People Refusing Astra Zeneca - What Happens?

[Nootkah]

I've seen an increasing number of people on here and on social media saying they'll go to their mass vaccination centre appointment but if it's Astea Zeneca, they'll refuse. I'm curious as to what actually happens next? They've had an appointment, been offered a vaccine that remains approved for their group, and have declined. Are they "ticked off" the list as "offered" or do they stay at the top of the list for upcoming appointments and continue to be invited?

@XiCi

That's fair enough but there has been a lot of complaints on FB about the over 50s refusing AZ and slowing down the vaccine reaching younger people How is this slowing down the vaccine reaching younger people? Whatever age you are you are entitled to refuse the vaccine if you don't want it. The vaccine programme doesn't stop and wait for people to change their minds. Its not like 20 year olds will not be vaccinated until every single over 50 has been persuaded to take it.

The thread on MN which was complaining about over 50e was saying that people turn up for their vaccine, then refuse it if it is AZ - so they have taken a slot and not used it. They then keep rebooking until they get to an appointment which offers a vaccine they are happy with. This delays the opening up of the booking site to younger people. I stress this is what is being said by other people on MN (and I think partly what this thread was originally about?) not something I am claiming to be true.

It's possible that Novovax would prove lower risk for younger people if spike protein is the issue, as it's similar to how flu, HPV and HepB vaccines work. Not clear when it's being approved, but the efficacy against all variants looked great from trials.

Re: whether it would be a "punishment" to be assigned to the mop-up group to be got round to when everyone else is sorted, if you refused AZ without clinically-identified reason — not as such, IMO, but I think it could legitimately be argued that demanding a particular vaccine without an objectively-identified medical need may have to be disincentivised in some way, as large numbers of people doing so would disrupt the mass vaccination programme, which could have serious consequences for the country as a whole.

Suppose the AZ vaccine, while preferable to remaining unvaccinated for the vast majority of people, really is riskier and less effective than the others. In that case, on an individual level, it makes perfect sense to refuse the AZ if the result is likely to be "Okay, we'll give you one of the better vaccines, then". And if that was the likely response, lots and lots of people would, quite rationally, request the better vaccine for themselves.

Unfortunately, there's not so much available of the other vaccines, and they need to be earmarked for certain people — second-dosers, those who've been clinically evaluated as being medically unable to have the AZ, and so on. Plus, letting people pick and choose based on their own personal preferences is an admin nightmare and slows everything down.

In a situation where most of the available vaccines are of a slightly inferior type (while still being well worth having), the only way to allocate these vaccines fairly and administer a mass programme efficiently is to have objective criteria by which to select the people who will get the better ones, and for those who don't fit those criteria to be told, "It's this or nothing for now — and the evidence we have shows that of those two options, taking the AZ is likely the safer choice, but you're welcome to go away and wait for the mop-up, and hope you'll be offered a different vaccine then".

If you want to think of that as a punishment for not being willing to accept (what you believe to be) an inferior, higher-risk vaccine, then fair enough, but there's no perfect way to do this thing.

(FWIW I'm in my thirties and awaiting my second AZ dose. Given a free choice I'd have probably picked the Pfizer vaccine, but I'm happy to have been able to receive any effective vaccine so soon — family and friends across Europe, Asia and North America haven't been so lucky.)

@bookworm1632

If it was down to me, that would be it - their only option in future would be to pay to have the jab privately as they've wasted a perfectly good dose that someone else could have used, not to mention the time of the vaccine centre staff.

They will certainly put in measures to ensure that people cannot simply keep refusing the AZ vaccine until offered something else - there isn't enough Modern/Pfizer.

Or you could look at it another way. The government backed the wrong horse and is forcing other people to live with the consequences of that mistake.

And if the NHS had had proper investment over the last decade, their IT and communications systems would be able to handle people expressing a preference in advance, so jo need for “waste”.

