Did they not try, or it's still ongoing, or did they have problems?
by 5cents on 3/18/21, 12:07 PM
Physicians in Norway have now found specific antibodies destroying platelets and concluded that it is very unlikely that the vaccine is not the cause
Google Translate: https://translate.google.com/translate?sl=no&tl=en&u=https:/...
by theptip on 3/16/21, 7:40 PM
Worth noting that the EMA says (in bold):
> the benefits of the AstraZeneca vaccine in preventing COVID-19, with its associated risk of hospitalisation and death, outweigh the risks of side effects.
https://www.ema.europa.eu/en/news/emas-safety-committee-cont...
by maxerickson on 3/15/21, 3:46 PM
It seems the rate of these conditions isn't any different for the vaccinated than for the population (last bit of the article makes this point).
What's the thought process here?
by petre on 3/15/21, 4:22 PM
They should at least donate the vaccines to Ukraine and Moldova and other poorer countries through the Covax mechanism instead of letting them go to waste.
I'm due to get vaccinated with AZ in less that two weeks and I will deninitely do it regardless, if doesn't get halted of course. Most EU countries decided to use it on recipients older than 55 and now they're halting it due to a baseless claim. It has worked fine and the UK has already vaccinated millions of people with it.
https://yougov.co.uk/topics/international/articles-reports/2...
by TheOtherHobbes on 3/15/21, 9:42 PM
Most interesting would be data from the UK. My understanding is they've had by far the biggest AZ rollout, so any anomalies should be more obvious - assuming it's a design problem, and not caused by a manufacturing defect from one specific supply.
by the-dude on 3/15/21, 4:03 PM
The EU commission has framed AZ as not trustworthy from the moment the first delivery targets could not be met.
This has influenced public opinion in NL quite a bit ( in DE too I suspect ). I can read in the local comment sections that people want to decline the AZ vaccine as they don't trust it, and it is only 60% effective. They would rather have Pfizer, even Sputnik or rather no vacination at all than AZ. These commenters seem quite hostile to AZ and the UK for that matter.
And these comments are from before the clotting allegations.
This is and has been quite a contra-productive negotiation strategy from the EU commission, directly endangering public health in my humbe opinion.
by dash2 on 3/15/21, 3:37 PM
This seems like a case where the precautionary principle is misleading. Maybe there's a small chance that the vaccine can be harmful for a few people. Meanwhile there's a large chance that not having the vaccine can increase your chance of getting COVID. Doesn't even a week's delay in vaccinating predictably increase the number of deaths in a country, perhaps by a large amount given the nonlinear dynamics of epidemics?
I'm assuming that these decisions aren't political and are genuinely being taken for medical reasons. I mean, I sure hope so.
by mywacaday on 3/15/21, 5:08 PM
Poor reporting to not include that Italy, France, Ireland, Bulgaria, Denmark and The Netherlands have all paused the vaccine along with Norway which is mentioned. Expect better of Reuters.
by jansan on 3/15/21, 3:53 PM
How many countries have stopped AZ fo far?
- Denmark
- Norway
- Ireland
- Netherlands
- Iceland
- Bulgaria
- Romania (only partly, see child comment)
Am I missing any?
by matthewmorgan on 3/15/21, 4:28 PM
From the BBC's health correspondent: "The data supplied by AstraZeneca shows there have been 37 reports of blood clots among the 17m people across Europe who have been given the vaccine" ... "The 37 reports are below the level you would expect. What is more, there is no strong biological explanation why the vaccine would cause a blood clot."
by de6u99er on 3/15/21, 10:44 PM
My better half was olanned to get vaccinated with it tomorrow. Because of people dying from blood clots after getting vaccinated, we decided it might be a good idea to take Aspirine as blood thinner. But today I read that oeople had issues with bleeding and cloting.
by mchusma on 3/16/21, 1:20 AM
The language here confuses the truth.
