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AZ/Oxford Calculations

Update: the FDA has now paused use of the J&J vaccine due to 6 incidents of what appears to be VITT. 

We have a lot of vaccine news to catch up on! First up is the latest on the possible clotting side effects seen with Oxford/AstraZeneca. This is looking more and more likely to be a rare-but-real effect, and I’m not happy that it’s holding up. I had hoped at first that this was a false signal, but as more data have come in, that possibility is fading. The EMA and others have been coming around to this view, and the question now is what to do about vaccine-induced immune thrombotic thrombocytopenia (VITT). Kai Kupferschmidt and Gretchen Vogel have an excellent overview on this here. As with all public health measures and all drug treatments, there’s a risk/benefit calculation at the heart of this matter. I gather from my email and messages that not everyone is reconciled to those, and while I sympathize – it would be a lot easier if we didn’t have to – I can only reiterate that it’s the only way to go. “You can’t put a price on a human life” is the saying, but while you may well not be able to put a price on yours or on the lives of your loved ones, that statement’s force dissolves when you have to consider millions of people.

Still not convinced? Try an unpleasant thought experiment, then, a sort of vaccination trolley problem: how many people should die of Covid-19 in order to keep one person from dying from a vaccine-induced thrombosis? There are all sorts of calculations imbedded in the answer – coronavirus incidence rates and fatality rates overall and in different cohorts, those same incidence and fatality rates for VITT across those different groups, the estimated effectiveness of the AZ/Oxford vaccine under current conditions in those populations, its availability (and availability versus other vaccine alternatives) and how many people you’re hoping to vaccinate in general with these supplies, the current state of coronavirus spread in the population that you’re looking at, and more. Complicating some of these (or making the comparisons starker, anyway) is the observation that thrombotic events also seem to be more common among people who are infected with coronavirus! You can obviously turn the dials on these numbers to get any answer you want by making enough assumptions. But a pretty solid one number to start with is that fatalities and serious complications from the coronavirus are more likely in older patients, and that tilts the scale towards them getting any vaccine rather than none. With that in mind, German authorities are saying that that AZ/Oxford vaccine should only be used in patients over 60. France puts the cutoff at 55, and the UK at 30 – other countries are all making their own calls, but the EMA itself is not making any recommendations like this (or not yet).

Why wasn’t this picked up in the clinical trials? Numbers, again. The thrombosis risk is still tough to estimate well, but might be roughly around 1 in 100,000. That means that in a clinical trial that doses some 20,000 people, you are simply not going to pick up this signal. No one has ever run a controlled trial (for a vaccine or for anything else) large enough to get good statistics on an incidence rate like that. You’re simply not going to see it, until you get out into a much larger population, which means after approval. That may not be fun to think about, but it’s been the case with every drug that has ever been approved. AstraZeneca and Oxford have made mistakes in the testing and rollout of this vaccine, but this problem isn’t on that list.

And to get all cold and clinical about it again, a one-per-hundred-thousand death rate can mean different things. It would be completely unacceptable for a drug that reduced common cold duration by two days, or one that cut down on the amount of hair growing out of your ears. But if you had a drug that was really effective against glioblastoma, pancreatic cancer, full-blast Huntington’s chorea or other such diseases, patients and families would be beating a path to your door, whooping and waving and shouting for joy and hardly giving that death rate a second glance. After all, nearly everyone with those conditions is going to die sooner rather than later and in relentlessly increasing pain and disability, so why not?

The calculation is nowhere near as stark for the coronavirus, of course, and the calculation is correspondingly harder to make, as detailed above. As we get more data, things will surely adjust. For example, it seems for now that women may be at greater risk than men – if this is true, then you could adjust in that direction. It may be that people with existing antibodies towards the PF4 protein are at greater risk, too, and that would be worth knowing about as well. More important questions that we don’t have answers to yet include whether this is a general adenovirus-vector effect or not. You could imagine that going either way. The Oxford/AZ vaccine uses a chimpanzee-derived adenovirus, whereas J&J uses a less-common human one (and the Gamaleya “Sputnik-V” vaccine from Russia uses that one and the more common adenovirus-5 in its two doses). There could be some protein-binding event that’s unique to the ChAdOx platform, or it could be more or less common across the other adenoviruses. There have been a few scattered reports of what may be VITT symptoms among people who have been vaccinated with the J&J shot, but the situation is far from clear.

And let’s not lose sight of all the ways in which this side effect is bad news. It has directly affected scores of people out of the millions vaccinated, of course. It has also thrown a number of national vaccination campaigns into turmoil, and that’s bad, too. One of the ways that’s happened is through making many people wonder about the safety of vaccination in general, and we certainly didn’t need a real reason for hesitancy thrown onto all the not-so-real ones. The AZ/Oxford vaccine was set to be widely used around the world, with huge numbers of doses being produced, so having this happen with it in particular complicates the timetable of vaccinating the whole planet. No, we didn’t need this at all.

119 comments on “AZ/Oxford Calculations”

  1. Brussels bureaucrat says:

    Great summary!

  2. John Wayne says:

    Humans are good at some thing, and bad at others. Two things we are bad at are (1) objectively weighing relative risks, and (2) making ethical decisions that effect large populations. The problem outlined by Derek above rolls both together into a hairy ball. When applied to large populations any decision comes with probable harm. To make things worse, those same decisions cannot take the future unknowns into account (both good and bad ones.) Politicians and regulators are put into an uncomfortable position knowing that they will also be held accountable for the medium and long term safety and efficacy of whatever they recommend (relative to other options.) This is why no reasonable person will make a specific vaccine recommendation.

    In the USA we tend to deal with these ambiguities with personal choice. Nobody will force you to be vaccinated, or take a specific vaccine option. At least this is what is happening so far, and I hope it stays that way.

    1. Anon says:

      The problem with relative risk is that we are asking young healthy people to take a small, but apparently real, risk on behalf of old people, who have already lived a long life, and unhealthy people, many of whom make terrible health choices. And please spare me the poppycock about Covid being an equal opportunity disease. You all tried that nonsense with HIV, and the last year of college and professional sports have showed how young healthy people have little issue with Covid.

      1. Richard Ward says:

        Much easier to ficus in risk/benefit to the individual rather than on society. In doing so rge AZ vaccines has a positive risk/benefit profile in people of all ages in the vast majority of Western countries right now. Only in those countries who have now got the disease under control, and only in the youngest age groups does the risk/benefit ratio of the AZ vaccine now make less sense. These slides illustrate the risk/benefit very well:

        The interesting thing is that as recently as February in the UK vaccination with the AZ vaccines was beneficial for ALL age groups. Risk has changed as the vaccines have helped to bring the pandemic under control in the UK. (risk from Covid has declined whereas risk from vaccine is unchanged).