Or you could keep viewing it like dipping sheep

It's mass vaccination. We've got to administer vaccines to tens of millions of people. It does kinda need to be like dipping sheep.

It's this or nothing for now — and the evidence we have shows that of those two options, taking the AZ is likely the safer choice, but you're welcome to go away and wait for the mop-up, and hope you'll be offered a different vaccine then".

I think that's fine, as long as we don't introduce vaccine passports. I think that's why people are finding the whole issue so upsetting. I'm more than happy to wait longer for an alternative vaccine, or to wait for further data. As I said before, personal reasons mean I don't have a massive risk of catching or passing on Covid. I don't want to be forced into making a decision because of the threat of being excluded from normal activities if I don't. If the vaccine is slightly higher risk then I've no issue with being asked to wait but I do have an issue with being coerced into having it.

@TheOtherMaryBerry1

It's this or nothing for now — and the evidence we have shows that of those two options, taking the AZ is likely the safer choice, but you're welcome to go away and wait for the mop-up, and hope you'll be offered a different vaccine then".

I think that's fine, as long as we don't introduce vaccine passports. I think that's why people are finding the whole issue so upsetting. I'm more than happy to wait longer for an alternative vaccine, or to wait for further data. As I said before, personal reasons mean I don't have a massive risk of catching or passing on Covid. I don't want to be forced into making a decision because of the threat of being excluded from normal activities if I don't. If the vaccine is slightly higher risk then I've no issue with being asked to wait but I do have an issue with being coerced into having it.

If choosing to refuse the effective vaccine you've been offered would result in other people being unwilling to expose themselves to the extra risk you pose to them, then that would just need to be factored into your decision, surely?

I agree with you @TheOtherMaryBerry1

I don't want vaccine passports for any reason anyway, well certainly not domestically, seems to me anyway that is obviously beyond our government's control about what is required internationally but they can choose to be fair and prioritise people's liberties in this country.

I'll be taking any vaccine thats offered to me as soon as I'm invited, 33 yr old woman, healthy BMI, no health conditions. Would be really happy with AZ and I honestly think it's getting silly now- people have lost all ability to judge risk.

But people are entitled to feel different and want a choice. Unless it's for an actual medical reason, they'll probably have to accept waiting for their vaccine but like you've said, you're happy with this IF (and I say IF) it's meaning that younger people are facing delays due to older people refusing the AZ vaccine, that needs to stop immediately. And there can't be delays in removing the restrictions because of this either.

Just allow the choice and treat people like adults, they can accept they'll have to wait longer for their chosen vaccine.

Take a look at how far along the rest of the world are, then think if you have a real right to grumble that you're being offered a vaccine that's lower risk than aspirin: ourworldindata.org/covid-vaccinations.

If you don't feel able to take a 1 in 500,000 risk despite the risk of covid being greater and there being risks with all the vaccines, then don't. I think it's an incorrect assessment of the real risks to you and others around you, but that's ok. What people shouldn't expect it to then muscle their way into special treatment over others who are happy to stick with the NHS programme as the fastest and best way past this pandemic. Nor to be allowed to put vulnerable at greater risk because they've chosen not to be vaccinated. It's most likely anyone choosing not to be vaccinated would just have to pay for extra testing anyway for travel and various events or quarantine costs, so It becomes just a time and money issue.

@MRex

Take a look at how far along the rest of the world are, then think if you have a real right to grumble that you're being offered a vaccine that's lower risk than aspirin: ourworldindata.org/covid-vaccinations.

If you don't feel able to take a 1 in 500,000 risk despite the risk of covid being greater and there being risks with all the vaccines, then don't. I think it's an incorrect assessment of the real risks to you and others around you, but that's ok. What people shouldn't expect it to then muscle their way into special treatment over others who are happy to stick with the NHS programme as the fastest and best way past this pandemic. Nor to be allowed to put vulnerable at greater risk because they've chosen not to be vaccinated. It's most likely anyone choosing not to be vaccinated would just have to pay for extra testing anyway for travel and various events or quarantine costs, so It becomes just a time and money issue.

