Alternatives to AstraZeneca vaccine for under 40s “could be considered” amid rise in blood clots 2

[Whichjab]

Just starting another thread as so much information still coming out. Interesting that Germany have just allowed AZ for all that want it.

Note, this is not an Anti-Vaccs thread. It is just a discussion about alternatives.

@Dementedswan I’m sorry! I honestly don’t know what I would do in your shoes. It’s encouraging that you were okay after the first and it looks like it’s rare with the 2nd. But I completely understand your concern.

@SempreSuiGeneris

Walkaround you could argue that case were it not for the position that societal risk is being prioritised over individual risk in all the messaging coming from Govt, NHS and PHE.

If you as an individual have a lower than average Covid risk, regardless of prevalence, due to health and lifestyle factors but a higher than average vaccine risk then you need much more transparent messaging around Covid risks and vaccine risks to make an informed choice.

Even the age stratified data from a couple of weeks back didn't bother to differentiate "Covid risk" in under 30s between M/F and underlying risk factor/no underlying risk factor. Information is openly available but regularly ignored in public briefings. This is despite them giving multiple versions of prevalence stats.

@SempreSuiGeneris - the charts people keep bandying about prove that societal risk affects personal risk-benefit analysis in any event, so you cannot ignore societal risk when assessing personal risk in any event. Also, nobody understands covid risks nor vaccine risks sufficiently to be able to calculate an accurate personal risk on an individual level. Everyone is looking at crude statistics in the midst of a pandemic.

The two charts posted above are different? Are they from different weeks?

@EducatingArti

"If large portions of the population are vaccinated with AZ then we're massively vulnerable to the SA variant." But still less than if they aren't vaccinated at all There's an interesting situation in Bolton at the moment. Cases of one of the Indian variants has shot up so that they are now over 100 people per 100000 with Covid compared to 22 in England as a whole. However these high rates exactly correlate to the areas that have been significantly lower in uptake of vaccines.

Vaccination with AZ is probably worse than nothing when it comes to the SA variant as it's not efficacious enough to make up for the change of behaviour in the vaccinated. And it's not AZ or nothing, it's AZ or one of two much more safe and effective vaccines. Maybe if they'd been less reliant on AZ then people could have been offered a choice from the SA start and vaccine uptake would have been higher.

@Iceniii I've just noticed that. That's even worse. Equal risk vs benefit.

[quote whataballbag]@Belladonna12 do we know the risk is lower with the second vaccine though? Given that the vast majority of those who have received a second AZ dose will still be within the 28 days? [/quote]
I'm going on the fact that they say it is similar to the rare immune reaction that can occur with heparin . With heparin, if the immune system doesn't react at the beginning of treatment it rarely does. With the AstraZeneca vaccine the vast majority of patients were found to have antibodies to platelet factor 4.

@QueenStromba - “ Vaccination with AZ is probably worse than nothing when it comes to the SA variant as it's not efficacious enough to make up for the change of behaviour in the vaccinated.” And your evidence for this sweeping statement is?

Vaccination with AZ is probably worse than nothing when it comes to the SA variant as it's not efficacious enough to make up for the change of behaviour in the vaccinated. And it's not AZ or nothing, it's AZ or one of two much more safe and effective vaccines. Maybe if they'd been less reliant on AZ then people could have been offered a choice from the SA start and vaccine uptake would have been higher.

There are not enough Pfizer or Moderna vaccines for everybody though at the moment so it is AZ or nothing for some people.

@Iceniii

The two charts posted above are different? Are they from different weeks?

I think the second one is for women only.

Belladonna12: It is "AstraZeneca" or nothing if there is no other vaccine though. We don't have much Pfizer or Moderna at the moment so the alternative is Astra Zeneca or nothing for the time being.

This is not the case. There are statistics people on Twitter who have been keeping track of supply for weeks - Scotland releases weekly numbers of available vaccines and based on knowing the percentage of population Scotland represents, it's possible to calculate the allocation for other parts of the UK.

The UK currently has millions of Pfizer doses stockpiled (on top of what is needed for 2nd doses), presumably partly because they knew this decision was coming. There are also still more Pfizer and Moderna deliveries coming in on a weekly basis. The 30-39 age group is only 4.5 million people in total and many have already been vaccinated early due to their jobs, being CEV/CV or because they got leftover jabs/their GP surgery was ahead/etc. So that probably leaves around 3.5-4 million at most still needing to be vaccinated in that age group - so around 8 million doses in total.

Novavax is also due to be approved anytime now (initially it was due to happen late April/early May) and they have been producing since February so there will be millions of doses ready to go as soon as it's approved. It's not an adenovirus vector vaccine like AZ and J&J so hopefully won't have this same issue, nothing has been found so far in the trials anyway.

The charts only relate to the risk of ICU with covid if infection rates are very low. That won't necessarily be the case for much longer.

And then add in the fact that az is not as effective against variants. I find this worrying. But as I've had one dose of az before this all came out I don't have a choice now. That's the kicker for me.

So when they say 'should be offered an alternative to Astra Zeneca if one is available, as long as it means no delay in getting the vaccination' ... What if it isn't in stock at the site we go too? It doesn't necessarily mean over 40s will ONLY be offered an alternative does it, it means, if its in stock where you go to?