        1. Not-an-epidemiologist says:

          Much easier to ficus in risk/benefit to the individual rather than on society

          Agreed, most people will only give a fig about themselves.

          1. William John Foley says:

            Clever pun!

      2. Andy says:

        Not necessarily. It wouldn’t be at all crazy for a 30 year old to rank their risk of long Covid much, much higher than 1/100000. Substantially reducing that risk at a cost of 1/100000 chance of death may be entirely reasonable, even ignoring the degree to which a vaccine protects those around the recipient.

      3. John Wayne says:

        This is a reply to ‘Anon’-

        I completely agree that younger people have less risk of having poor health outcomes due to Covid infections. I’d like to suggest that there isn’t a conspiracy to get young people to get vaccinated; you should want to for the following reasons:
        1. If you compare the possibility of poor health outcomes of getting Covid vs getting vaccinated, you are better off getting vaccinated (the AZ vaccine may be the exception to this – an important discussion.)
        2. You don’t get to pick if you are one of unlucky young people who suffer or die due to Covid.
        3. You don’t get to pass Covid only to old people who are both overweight due to their own choices and unknown to you.
        4. You don’t get to pass Covid only to old people who are done living (they are very rare.)
        5. You don’t get to ask the virus to not mutate inside of you into a more dangerous version of itself.

        If Covid killed kids the way measles did before a vaccine was produced, people would be screaming for it and forcing old people to get vaccinated. This entire discussion is a luxury.

        If you are a young person that isn’t sure there is a good chance you are an American. Go get the Pfizer or Moderna vaccine and be grateful that you have the opportunity to do so. Leave it to the USA to have the best possible medical options and still complain about them.

  3. bewd says:

    from the Science article ” Greinacher and his collaborator Rolf Marschalek, a molecular biologist at Frankfurt University, are also calling for tests of a simple solution: halving Vaxzevria’s dose.”

    how would you test / prove halving the dose resulted in efficacy and no blood clots without re -running a trial on hundreds of thousands of people???

    1. RvH says:

      Not as robust as a randomized controlled trial, phase 4 studies can address this. The question that remains is if you want to assess this if alternative options (other vaccines) are available.

    2. Scott says:

      We are now running trials on hundreds of millions of patients. Make no mistake all vaccines are experimental and an EUA is not an approval.

    3. Not-an-epidemiologist says:

      Uh, well, thanks to Oxford /AZ’s apparent inability to run a decent clinical trial, we already have the data on this (seriously, how has anyone forgotten the LD/SD thing??) We know that a first half-dose shot works at least as well as the standard dose, and we also know that it also great with a long interval between dosing (because those two things were linked). As an added bonus — you get more vaccinations from your vial. Win / win.

      (Safety considerations aside, I’ve been wondering for a while why countries with limited vaccine resources aren’t using a half-dose of AZ anyway for the first shot — seems a fairly sensible thing to do given that the efficacy data has actually been obtained? Am I missing something?)

      1. Chris Phillips says:

        “Uh, well, thanks to Oxford /AZ’s apparent inability to run a decent clinical trial, we already have the data on this (seriously, how has anyone forgotten the LD/SD thing??) We know that a first half-dose shot works at least as well as the standard dose, and we also know that it also great with a long interval between dosing (because those two things were linked).”

        I assume that’s a joke.

        Obviously that’s the conclusion they jumped to initially – before they realised there were other confounding factors, and highlighted the different interval between doses. But really who knows?

  4. steve says:

    What this shows, beyond any shadow of a doubt, is the absolute safety of vaccine programs. The monitoring system identified less than 200 people with this condition out of millions of people vaccinated. This puts the lie to all the rumors you hear about people dying from COVID vaccines, having horrible side effects, etc. and the idea that BIG PHARMA is hiding all these ill effects just to make money. The monitoring system works and is extremely sensitive to even rare side effects and being a BIG PHARMA confers no special exemption.

    1. Garfunkel says:

      Post marketing PV here is nothing but a joke and YES they are indeed hiding vaccine induced deaths. The media have reported many deaths in otherwise young healthy people – those that didn’t take AZ also, several in the US. All associations with vaccines denied. Covid deniers have a more valid argument than flat out ludicrous denial of vaccines causing these deaths.

      1. Steve says:

        Antivax hogwash

        1. steve says:

          You really would think people posting in a science blog would understand the difference between correlation and causation. If you inoculate tens of millions of people some will die soon after they receive the vaccine. That doesn’t mean that the vaccine caused the death. This is why we have statisticians and epidemiologists instead of random posters in a blog making the determination of what constitutes an SAE.

        2. Chris Phillips says:

          Yes. I’m afraid the anti-vaxxers have “discovered” this blog now, and there really needs to be some moderation of the comments.

          1. Brussels bureaucrat says:

            I agree, Chris.
            Perhaps the best way to stop this is to not take the bait or perhaps even ignore the obvious anti-vaccine misinformation, the EU conspiracies and all kinds nationalistic/political arguments that get thrown into the mix? After all, I don’t think this site is a major influencer of popular groups, so if we stop “feeding the fools” they may go away? Compared to the web in general this site is actually doing quite well. Let us try to keep it that way.

          2. Chris Phillips says:

            Brussels bureaucrat

            I think the best option would be for commenters to ignore it, but be given an opportunity of reporting it, so that it could be dealt with by moderators.

            To be clear, what I’m talking about is outright misrepresentation of the facts, or factual claims that can’t be backed up with references to source. Opinion and interpretation will always be things people differ about.

            Throughout the pandemic, I have found this blog to be a very useful source of information. I would hate to see comments by anti-vaxxers change that.

  5. Adrian says:

    You got the rationale for the age limit in countries like Germany wrong.
    The rationale is that this rare-but-real side effect seems to be confined to young people.

    In all 27 EU countries (including Germany) the AZ/Oxford vaccine does not amount to more than half the vaccine doses used, and due to the botched joint EU procurement the number of doses of all vaccines used so far in the EU countries is around 10% the doses necessary to vaccinate everyone. Age-based eligibility in Germany has only recently reached the age group 70-80.

    There is no defensible reason to kill young nurses and doctors with the AZ/Oxford vaccine when the easy option of changing who gets which vaccine is available.

    1. Chris Phillips says:

      “There is no defensible reason to kill young nurses and doctors with the AZ/Oxford vaccine when the easy option of changing who gets which vaccine is available.”

      An “easy option” that would mean millions of people at higher risk of dying of COVID-19 received a less efficacious vaccine than those at lower risk, and probably hundreds more of them died, in order to avoid perhaps a handful of people suffering fatal side effects.

      Perhaps some thought is advisable before grasping at “easy options” in difficult situations.

      1. Adrian says:

        Pensioners have better options to avoid getting infected in the first place than the nurse/doctor/teacher groups of young people who are priority exactly because their job carries a high risk of infection.

