AstraZeneca vaccine update: Under 30s offered alternative to AstraZeneca after blood clot cases

People under the age of 30 in the UK will be offered an alternative to the AstraZeneca vaccine amid concerns the jab causes blood clots.

They will instead be offered the Pfizer or the new Moderna vaccine.

England’s deputy chief medical officer Professor Jonathan Van-Tam hosted a briefing with the medicines regulator following an investigation into the Oxford/AstraZeneca vaccine and potential links with blood clots.

Prof Van-Tam was joined by Dr June Raine, chief executive of the Medicines and Healthcare products Regulatory Agency (MHRA), Professor Sir Munir Pirmohamed, chairman of the Commission on Human Medicines, and Professor Wei Shen, chairman of the Joint Committee on Vaccination and Immunisation (JCVI).

Dr Raine warned that “no effective medicine or vaccine is without risk”, and said that “in an extremely small number of people”, there was evidence of blood clots as a potential side effect. 

Up to Mar 31, there were 79 cases of people developing blood clots having received an AstraZeneca vaccine. 

Of those, 19 died, and three of those who passed away were under the age of 30. 

But Dr Raine stressed that after 20million doses of the vaccine have been administered, the chances of someone developing a blood clot having had the jab remains very small – four in one million. 

She also added that while it was “a strong possibility” the clots were caused by the vaccine, “more work is needed” to make absolutely sure this was the case. 

Prof Wei Shen of the JCVI outlined three changes to Government advice regarding the vaccine rollout. 

  1. Information to individuals being offered vaccination and to health professionals should be appropriately updated to reflect the latest considerations from the MHRA and JCVI
  2. Those who have received the first dose of the AstraZeneca vaccine should continue to be offered the second dose according to schedule
  3. Adults aged 18-29 years (who do not have any underlying health condition that put them at higher risk of serious Covid-19 disease) should be offered an alternative Covid-19 vaccine in preference to the AstraZeneca vaccine, when an alternative is available

A televised media briefing at 3pm on Wednesday came at the same time the European Medicines Agency (EMA) offered its own update on whether it thinks there is a causal link between the jab and rare clots.

The European regulator concluded that “unusual blood clots with low blood platelets should be listed as very rare side effects” of the Oxford/AstraZeneca vaccine.

It noted, however, that the benefits of being vaccinated outweighed the risk of any side effects. 

The EMA and the MHRA have both carried out reviews into reports of rare brain clots in people who have had the AstraZeneca vaccine.

Why is there concern over the AstraZeneca vaccine?

All the major European countries suspended the use of the AstraZeneca jab after a flurry of nations announced temporary halts to their programmes last week.

Norway and Austria were the first to sound the alarm – Austria reported that a person was diagnosed with blood clots and died 10 days after they had received the vaccination. Another was hospitalised with pulmonary embolism (blockage in arteries in the lungs) after being vaccinated.

Then Denmark announced that someone had died after receiving the jab and became the first country to suspend its AstraZeneca programme.

This prompted other countries, including Norway, the Netherlands and Ireland to follow suit. Thailand also suspended its programme but has now restarted it.

Mr Macron prompted an outcry earlier this year when he claimed the jab was “quasi-ineffective” for pensioners.

In February, Mrs Merkel, 66, faced heavy criticism for refusing the AstraZeneca jab, insisting it was not recommended for people over 65.

In her first major interview, Kate Bingham, the former head of the Government’s vaccine taskforce, accused the French president and German chancellor of encouraging anti-vaxxers after both cast doubt on the efficacy of the vaccine, developed by British scientists.

Bingham’s criticism comes as France and Germany currently face a third wave of coronavirus cases.

What does AstraZeneca say?

Previously, the company has reviewed its safety data and carried out further testing but has found no links to clotting.

The company’s chief medical officer Ann Taylor has said the number of cases of blood clots reported in the 17 million people across Europe who have received the vaccine is actually lower than would be expected in the general population.

She added: “The nature of the pandemic has led to increased attention in individual cases and we are going beyond the standard practices for safety monitoring of licensed medicines in reporting vaccine events, to ensure public safety.”

What do the scientists say? 

Professor Adam Finn, from the University of Bristol and a member of the JCVI, said it was vital to keep the vaccine programme going as society opens up, in order to help stave off rising infection rates.

Some European countries have restricted the vaccine use in younger people following reports of low platelet counts and cerebral venous sinus thrombosis (CVST), a specific type of clot that prevents blood from draining from the brain.

Asked if different vaccines could end up being used for certain groups as more vaccine types come on stream, Prof Finn told BBC Breakfast: “That’s certainly possible.

“We are seeing another vaccine coming in (Moderna), and further vaccines are approaching licensure, and I know that the UK has made contracts for quite a wide range of different vaccines.

“As time goes forward, we will have much more flexibility about who can be offered what.

“On the other hand, we do need to keep the programme going if the plan to open things up and allow things to get back to normal is to proceed without another wave of the pandemic coming through.

“So it’s quite a tricky balancing act here, getting the balance right, getting vaccines coming through… getting the risk-benefit right for people coming forward.”

He urged people being offered the vaccine at the moment to take it, saying the “risk-benefit is very strongly in favour of receiving the vaccine”.

But Dr Maggie Wearmouth, a member of the JCVI, told The Telegraph that “perhaps slowing things down” with the rollout “until we’re absolutely certain” might be wise.

Speaking in a personal capacity, she said: “The issue is about safety and public confidence. We don’t want to cover anything up that we feel that the public should be knowing.

“We’re not here to blindly follow targets or due dates. We will do what is necessary.”

In the last MHRA update, 30 cases of CVST and seven deaths were reported in the UK among more than 18.1 million people receiving the jab.

Meanwhile, GP Dr Ellie Cannon, who appears on TV and writes for newspapers, told the BBC the rate for this type of blood clot was around one in 2.5 million people.

She said that, in contrast, among 2.5 million 40-year-olds with Covid “we would expect around 2,000 deaths”, adding the risk of a clot was “incredibly rare”.

Professor Calum Semple, a member of the Scientific Advisory Group for Emergencies (Sage), which advises ministers, said he was “not worried one little bit” about headlines around the AstraZeneca vaccine.

Speaking in a personal capacity, he told LBC radio: “I’ll take (it) myself, I’m 53, my risk of death from Covid is about one in 13,000, for me it’s a no-brainer, I need to have the vaccine.

“This vaccine is safe. What do I mean by safe? You can look right, look left, look right again, cross a road, it’s safe to cross because you don’t see any cars (but) you can trip, you can stumble.

“Nothing is risk-free, but is the vaccine safe? I would say yes.”

Former MHRA chief Professor Sir Kent Woods also told LBC radio: “Covid itself – the infection itself – is known to be associated with a substantial increased risk of blood clots of various kinds.

“At a time when the population has got lots of Covid going around, it’s very difficult to know what the actual background rate of these clotting events is without the vaccine.

“We can say, I think, that if there is a connection, it’s a very, very rare one.”

Meanwhile, Ravi Gupta, professor of clinical microbiology at the Cambridge Institute of Therapeutic Immunology and Infectious Diseases, also urged people to keep their vaccine appointments.

He told Sky News: “I think that’s on balance at the moment – there’s still transmission of Covid, and there is a risk to all of us of being infected, particularly as the economy is being opened up and society’s opening up, we are at risk of getting severe infection.

“So I would certainly be going forward for that vaccine in the current situation.”

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