They banned people from taking a vaccine that is very safe and effective.
Give people a choice.
by systemvoltage on 3/15/21, 5:12 PM
The PR damage alone from this move is undeniably going to cause an unimaginable amount of loss. People who were on the fence of taking the vaccine have just solidified on their decision.
by chmod775 on 3/15/21, 5:50 PM
Absolute fucking stupidity.
Thirty cases of blood clotting out of five million. More people will die because they're not vaccinated.
And that's ignoring the fact that this may just be a statistical blip. There's a lot of diseases humans could catch, and sometimes there's going to be clusters.
German politicians said they're suspending vaccinations "out of an abundance of caution".
Given these numbers, we should continue to vaccinate out of an abundance of caution.
These people would refuse to board a rescue vessel because "it seems kind of unstable" and prefer to keep treading water.
by johnnycerberus on 3/15/21, 3:52 PM
Judging by what the German press is writing nowadays about their politicans, especially the populists (and the unionists also) that are increasingly frustrated on the incapability of Germany (and the EU altogether) to handle the COVID situation and deliver a homemade vaccine, without the help of the USA and UK, it doesn't surprise me. It could be politically.
by jokethrowaway on 3/15/21, 4:53 PM
The deaths don't seem very high, I wonder if this is meant to be exactly the opposite of what they say: purely a political move to justify their slow vaccine rollout compared to the quick UK one (which used AZ).
by globular-toast on 3/15/21, 5:01 PM
These vaccinations are the largest unethical experiment since the fear of fat.
by rurban on 3/15/21, 4:49 PM
So far they only vaccinated older people with it. These complications all happened in younger people where we don't have a coverage if millions. More like a few thousands.
Thanksfully Germany acted now rationally, like the other countries. One idea would be to administer only half the dosis on younger people, as this was already tested, with much better results than with the full dosis. AZ is pretty strong, compared to the others.
by verytrivial on 3/15/21, 4:30 PM
As far as I understand it, the EU member states are not generally short on doses, more on distribution and other regulatory issues. If they pause AZ, they can use something else which is already being manufactured right now, and likely within the EU, quelle surprise.
I would not be surprised if this is simply a political and economic snub from the EU, one of very many the UK can expect over the coming decades.
The UK has spent the last half decade ENDLESSLY trying to score points against the EU on any and every topic. This sort of wrangling is part and parcel for the relationship the UK has chosen. Basically, if the current UK Government has gone anywhere NEAR this topic, don't expect the truth to linger. This certainly includes the chest-beating around the AZ vaccine, which the government were actually going to require be shipped with a fscking Union Flag on every vial.
Edit: My understanding was based around stories like this suggesting some delays, that AZ were "striving" to deliver, and more dosed being ordered after AZ testing not covering over 65s (at the time), some hesitancy, and general mud slinging. When I say "generally short" I guess I should say that I doubt even the chest-beating Brits will be fully two-dose vaccinated to 80-90% before Autumn. It's been a year and a month or two is second order optimization in my view.
If you are concerned about shortages, there are some other continents to consider first.
https://www.theguardian.com/world/2021/feb/24/astrazeneca-ex...
https://www.biopharma-reporter.com/Article/2021/02/18/EU-add...
by tablespoon on 3/15/21, 4:36 PM
It's also worth noting that it seems like Germans perceive the AstraZenica vaccine as second-rate, and were even skipping appointments in the hope of getting the Pfizer/BioNTech shot later.
https://www.nytimes.com/2021/02/25/world/europe/germany-coro...:
> Many people — including health workers — are skipping appointments or refusing to sign up for the AstraZeneca shot, which they fear is less effective than the Pfizer-BioNTech vaccine, the officials say. As a result, two weeks after the first delivery of 1.45 million doses of the AstraZeneca vaccine arrived in Germany, only 270,986 have been administered, according to data collected by the public health authority, the Robert Koch Institute.