        You want to kill people with the AZ/Oxford vaccine instead of giving them a more efficacious vaccine – people in groups that are already at higher risk of infection due to their work for society.

        1. Chris Phillips says:


          “You want to kill people with the AZ/Oxford vaccine …”

          I keep thinking anti-vaxxers can’t stoop any lower. But I’m always proved wrong.

    2. Christian Weisgerber says:

      The rationale for Germany’s STIKO recommendation is a risk/benefit analysis that incorporates (1) that the VITT adverse reactions primarily (95%) affect under-60s and (2) that the risk of dying from COVID is fifty-fold higher for over-60s than for adults 18-59. Thus, as a rule, AZ should only be given to 60+, although its use with younger patients remains possible as an individual decision between patient and doctor after explanation of the risks.

      The full text of the STIKO recommendation in German is here, the AZ issue is set out in section, about three pages in total:

    3. Laura says:

      Unfortunately, I am on the horns of this dilemma. I got my first dose of AZ really early, not for being a young nurse, but for being a mid-fifties cancer patient. I consider my personal risk of severe COVID-19 far higher than that of VIIT.

      Now, by very strong recommendation in Germany, I’m supposed to get an mRNA vaccine for my second shot. But there does not seem to be any good data about effectiveness against infection or severe COVID of that mixed scheme.

      I am not happy. Not personally, though I can probably work around it via my GP, nor on principle, when a scheme of unknown effectiveness is proposed right in the third wave of a pandemic. “It might even work better!” Yes, that’s nice. It might not. Where’s the data?

      1. Christian Weisgerber says:

        The adverse events happened after the first AZ dose. The STIKO rationale is this: (1) The extent of the potential risk associated with second doses in under-60s is impossible to estimate. (2) There is no hint and no plausible immunological reasoning that giving a booster with a different vaccine could do harm. (3) There is no data whether such a vaccination will produce an equivalent immune response. Studies have been initiated, but results will not be available in time. (4) Overall, the STIKO considers a heterologous vaccination of under-60s as very probably effective and as safer than two doses of AZ.

        Again, the full original text in German is at the tail end of section here:

        1. Chris Phillips says:

          I took a first dose of the AZ vaccine on the basis that the benefit would far outweigh the tiny (1 in a million risk). I have objective evidence of the benefit of the second dose, which I hope to receive in 7 weeks’ time.

          If anyone wanted me not to have the second dose, or else to have a reduced dose, or else to have a dose of a different vaccine, then they would need to show me equally strong evidence of the benefit of that. Or else equally strong evidence that the second dose would be more dangerous than the increased risk from COVID-19 of remaining incompletely vaccinated.

          Otherwise, I’d be inclined to raise merry hell. In legal terms, one could say I took a (tiny) risk of personal injury on the condition that I benefitted from the full course of immunisation. If I were denied the full benefit of the course of immunisation on the grounds that the risk was much larger than I was led to believe, then I – and no doubt many millions of others – would expect to be very handsomely compensated …

        2. Laura says:

          I’m willing to accept a slightly higher risk for proven high efficacy.
          I am far less willing to accept unproven efficacy for a probably lower risk.
          Even without killing a person outright, COVID-19 is nasty, and if it delays cancer treatment or makes it impossible due to coronary damage, this can end up being just as fatal a the infection itself.

          Of course the RKI thinks that it will probably be efficant. I did not assume they didn’t. But Merck throught their vaccinatin would be efficant, too. Only numbers will tell.

          Currently it seems that my only alternative to the yet-unproven mixed scheme is not to get a second dose at all, which might be low-risk, but it really fails on efficacy.

          Fortunately there’s still time for data to appear. I am very impressed by what science has done in the past 17-or-so months and am hoping for a good solution .

          1. bewd says:

            there should be some early results from the uk next month on the first stage of mix and match vaccines.

        3. Christian Weisgerber says:

          Unsurprisingly, France’s Haute Autorité de Santé (HAS) has issued the equivalent recommendation: Under-55s who had a first dose of AZ should get a second dose with one of the mRNA vaccines.

          (in French):

  6. Matthew says:

    There’s a very simple answer to anyone who says “You can’t put a price on human life”. Ask them if they support red flag traffic laws. 38,000 people a year die in the USA from road deaths. Every single one of those would be prevented if cars had to proceed behind someone walking with a red flag at all times. It’d solve unemployment too.

    Cost? What does it matter, human life is more important than money.

    1. Anon says:

      This also goes the other way as well. The lockdowns have cost all of us a year of our lives, and the younger you get the worse the effects are. Newborn children have no idea what their pediatrician, daycare caretakers, and most strangers look like. Do we care what’s happening to them?

      1. No anti-lockdown nonsense says:

        I’m pretty sure most newborn children, when they are old enough, will thank us for having tried to keep both of their parents alive long enough for them to grow up.

        1. DH says:

          Seriously? Do you think the risk of dying of COVID for young healthy parents in their 20s or 30s exceeds even the risk of driving to the day care center every day for a year? One thing this pandemic has shown is that there is massive and widespread ignorance of the concepts of relative risk and risk tradeoffs.

          1. No anti-vaccine nonsense says:

            “Do you think the risk of dying of COVID for young healthy parents in their 20s or 30s exceeds even the risk of driving to the day care center every day for a year?”

            Yes, DH, I do think that. Why? Because I’ve read the literature and the statistics show this is the case even for under-35s. We are talking about the risk of vaccination, though, which is considerably safer than driving so the statistics are even more in favour of getting vaccinated.

      2. Kaleberg says:

        How did it cost them a year of their lives? Do we know the impact of lock downs on longevity?

        1. Anon says:

          I’m talking about the year young people were locked indoors, prevented from socializing and having the experiences that come with that age. For example, a 2020 senior in high school did not get to go to prom, walk at graduation, have that wild first semester in the dorms, and in many cases the spring semester. We all experienced some degree of this as well. Loved ones were not able to morn people who died together, Covid-cause or not. Old people spent a year in captivity and died anyway.

          And don’t go down the “prom/freshmen dorms/etc aren’t actually that cool” route. We get it, you were a loser in your younger years, and the “fond recollections of high school are lame” midset is just coping.

  7. Druid says:

    It is disappointing, and a pity for those who fall victim to VITT, that the AZ/Oxford vaccine carries this risk. Perhaps others vaccines will be shown to be less risky – I hope so – but I think that in April 2020 we were dreaming of getting any vaccine as effective and relatively safe as this. As it is, we still have the problems around manufacturing and supply which will have to be solved to get the infection under control in every country. In the meantime, we are learning fast how to be more objective about detecting and assessing rare events. In the past, these problems had to be dragged out into the open.

