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Is it Safe? Vaccine politics, Signal Transparency
Are vaccines above politics? Apparently not.
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This is a light post, work is pretty busy at the moment, and I’ve taken on some additional work at a vaccine hub. So, some brief thoughts on a couple of things.
That anti-vaccine advocates would attack the COVID-19 vaccines with their normal tropes, an accusation that they were “rushed”, and an endless fountain of nonsense about 5G or chips from big tech (make mine an Apple M1 please) was no surprise. However, I slightly disappointed that just at the time when we need to have a united front on vaccines, that some Members of Parliament and health professionals who have axes to grind, have decided to grind them on what is looking at first blush as a rather good start in the UK vaccination programme.
There were some warnings about this a few months ago. An utterly moronic piece by a UK academic: ‘If my university is the first to develop the vaccine, I’m worried that it will be used as it has been in the past, to fulfil its political, patriotic function as proof of British excellence.’ A warning in the Guardian from ‘experts’, who appeared to know little about UK drug regulation and their role in the EU, that the UK would fall behind the EU in vaccine procurement. In fact the UK is outperforming EU states and Germany is stepping round the vaccine solidarity plan.
In the past day there has been an attempt to argue that first doses don’t count as vaccination, to try and suggest that the UK government is spinning this vaccine success story. So instead of the flag waving vaccine nationalism, we get vaccine negative nationalism. Here’s a couple of examples.
If you have had a single dose of vaccine, you have been vaccinated. This is not spin, and is the accepted comparator being used internationally. I’m not going to go into the whole delayed dose policy again, covered in a previous newsletter, but here is Max Roser, founder of Our World in Data, where you can track the vaccinations.
This sort of ‘vaccine politics” is not anti-vaccine in the normal sense of the word, but it does undermine the good work being done on the vaccination campaign by the NHS, and might reduce confidence in some people. If you followed the reasoning of some of these people, you might think: ‘Well if I’m not going to be vaccinated with one dose of the vaccine, and it is only 50% effective, then I’ll skip my appointment’. This would throw away a calculated single dose efficacy with the Pfizer vaccine of around 89% at 3 weeks, and delay even further your second dose (which is presumably what these people are arguing for). A somewhat dangerous decision in the current surge of cases in the UK.
Some of this is normal politics, obsessional anti-Tory partisanship or lingering Leaver/Remain tribalism. Anything remotely going right must be undermined. Wouldn’t it be better just to say, the government are useless and they seem to be getting this right, so let us count our blessings? Rather than potentially undermining the work the NHS is doing?
Negative English nationalism was described by Orwell in Notes on Nationalism: l ‘Within the intelligentsia, a derisive and mildly hostile attitude towards Britain is more or less compulsory, but it is an unfaked emotion in many cases.‘ Most of this material is on twitter, where incentives drive this behaviour, and echo-chambers reward it. One reassuring thing about this is that twitter is not Britain, as someone once said.
Keep your politics out of vaccines.
There is a more interesting news story about the Pfizer vaccine coming out of Norway, with the death of 23 frail patients in nursing homes after receiving the vaccine. The BMJ reporting is clear and not sensationalised (even if other media reports and social media is). Norway has prioritised nursing home patients, for obvious reasons. There are some interesting suggestions, such as the idea that common minor adverse reactions, such as fever, diarrhoea, and nausea may have pushed frail patients over the edge. This is a signal of a possible drug harm, but not a causal link.
The classic WHO definition of a signal is:
Reported information on a possible causal relationship between an adverse event and a drug, the relationship being unknown or incompletely documented previously. Usually more than a single report is required to generate a signal, depending on the seriousness of the event and the quality of the information.
The mere fact of a temporal association, X happening before Y, is not enough to prove the vaccine is cause. If you took a cohort of frail patients who were terminally ill or had serious underlying conditions in nursing homes and followed them up a month later, a number would have died in the absence of a vaccine (The BMJ says 400 such patients die each week in Norway). The Norwegian Medicines Agency knows this, but is investigating each case.
This doesn't mean there isn’t a link, but signals are swirls of dust on the horizon. On closer inspection it could be a breeze disturbing the ground, or an approaching army. Carefully investigating signals in a transparent manner to find the latter is clearly important, but at the moment this signal is a concern in this patient group (as all vaccine signals should be), but not worrying.
Public understanding of pharmacovigilance processes is not high, so the tightrope walk of performing transparent pharmacovigilance in an age of social media and clickbait journalism is going to be a tough job for regulators and health systems.
Don’t forget to report your suspected adverse effects from medicines and vaccines. In the UK, this means using the Yellow Card Scheme