Well said, as per usual

Those who refuse should be able to pay to get an alternative privately once sufficient stocks become available.

What is considered ok BMI in England? I know the people over BMI of 40 is considered CV in England, but in my native country, people over BMI of 30 is considered CV, in the same category as other serious health issues.

@MRex spot on.

I can't understand it myself.

Do I want to accept the tiny risk of coronavirus and delay having a vaccine until the one of my choice becomes available, and also increase the likelihood of my friends/family catching the virus?

Or do I want to accept the far far far smaller risk of a really safe vaccine (when I do far riskier things on an everyday basis) which will protect me from coronavirus, with the added benefit of protecting my friends and family?

That's how I see it? Second option surely?

@MRex totally agree.

No problem with people refusing it. No problem with people being told what vaccine they are allocated ahead of time, and having all the info they need to make an informed decision.

But the choice should be "take what you're allocated, or wait until we're in sufficient vaccine surplus to get what you want".

Anything else is a recipe for widespread refusal of AZ and a derailing of the current roll out. We simply don't have the supply volume or domestic manufacturing capacity to do anything else right now.

Long term? I'd like to see some non-AZ capacity build up here, particularly for any of the mRNA vaccines.

Take a look at how far along the rest of the world are, then think if you have a real right to grumble that you're being offered a vaccine that's lower risk than aspirin:

I'm not surprised that people are grumbling though, now that they've stopped offering az to the under 30s. Right or wrong it sends a message about risk and and that's what is being heard by people. I may be being utterly stupid but it seems madness to me that I have 3 siblings, all under 30, two of whom are obese so at much greater risk of Covid than I am, but I am the only one who will have to accept a 'higher risk' vaccine because of an age difference of a couple of years.

@TheOtherMaryBerry1 it still remains that aside from being obese in the case of your siblings, the risk/benefit thing for people in their 20s is more complex to consider than for people in their 30s. There was always going to be a cut off point as with everything- and those in their early 30s are clearly not really much more at risk than late 20s but that's how it works with a cut off? I'm not concerned by it and don't feel I'm being treated unfairly by it.

And actually I think it's pretty unreasonable and out of order to be grumbling about it- of course it's understandable to have concerns but the evidence shows that the risks are absolutely tiny! Totally hypocritical for people to be making a fuss about this if they've had all their childhood vaccinations, other vaccinations for travel, medications. Plus all the other far riskier things they do on a daily basis such as drive a car.

I know people who are happy to take recreational drugs but are saying they won't have the AZ vaccine. Shame there's no vaccine for being totally fucking stupid.

@TheOtherMaryBerry1 - under 30s are treated differently because your risk from the vaccine is over 30% lower than theirs, and your risk of death from covid is over 330% higher than theirs, because you are older! The UK has had over 127,000 dead from covid and this risk might mean 70 deaths in total if every single adult in the UK was vaccinated with it. Actually far fewer than that now; 19 already happened, at least 1/3 of the population are having other vaccines, and the death rate should drop because anyone vaccinated is made aware to seek help sooner. Having vaccines that work so well at such low risk is a scientific triumph and I don't wish to be rude by being blunt but I want to be clear; I find it surprising that people have all been through the last year and feel entitled to have such contempt towards these life-saving achievements while those very achievements are on the cusp of bringing us out of this pandemic. I don't know of any scientist who speaks like that about these vaccines, so I'm sure it's lack of understanding, I'm just really confused about how to bridge the knowledge gap.

@TheOtherMaryBerry1, you say higher risk vaccine, but if you think logically, risk isn't that high at all.

"It is challenging to think of such low risks: when we have to count the zeros, all intuition goes. So what else has roughly a one in 100,000 chance for a young adult? We could choose from the risk of dying when under general anaesthesia, or in a skydiving jump, or, on the positive side, winning the Lotto jackpot if you bought 450 tickets, or guessing the last five digits of someone’s mobile phone number.