  8. Tom says:

    I’m male, in my early 30’s living in the UK and somehow have already had my first AZ/Oxford shot at the beginning of April (a local pharmacy had to use some up and I was given an appointment). My first shot occurred as a lot of this information on VITT was gaining traction. I consider myself educated in the risks (I work in the sciences and have been keeping tabs) and so I can still gladly say I will be happy to roll my sleeve up in a few weeks for my second shot… My risk factors are lower than many (and some you include in your excellent post) so I have less to worry about admittedly, but I do consider it important to accept the vaccine I’m offered as soon as its offered to help in the overall program towards regaining as close to our previous normalcy! Fortunately, most of my friends/family have all agreed these risks are worth it to do the same…

  9. A Nonny Mouse says:

    This helps to explain the UK decision.

    David Spiegelhalter has been a breath of fresh air over the past year giving us a sense of the problem.

  10. Marko says:

    “..And to get all cold and clinical about it again, a one-per-hundred-thousand death rate can mean different things. It would be completely unacceptable for a drug that reduced common cold duration by two days, or one that cut down on the amount of hair growing out of your ears.”

    I would take that ear hair drug.

  11. Daren Austin says:

    This is a triumph of pharmacovigilence and shows the systems working exactly as they should. One should not forget that.

    1. Druid says:

      Agreed … though perhaps not so well by those authorities that jumped in and halted the use of one vaccine before knowing the details, and broadcasting their decision. In retrospect the temporary restrictions seem too precautionary.

    2. Garfunkel says:

      Are you nuts? This is exactly how NOT to do PV… this problem was systematically denied and PV around these vaccines is terrible on several fronts – e.g. incidence of breakthrough infections and deaths occurring within 28 days of vaccination metrics are not recorded by most regulators. The onus should be on the manufacturers selling billions of these vaccines which aren’t even going to be effective in the medium term or in the real world (one where people mix and travel). What planet do you live on? There is a complete lack of coherent data on vaccine deaths and side effects – if it were available then other vaccines would be similarly tarnished. Show me where I can find this collated data, by country, which is absolutely critical to assessing safety in use of experimental medicines? I think your vaccine gave you a bleed in your frontal lobe

      1. Druid says:

        In the UK, after vaccinating 32 million people (mostly once) out of 68 million, the rate of death is now lower than the 5 year average, and if you take away the deaths due to covid, about 10% lower. This is a result of the cull of older people by the covid epidemic in 2020 and January 2021. If you were remotely right about deaths due to vaccine, the bodies of vaccinated people would be piling up in the streets, which it is plain to see they are not. Covid vaccines may have killed scores of people. Covid has killed 3 miilion people and seriously injured many millions more. We will have to wait and see what happens when travel and mixing happens again, but we already know what happens without vaccine.
        As for “manufacturers selling billions”, the total world-wide vaccination as of 11 April was 439 million people with at least one dose, and around 620 million doses in total. A few billion doses would be useful right now.

        1. Garfunkel says:

          Druid, multi-billions in sales was what was meant. The 3 million deaths from Covid – do you really believe this? Apply the same metrics to any common virus and we’ll have been living in a pandemic all our lives please remove the pandemic hysteria! If you widely tested for and counted deaths 28 days after the common cold after the last decade do you not think scores of millions would have been ‘killed’ by the common cold? Come on.
          In contrast, the deaths from vaccines are clearly being hidden or denied. That’s a fact – e.g. WHO, EMA denials of VIPIT, assurances of safety and subsequent U-turns.
          You still make the wild assumption that vaccines will effectively save us from this scamdemic, yet there’s no long term safety or efficacy data and plenty of evidence emerging of breakthrough infections and positive selection pressure waiting to undo the so called efficacy seen to date.

          1. Have a word with yourself says:

            “If you widely tested for and counted deaths 28 days after the common cold after the last decade do you not think scores of millions would have been ‘killed’ by the common cold?”

            If you did this analysis you would see waves of exponential growth in common cold infections. However this would not be followed by a matching exponential growth in excess deaths among those testing positive a few weeks afterwards. This is so obvious it should not need stating, yet apparently it does to everyone who can use the word “scamdemic” without a trace of irony.

      2. John Wayne says:

        It is hard to know things. The fact that we don’t have great data across different countries isn’t an indication of wrongdoing. It means that people aren’t organized enough to collect data in different countries that can be compared to each other.

        Clinical trials are done on tens of thousands of people, and more data is collected when the product goes to millions. The only thing that is different here is the scale and speed of it, which is what ‘we the people’ have demanded. Nobody gets rich making vaccines. A billion dollars is a joke to most of these companies. This constant complaining about one of most important human inventions is pushing one company after another out of inventing and manufacturing vaccines. We should be kissing these people’s feet, not accusing them of mass murder. I think your perspective is flat wrong.

        On the other hand, I will defend your decision to not get vaccinated.

  12. ezra abrams says:

    In diagnostics (tests, say a blood test for prostate antigen for men) it is *common for the commpanies tht do the test to pick up subtle lot to lot variations in the test kits performance that were missed by the manufacturer of the test

    this is cause a big testing company will run far far more PSA tests the the manufacturer can or would

  13. jay says:

    1 in 100,000 or 1 in 1 1,000,000 or greater, most people do not understand statistics. Furthermore, our psychological minds are unable to internalize what these mean. What the majority grasp are sound bites. Messaging overrides all.

    How is the message perceived? To use an extreme example, I know people that are hypochondriacs or have other disorders and anxieties over medicines. One person is so worried about an allergy to the vaccine (any vaccine) that this person will rather go without the vaccine than risk getting an anaphylactic response leading to death. I know a family member who refuses to take ibuprofen despite debilitating pain, because of a fear of severe adverse effects to the tablet excipients. One time, this person did take an ibuprofen tablet because the pain was so debilitating. It worked. The tablet was from some generic manufacturer. Now, this person will only take ibuprofen tablets of the same shape and color as that tablet. It was a annoying trying to source that supply and I dread the day this becomes unavailable.These people exist. On a spectrum, one does not have to be so extreme to still reject vaccination.

  14. Brussels bureaucrat says:

    Can anybody explain why the clotting side effects of the AZ vaccine were first identified in relatively small countries (Austria and Denmark) and after only relatively short use in these countries ? Wouldn’t you expect that the very, very rare side effect would be discovered first in a large country and only after the vaccine had been used for relatively long time?

    1. Petros says:

      Or is that done to subtle differences in:?
      batch/manufacturing site
      patient population injected

      All have been suggested as factors that may affect the outcome

      I had my first shot of AZ in early February with no effects at all as was also the case for my wife

      1. albegadeep says:

        Don’t forget transport and storage conditions and handling differences. We had a case recently (can’t remember the details, otherwise I’d post a link) where people who received their shot at one particular facility had a much higher chance of getting sick. Was it the vaccine itself? Unlikely, otherwise there would have been tens of thousands who got sick. Could be contamination at the medical facility, could be not storing the doses at the needed temperature, etc.

    2. Fox mulder says:

      Yes I can EASILY explain, these side effects were known about, hidden and denied. The BBC broke the news after the MHRA denied it existed. The Jenner institute lied about preclinical efficacy for their TB vaccine a few years back. Used these dangerous lies to fund trials on infants in South Africa. Leopards don’t change their spots and now we have the AZ covid vaccine or whatever they changed its name to to put distance from it.

    3. Roland says:

      I think there’s a little too much reluctance to flag up potential problems in case it feeds into irrational vaccine hesitancy, which creates a weird self-fulfilling kernel of truth to the whole vaccine conspiracy thing.

      Perhaps in those smaller EU countries the bad press AstraZeneca had made doctors a bit more sceptical and more likely to consider vaccine side effects instead of brushing off all serious unexplained blood cots as ‘oh it’s probably just coincidence’? Or just different approaches to healthcare, or hospitals which weren’t quite so burnt out by recent Covid numbers.

      In the UK the yellow card system should collect reasonable statistics on side-effects but it appears the specific combination of blood clots, tending to be widespread or cerebral, alongside low platelet count is surprising and not something specifically tallied until it was flagged up by others and then actively looked for. Blood clots on their own for example are more common and so not statistically linkable to the vaccine. I think they were still slow to find the statistics but incompetence is a perfectly reasonable explanation. If there were a conspiracy they would still be silent now.

      All-in-all it’s a good lesson that anecdotes have a very real role to play in scientific understanding. It’s tedious that so many so-called scientists are so quick to entirely discount theories for which there is only very weak evidence, before there’s been any attempt to collect stronger evidence.

      1. Anonnymousse says:

        Maybe, but on another site I’ve seen a number of unverifiable anecdotes from first-time posters who claim to have suffered clots from vaccinations (not the rare sort that might be real). If true it seems unlikely to me that anyone would decide to announce this on a forum where they’ve never posted before. I don’t doubt for a second that there are people so opposed to vaccination that they’re prepared to lie about having had side-effects.

    4. Kaleberg says:

      One obvious reason is that health authorities in big countries expect to see all kinds of outliers. If you are used to working with small N, then the one in a million stuff is rare. It’s a small pond, big pond effect.

  15. Phili[ says:

    I would like to point out that the AZ vaccine, unlike the J&J and the mRNA vaccines produces a wild type spike. The J&J and mRNA vaccines produce a prefusion stabilized spike protein.

    As more data comes in we may be able to determine if and why the AZ vaccine is inducing VITT. Assuming that VITT is a problem caused by the AZ vaccine, what would be the cause if there are problems with other vaccines. If there is a problem with Sputnik V, but not with J&J and the others, that would point to wild type spike being the problem. If there is a problem with Sputnik V and J&J, I would expect the problem to be the adenovirus vector. If the only problem is with the AZ vaccine, blame the Chimp adenovirus vector. If VITT is a problem will all of the vaccines, forget about it and just take the vaccine, it is a much better bet than getting COVID-19.

    1. Mandark says:

      Unfortunately we won’t find out about Sputnik V unless/until it’s approved and rolled out in the EU. I wouldn’t expect good pharmacovigilance data from the countries that currently use it.

    2. Brussels bureaucrat says:

      The spike protein is heavily glycosylated. But is it plausible that a protein produced from a vaccine vector would subsequently be differently post-translationally modified compared to the same protein produced by vaccine mRNA? Also, perhaps the stabilizing AA changes could influence the degree/pattern of glycosylation? Unfortunately, glycosylations are very difficult to characterize.

      In addition the spike protein hypothesis, in a new NJEM paper they speculate that “free DNA” could be a cause:

      “One possible trigger of these PF4-reactive antibodies could be free DNA in the vaccine. We have previously shown that DNA and RNA form multimolecular complexes with PF4, which bind antibodies from patients with heparin-induced thrombocytopenia and also induce antibodies against PF4–heparin in a murine model.24 Unfortunately, other Covid-19 vaccines were not available to us for testing.”
      Open access:

      1. Marko says:

        Their original paper in Blood, in 2013:

        Complex formation with nucleic acids and aptamers alters the antigenic properties of platelet factor 4

        “We suggest that clinical trials of aptamers or other therapeutic nucleic acid constructs should include screening for the development of anti-PF4/aptamer antibodies and potential clinical features of HIT as part of their safety end points.”

        I wonder if anyone has screened for these anti-PF4 Abs during the vaccine development and clinical trial phases. If not, it might be a good idea going forward.

    3. Garfunkel says:

      Looks like your observation has now been confirmed that JNJ’s stabilised spike is not a protection from this side effect. Young people have no business dying from these vaccines especially when the horror stories emerging now could be followed by far worse in the future, who knows long term effects? Hands up in the classroom! How can people advocate for something they know nothing about? Every media channel and politician has been feeding people BS about these vaccines having been proven safe and effective. Well some people knew already that this was fake news and politicians were liars. Proof has arrived now, the horrible truth dress up as ‘an abundance of caution’.

      1. Philip says:

        1 in 600,000 for the J&J vaccine in the US. In the real world that is safe. If I was a young woman, I would look for one of the mRNA vaccines. If I could only get the J&J, I would weigh 1 in 600,000 chance of VITT vs COVID-19 having killed 1 in 600 people in the US over the last year. I would then take the shot.

      2. Tom A says:

        Garf: The precautionary principle taken to the extreme. Don’t let us catch you driving in a car, crossing a street, or flying in a plane. You don’t know what will happen to you in the future.

        1. a s says:

          Driving a car is indeed quite dangerous and society doesn’t do enough to make it safer (by encouraging shorter trips at lower speeds)

  16. CET says:

    “In the USA we tend to deal with these ambiguities with personal choice. Nobody will force you to be vaccinated, or take a specific vaccine option. At least this is what is happening so far, and I hope it stays that way.”

    Agreed. And I’m a little confused as the why there is such a row over this. It seems obvious that the AZ vaccine should be available to folks (within the framework of a larger vaccination program), along with all of the information about it, but that no one should be forcibly given it.

    1. Roland says:

      They can’t buy the AstraZeneca vaccine in the US yet, so much for personal choice. Like it or not the decisions of institutions affect us all, huge numbers of people trust doctors – rightly and sometimes wrongly – and will use these signals as their sole reasoning for whether or not to take a treatment. Those institutions know that and hopefully use their power with good judgement but are frequently accused of not doing so. So there’s the row.