Perhaps more pertinently, it’s roughly the risk of a young woman on the contraceptive pill having some form of blood clot in one week."

source: www.theguardian.com/theobserver/commentisfree/2021/apr/11/how-big-are-the-blood-clot-risks-of-the-az-jab

[quote RockingMyFiftiesNot]@Lalalablahblahblah yes I do see what you mean. But a lot of talk on social media, including MN, has been around over 50s refusing the AZ so slowing down the vaccination of younger people. My comments really are aimed at those who are currently refusing the AZ I.e. older. Yes, if they are still able to have children pregnancy remains a risk but lower than in younger age group whereas risks from COVID are massively higher if you are over 50.[/quote]
Nhs guidance states women over 50 should not be given the combined pill due to the risk of blood clots so I’d rethink that one if I were you!

I have seen no news reports stating vaccine refusals is slowing anything down.

@Weatherwarnings sorry if I'm not making myself clear. Lots of women over 50 took the pill for decades without worrying about clot risk .I'm not talking about taking it now.

I haven't seen any news reports about it slowing things down either but as I said , it is a commonly held belief on MN that the over 50 refusers are turning up to appointments, not taking them if AZ , rebooking and hence slowing things down for the younger folk still waiting to be called.

your risk of death from covid is over 330% higher than theirs, because you are older!

Yes, I'm sure it is an understanding gap because whilst i can see this is what the stats say it seems to me that lumping people into decade groups is flawed. Again, I'm not saying that I won't have the jab or anything like that but you surely can't be saying that a 31 or 32 year old is closer in terms of risk to a 39 year old than a 29 year old?
I can understand that it's a flawed system that is borne of necessity but then why can't there be some leeway or even just some openness with it all.

@TheOtherMaryBerry1 it's like with any 'cut off'- there are bound to be people who aren't happy with it. I'm sorry but I think anyone in their early 30s making a fuss and claiming this is unfair is quite frankly ridiculous now- what about the length of time someone in their 60s had to wait to even become eligible for the vaccination? At far higher risk of the virus, but very likely still to be working and coming into contact with others or providing childcare? What about men- they weren't prioritised for vaccination despite it being clear certainly in older age groups that they were worse affected than women. I'm not saying things should have been done differently- I'm just pointing out the other cut offs in the implementation of this rollout and the complaints others could make.

You can't say for definite that you are definitely more like a 29 year old than a 39 year old- there are so many variables to this. It's honestly sounding so self-indulgent now for anyone in this country to be whining about the vaccine they will be offered- we are so so privileged here. You may not like the cut off but I can totally understand and accept the judgement given the risk of the AZ is so so tiny and the risk of coronavirus is so much worse.

@TheOtherMaryBerry1

your risk of death from covid is over 330% higher than theirs, because you are older!

Yes, I'm sure it is an understanding gap because whilst i can see this is what the stats say it seems to me that lumping people into decade groups is flawed. Again, I'm not saying that I won't have the jab or anything like that but you surely can't be saying that a 31 or 32 year old is closer in terms of risk to a 39 year old than a 29 year old?
I can understand that it's a flawed system that is borne of necessity but then why can't there be some leeway or even just some openness with it all.

You also get offered the vaccine first, so there's favouritism for your age there that someone at 29 who feels exposed and vulnerable will find hard to accept as they wait weeks longer. You might be fine, you might not, none of us can know, all we can do is look at the figures. Death risk is fairly low. The risk of the AZ vaccine is vanishingly small, but so too are risks with other vaccines; you could be someone who gets Pfizer or Moderna and gets thrombocytopenia from that vaccine. Or you don't get offered any of them and get offered the traditional style Novovax instead.

1 in 20 get long covid; some of them are struggling with clots, new onset diabetes and other issues a year after first infection, while others just have a few months of illness largely treated at home. Do you consider long covid to be a risk worth considering, or not?