      I’d be truly grateful if no one in any country were held down and forced to take a Covid vaccine against their will but already there are soft-mandates in supposedly free Western countries: If you want a job in a care home, to travel to certain countries, avoid a nasty family argument next Christmas when the oldies visit, and maybe even just to visit entertainment venues, then a vaccination is looking like a significant advantage. With luck a negative Covid test will do instead but they aren’t unintrusive or entirely complication free either.

      Personal choice is fantastic in theory but it gets eroded fast when the food needs to hit the table for your crying hungry kids.

      1. metaphysician says:

        Your personal choice to go unvaccinated does not negate others personal choice to avoid you and the risks involved with you.

        1. albegadeep says:

          Hear hear. Having kids young enough that they CAN’T be vaccinated, once we (parents) are fully vaccinated, we’ll start having other adults over occasionally – but only fully vaccinated ones. Sure, the kids’ risk level is pretty low. But it’s not zero, and I’m not going to subject my kids to unnecessary risk because an adult doesn’t want to get vaccinated. Freedom of choice doesn’t mean freedom from all consequences of that choice.

  17. Marko says:

    AZ COVID Vaccine: Causal Link to Severe Thrombosis Established

    Read this.

    1. Marko says:

      I haven’t seen any statements like this previously:

      “Holme told Medscape Medical News that he does not think the AstraZeneca vaccine is safe. “Historically, I cannot imagine any vaccine with such severe side effects that hasn’t been withdrawn. I understand that we are in a very unusual crisis situation with COVID, but we have other vaccines that have not been shown to have this side effect.

      “These decisions are very difficult and have to be made with a very careful risk-benefit analysis. But it is devastating to see a healthy 40-year old dying from a vaccine complication who would have likely been fine if they had caught COVID.”

      1. Doug H MD says:

        what do you make of that?

        1. Marko says:

          I don’t know what to make of it. My initial thought was that Holme was badly over-reacting, but I’d like to hear what other experts have to say. His group saw a cluster of 5 cases with 3 fatalities among ~130k AZ vaccinees, with the cases ranging in age from 32-54. So that’s about 1 case per 30k, and about 1 death per 43k. There was apparently another case that was found from the same cohort after his NEJM article was published, which would bump up the case frequency a bit, and perhaps the deaths as well. Are these the sort of numbers that would get any other vaccine withdrawn, as he suggests ?

          1. Brussels bureaucrat says:

            I surely don’t know the answer. The question just reminds me of the decade long discussion about mammography screening for breast cancer, PSA-screening for prostate cancer, colonoscopy screening for colorectal cancer, etc. Basically: “how many people must die/be inconvenienced in order to save/prolong the life of one person”? These discussions are still ongoing…

          2. Roland says:

            “1 case per 30k”

            This is such a huge difference to the UK statistic it surely can’t be explained by age demographics alone. I wonder if the ‘free DNA’ hypothesis is true whether that’s also a plausible mechanism for significant batch variation? Or we could still be looking at some unnoticed drug or pathogen interaction.

            It should be a big worry that the mechanism hasn’t been pinned down yet, also because it means we don’t know whether the risk is the same, lower, or much worse with the second dose which is only being administered in significant numbers the last couple of weeks. Perhaps these Norwegian cases were previously sensitised in some way which makes them more representative of second vaccine dose patients.

      2. Chris Phillips says:

        To ask a possibly stupid question – or possibly practically a redundant question in the current atmosphere – is there any argument at all in the preprint to which Holme has put his name, that the vaccine is responsible for the problems reported?

        Because I don’t see any, despite the fact that MedScape presents it and one other under the headline “Causal Link to Severe Thrombosis Established.”

        Please don’t get me wrong. Statistically it looks as though there is a link given what I’ve seen about the normal incidence of these conditions – though I think the statistical comparison between normal incidence and incidence after vaccination is extremely difficult, given the huge publicity given to incidence after vaccination, and the much greater scrutiny of any problems after vaccination. But even so, surely it’s fair to ask for at least some scientific evidence of a link before a scientist publicly declares a vaccine unsafe.

        Particularly when that vaccine has made a net saving of thousands of lives, even on the worst-case assumption. And perhaps is capable of saving tens or even hundreds of thousands of lives in the long run.

        1. bewd says:

          I guess the best way to compare “normal incidence” is to compare the AZ vaccine number of doses versus the mRNA vaccines number of doses and number of clotting events , i:e assume the level with the mRNA vaccines is background.

          1. Chris Phillips says:

            “I guess the best way to compare “normal incidence” is to compare the AZ vaccine number of doses versus the mRNA vaccines number of doses and number of clotting events , i:e assume the level with the mRNA vaccines is background.”

            I see what you mean, in the sense that more attention is likely to be paid to symptoms after mRNA vaccination than after no vaccination at all (though ideally for this approach you’d be wanting the media to be bombarding people with stories about Pfizer and Moderna blood clots for a few weeks first, to ensure equality between vaccines).

            But on the other hand, what if it were a side effect common to all coronavirus vaccines? Then you’d get a false negative result. I’m afraid there’s no easy way around the problem.

          2. bewd says:

            But on the other hand, what if it were a side effect common to all coronavirus vaccines?

            if this was so wouldn’t we be seeing these rare clots with the mRNA vaccines??

        2. Not-an-epidemiologist says:

          I can’t see any direct causal link in the Schultz et al. study (assume this is what you’re referring to, although it’s not a preprint, but published?) The only language that comes even remotely near suggesting one simply states that “by providing a link between thrombosis and the immune system, these results strengthen the view that vaccination may have triggered the syndrome”, which is very far from demonstrating causality.

          The Greinacher et al study published back-to-back is more useful in general I think. However, the “free DNA” throwaway line is a bit odd. Why would there be free DNA present in the vaccine? — no evidence is presented that there should be, and their earlier study on this mostly focused on very specific DNA aptamers.

          Still, I think it’s looking very clear that some covid vaccines and this specific form of thrombosis is linked, albeit at extraordinarily low rates. Specificity to ChAdOx vaccination as opposed to adenoviral vaccination has not been shown, although I think at this stage, given the numbers of vaccinations, we can rule out the mRNA vaccines as being affected? The J&J data is looking more and more as if it might be broader than just ChAdOx, though.

          1. Chris Phillips says:

            “… I think at this stage, given the numbers of vaccinations, we can rule out the mRNA vaccines as being affected?”

            It certainly looks that way, but on the other hand a couple of weeks ago it seemed that the UK data taken in isolation would have ruled out AZ as being affected. Statistically the UK data still seem very different from the European data.

  18. The pandemic has given the world a whole new flavour of prejudice – AntiZenecism!

  19. Mariner says:

    Calls for a pause on the use of the J&J vaccine due to blood clots:

    Is it just a rare issue with adenovirus vector vaccines? It will be interesting to see how the numbers match up with the rare problems seen with the AZ vaccine.

    1. Christian Weisgerber says:

      Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine

      1. Mariner says:

        So, if it is 6 cases from 7 million doses, that’s going to be a about a third of the risk compared to thrombotic episodes reported by doses of the AZ vaccine in Europe. I think that’s roughly correct. Obviously, the lower, the better. It will be interesting to see if more cases come to light for doses given in the past couple of weeks.

        1. Philip says:

          7 million is the wrong denominator. Should be more like 4 million. You need to use the number of does given 6-13 days ago before VITT was recorded. It takes that long for VITT to show up after the injection.

  20. bewd says:

    U.S. Calls for Pause on Johnson & Johnson Vaccine After Clotting Cases

    1. JJ says:

      Note position on EU roll out.

      Thank you for providing these excellent articles and thanks to those who contribute their expertise through the commentary.

  21. Mariner says:

    Here’s an interesting article about the diagnosis of the clotting problem and the use of the PF4 antibody test in the UK:

    Reading between the lines, it sounds as though the UK authorities didn’t exactly attempt to keep the story quiet, but obviously didn’t react in the same public manner as the German and Norwegian authorities. They obviously thought the rollout of the vaccines was more important than scaring the horses about a small risk factor.

    It doesn’t speak well of the German group who, the article claims, didn’t share the information about their discoveries very readily. The article finishes on a positive note indicating everyone now has treatment plans with a WhatsApp Group sharing information between 500 specialists around the world. How very 21st Century! Could be a bit of pro-vaccine propaganda as well, I suppose.

    Hopefully, the awareness of these issues will mean that fewer lives are lost, regardless of the type of vaccine causing the problem.

    1. Helena says:

      I am a UK resident but I cannot blame Germany.
      Back in March UK basically denied blood clots, ridiculed EU and made it part of Brexit saga.
      I would have very difficult feeling to working with UK doctors in that situation.
      And now we know which was the real propaganda.

      1. Chris Phillips says:

        “Back in March UK basically denied blood clots, ridiculed EU and made it part of Brexit saga.”

        What a ridiculous comment to make.

        If you’re willing to characterise a whole country on the basis of a few ignorant hotheads ranting on social media, your opinion isn’t going to be worth much. In fact, you yourself become an ignorant hothead ranting.

        1. Subject of the banana monarchy says:

          I think citizens of the EU might have reacted more calmly to reports of AZ vaccine blood clots had our glorious leader not attempted to link the UK vaccine rollout and the Oxford/AZ vaccine quite so closely to the UK’s flag and to himself. He certainly started the vaccine nationalism we’ve seen and raised hackles on the continent by gloating about their relatively slow start where there was no good reason to do so.

  22. Marko says:

    Some countries have the luxury of watching these risk/benefit debates as a form of entertainment. Their risk of contracting Covid-19 is 100-1000 or more times less than it is in the US. They can afford to wait until the vaccine safety sweepstakes has concluded before committing their populations to one or the other vaccine :

    (You’ll probably have to copy/paste the broken URL)

    1. Doug H MD says:

      exactly. if you live in thailand, laos, Japan, Vietnam, MZ, Au, etc etc why rush?

      1. theasdgamer says:

        The rats are waiting on human trials to see if they want to get the vaccine.

      2. Not-an-epidemiologist says:

        … because until you have population-level vaccination, you’re just an uncontrolled outbreak away from being in the same situation as anywhere else?

        I am very, very glad to live in a country that’s eliminated covid (for now, at least). But seriously, shut up and jab me in the arm already! I’ll happily use up an AZ shot going to waste elsewhere, and honestly, the thought of being unable to travel for at least another year to see family and loved ones, while the rest of the world re-opens, is not a good one.

  23. Marko says:

    Concerns over rare clotting disorders halt use of Johnson & Johnson’s COVID-19 vaccine

    I think this crisis will soon pass, and the AZ and J&J vaccines will continue to be used, with some restrictions based on age. The good thing about it may be that we do better screening for thrombocytopenia with anti-PF4 Abs among those with clotting side effects and in future vaccine trials. The bad thing about it is that there will likely be some increase in vaccine hesitancy, but I’m not sure that this was avoidable.

  24. exGlaxoid says:

    The VIIT appears to be worse in young women, I have heard speculation that birth control pills may be a factor in making young women more suseptible to clotting issues, it will be be interesting to see if there are any clear links to the affected people. But certainly if they just gave the AZ and JNJ vaccines to older people, especially men, that would help minimize the risk.

    At least in the US, there will be enough mRNA vaccine to innoculate everyone that wants a shot within a month or two, so no big deal. And in many other countries, there is a shortange of vaccine, so using the JNJ or AZ vaccine for older people first will make the most sense in that case as well. In due time, the mRNA vaccines can be ramped up more in scale, and they will likely be the best answer for now. Maybe the Novavax vaccine will also be better, not clear yet.

    1. Mariner says:

      The numbers reported in the UK didn’t show greatly higher prevalence of VIIT/VIPIT (or whatever it ends up being called) in women over men on a per dose basis. More cases among women, but this reflected more doses of the AZ virus given to women.

      I don’t think a breakdown of ages by gender has been provided, however. If more doses have been given in care homes, this may skew figures. If older women aren’t at much risk then a greater number of cases in younger women could be obscured.

    2. Christian Stubø says:

      In Norway, at least, the Astra-Zeneca vaccine has been given pretty much only to health workers, roughly 80-85% of whom are female.

  25. Helena says:

    When Europe countries started rolled out. They got Pfizer and AZ roughly same time and by that time, some popular study said AZ might be less effective than Pfizer. Thus many Europe countries decided to give Pfizer to front-line med worker and most elderly. And AZ for less-dangerous med workers. Sounds like a fair plan? Yep. In Norway, less-dangerous med workers consist more young-middle age female – which happened to be the most venerable to AZ blood clot. And as they all work in medical, they are very aware of their symptoms and their medical history are very detailed. Thus the problem surfaced in a big way.

  26. jqueenuk says:

    More important questions that we don’t have answers to yet include whether this is a general adenovirus-vector effect or not

  27. Observer says:

    Is there any indication that the patients who susceptible to the clotting adverse event would similarly be affected by the negative clotting indications of COVID-19 infection? If there were to be the case, stopping use of the vaccine might have greater negative indications for the susceptible patients as they would be far more likely to contract COVID-19.

    Best would be some way to identify these patients in advance due to CBC or some specific susceptibility marker.

  28. Some idiot says:

    Just out here in Denmark: The department of health here has just announced that they are _permanently_halting_ the use of the AZ vaccine.

    A couple of relevant points from the press conference:
    (a) the epidemic is under control here in Denmark. If we had been in the middle of (say) a 3rd wave, then the AZ vaccine would have been taken in use again.
    (b) The supply of the AZ vaccine has only been small compared to (eg) Pfizer/BioNTech, so the impact on the vaccination program will be small (everyone who wants it is expected to be finished vaccination early-mid July (2021…), i.e. a delay of only a few weeks.
    (c) J&J vaccine will be kept on hold until they hear what the FDA says.
    (d) Their evaluation of the risk is approximately 1 : 40 000 (that surprised me; I will be looking forward to digging out more info to see why it is so low).
    (e) Screening/treatment of affected individuals was a considered option, but the risk-benefit came down to dropping the AZ.
    (f) (And this is the one that _really_ surprised me): Those who have had one shot of the AZ will be offered a shot of a _different_ vaccine as their second. And boy, I am looking forward to their rationale behind that. The boss there (Søren Brostrøm) is very consistent about “talking with data”, so I will be interested to hear what data that is based on…!

    1. Marko says:

      “(d) Their evaluation of the risk is approximately 1 : 40 000 (that surprised me; I will be looking forward to digging out more info to see why it is so low).”

      Apparently they placed more weight on the Norwegian data, which showed a risk in that ballpark. As Helena mentioned above, in Norway the bulk of the group who got the AZ vaccine were working-age HCWs, so both the age group perhaps more susceptible and also a group more likely to recognize their own symptoms, report them, and then be diagnosed.

      1. Some idiot says:


      1. Some idiot says:


  29. bewd says:

    Towards Understanding ChAdOx1 nCov-19 Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT)

  30. J says:

    ‘Covid-19: Canada relaxes age limits on AstraZeneca vaccine as Ontario cases surge’

  31. Woody says:

    In this story about a young Australian woman with blood clots there is a list of other people with Oxfrord/AZ vaccine related blood clots. The 7 people in the list are all men over 50. I thought this was worth mentioning as it’s supposed to be young women who are more at risk.

  32. EXPAT says:

    Norway: a special place for “special people”

    Some thougths about this. Norway and UK specialist are ofcourse correct to point this out, very quick and good diagnostic skills. But with a one trillion Sovereign fund and “good ” luck that makes them look smarter than they are they still managed to make a quite messy vaccine campaign. The good luck is also down to small and spread population, and well runned GP/family medical system. All testing is free or close to it, and paid sick leave so no punishment for testing positive. Effective PCR test nationwide. The sister of the NATO boss, both Stoltenberg (you see politics in Norway is often or seems “like family business”). They share a bit clumsy persona in public. So she is head of their “NIH”. The the health minister who is smart guy also makes policy, and thirdly the Directorate of Health also some policy. So these three sources of guidelines has been a bit comical and painful to watch from the outside. They did not learned little from how Dr. Brundtland handle COVID in 2003. They had immediate lock down. And I think a few thousand people died in total.

    I entered Oslo Airport late September last year there was big COVID-19 signs for testing (But I was the only one following the signs and when I arrived to the end no one was there to take a test neither). Oslo is on total lock down more or less, Norwegian Airlines etc close to collapsed. So this lethargic and stupid slow reponse allowed for infection all over Norway now. They implementert test everyone that arrive and quarantine one year too late. I will not mention Sweden here because that is such hopeless and stubborn handling that it’s easy to look good such a neighbour.

    Still Norway will be fine, GDP down about 10% roughly. But an ounce of prevention is worth…billions?

    Then not only did we pay more than the EU (I think together) sponsor COVAX that is think is good. But we also agreed to buy vaccibes through Sweden/EU(that at the same time was running out of propofol and we had to export that for their tragedy).

    So Norway financing most vaccine developments agreed not sit at the negotiation table, probably pay the most, and by from the EU through Sweden.

    Now “Dr” Usrual Leyen or her Nobel title Dr. Ursula von der Leyen took monopoly on medicine and vaccine procurement. And you have read it to belive what a incompetent politician? she is that has been dumped there to avoid here messing in German politics. She has a “PHD” well the German type that is not recognized anywhere else as PhD as its more like 1 year student project than a 5–6 year dissertation elsewhere. And that is her only “punlication” to find online (through Der Speigel as it was almost withdrawn due plagiarism (But with her husband being professor at the University and she keeping another position as well, many think she got lucky due to influence and manipulation of the reveiw process). She basically left medicine after graduation and have soon 30 years since she seen a patient). Supposedly she is also a public health expert. Again zero publications. As a member of this strange sect like CDU party she have 7 children and is basically a full time mother for most of her working life (I repect that). Anyway a terrible job as German military defense minister. Leaves that. Read other articles about it is comical. Angel Merkel seems to have miles feelings about her but together with Macron they rigthly choose a weak and useful idiot they can control. Horrible politician, dangerous mix of arrogance/ignorance, no detectible nobility or never practised as a “doctor” without supervision until now. Google it and you will not belive it.

    To head procurement for the EU she selects DG Sante headed by Cypriotic Psychologist Stella K and a Italian translator Sabrina X. No one neither their president nor themself have any clue how to organize and deal with either a pandemic nor big pharma. I have read they where so unprofessional etc that they hardly got through to CEOs of some big pharma. They did however sign a deal for remdesivir mid/late November with Gilead. And was not aware WHO would declare against using it a few days later. Anyway did not offer reasonable terms, and while UK, Israel and US used professional negotiators and bougth as much as they could, whereas this “troika” realised very late the EU was expecting vaccines.

    So for Norway to pay so much, then it get outsourced to such a unprofessional team and process is amazing. It was a handicap Norway did not even need to have. So the slow trickle of vaccines via Sweden has also resulted in extremely slow roll out where you get better chance to pick up rare events.

    But then this fear spreads and now even placeses part of COVAX countries prefer Sinopharm over AZ because some are scared of it but their risk is at the moment much higher. So it send a strange signal to the rest of the world. The COVAX sponsor do not want the vaccines in the COVAX program. They will be forced to slow opening costing billions more due hesitation. Unclear who decided what vaccines to approve. Many Norwegians would be happy to take both AZ or J&J esp those that are let say male etc. And like elsewhere kids/teens forgotten and neglected so far with no vaccine for them. The same teens/young people are then blamed for being selfish/careless, but given no way out of this neither yet other than herd immunity I guess.

    So it looks like Norway without any vaccine production is going to figure this out on their own way, rather than follow international guideline or EMA/US approval. The only research often taking place in Norway is to check what is already known from outside studies. Expect big money contributions it is thin scientific harvest from Norway. Though they where correct to explore the HIT/thromboemolic events, it needs to be out into context. Risk is hard to consider when asked up front. But it has also hurt the image of the much needed COVAX in other countries.

    I stop there, but even money can not buy out of this problem, maybe it creates too many options.

    Sorry for typos did not have time to proof read.

    1. Doug H MD says:

      Here is a shorter version:

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