I really don't know what to do now. I've been going back and forth in my head literally all day (not the best use of a day off work! 🤨) I am booked for my first jab on Sunday and I can't see anything to suggest I'll get anything other than AZ at the place I'm booked in for (although I don't know that for sure obviously). I tried to rearrange my appointments this morning but was only given the option to cancel. I will probably go along to the appt and see what they say, but I can't say I will def have it BUT then I will probably be one of those people who wastes a dose and I never wanted to be that person. I'm 40, 41 in June so just about too old to be offered a choice. Ffs!

@nordica

Belladonna12: It is "AstraZeneca" or nothing if there is no other vaccine though. We don't have much Pfizer or Moderna at the moment so the alternative is Astra Zeneca or nothing for the time being.

This is not the case. There are statistics people on Twitter who have been keeping track of supply for weeks - Scotland releases weekly numbers of available vaccines and based on knowing the percentage of population Scotland represents, it's possible to calculate the allocation for other parts of the UK.

The UK currently has millions of Pfizer doses stockpiled (on top of what is needed for 2nd doses), presumably partly because they knew this decision was coming. There are also still more Pfizer and Moderna deliveries coming in on a weekly basis. The 30-39 age group is only 4.5 million people in total and many have already been vaccinated early due to their jobs, being CEV/CV or because they got leftover jabs/their GP surgery was ahead/etc. So that probably leaves around 3.5-4 million at most still needing to be vaccinated in that age group - so around 8 million doses in total.

Novavax is also due to be approved anytime now (initially it was due to happen late April/early May) and they have been producing since February so there will be millions of doses ready to go as soon as it's approved. It's not an adenovirus vector vaccine like AZ and J&J so hopefully won't have this same issue, nothing has been found so far in the trials anyway.

I haven't said that they don't have enough Pfizer to cover the 30 to 39 age group but they're not the only people who haven't been vaccinated! I thought that we had only received 500,000 Moderna vaccine so far. If we know how much is already in the UK then perhaps give the figure? Is it enough for everybody? We may have Novavax in the future but we don't have it yet. Therefore, as I said it is AstraZeneca or nothing for some people at the moment.

[quote Walkaround]@QueenStromba - “ Vaccination with AZ is probably worse than nothing when it comes to the SA variant as it's not efficacious enough to make up for the change of behaviour in the vaccinated.” And your evidence for this sweeping statement is?[/quote]
www.nejm.org/doi/full/10.1056/NEJMoa2102214

@Belladonna12 Thankyou that's really helpful

@rainbowfairydust

So when they say 'should be offered an alternative to Astra Zeneca if one is available, as long as it means no delay in getting the vaccination' ... What if it isn't in stock at the site we go too? It doesn't necessarily mean over 40s will ONLY be offered an alternative does it, it means, if its in stock where you go to?

I expect the booking system will be adjusted to deal with this as the system already knows which site has which vaccine and when (otherwise it wouldn't be able to let you book your 1st and 2nd doses at the same time and make sure you get the same vaccine).

You won't be able to go to your local pharmacy and get Pfizer no, as they still won't have the storage facilities for it.

Adam Finn was on the BBC earlier explaining that the vast majority of 30-39s will get Pfizer/Moderna but there may be some instances where it is not possible to get those locally anyway due to logistics. Everyone should have a choice to opt for it though but it may mean travelling further or waiting a little longer. AZ will still be an option for those who want it in those instances if they prefer to take AZ and not wait.

QueenStromba

This study produces very large confidence intervals (given its relatively small size).

It is also based on a sub-optimal interval between the two doses (under 35 days). AZ is much more effective when the gap is extended.

Real-life evidence (an outbreak in Lambeth care home) suggests that AZ is still effective (especially against severe outcomes) even though its efficacy is reduced.

Those updated charts are very interesting, thanks for posting them. So at the moment, for women in their 40s the risk of the vaccine does NOT outweigh the benefits. It is what the Ema chart showed too. Fwiw I believe the clotting risk to this age group will eventually turn out to be higher than 1.2 in 100,000. Especially for women. We will see how the data develops but it’s looking highly likely that the risk rate is heading in that direction. So the cutoff should have been 50 or even better, 60. And yes I get the whole thing with supply issues and not wanting to slow down the vaccination programme, but other countries have rightly put the safety of people first, even if that has meant a setback in the fight against the pandemic. They are now catching up. The UK has been too dependent on AZ.

@Schulte

Those updated charts are very interesting, thanks for posting them. So at the moment, for women in their 40s the risk of the vaccine does NOT outweigh the benefits. It is what the Ema chart showed too. Fwiw I believe the clotting risk to this age group will eventually turn out to be higher than 1.2 in 100,000. Especially for women. We will see how the data develops but it’s looking highly likely that the risk rate is heading in that direction. So the cutoff should have been 50 or even better, 60. And yes I get the whole thing with supply issues and not wanting to slow down the vaccination programme, but other countries have rightly put the safety of people first, even if that has meant a setback in the fight against the pandemic. They are now catching up. The UK has been too dependent on AZ.

The UK didn't really have a choice about being "dependent" on AstraZeneca because that was the vaccine that we had ordered in advance. It is easy to say in hindsight that we should have ordered more Pfizer instead but there was no way of knowing in advance which one would be best. It made sense at the time to go with the one developed in the UK. I don't agree that it would have been putting "safety first" not to use AstraZeneca either as we have had far fewer deaths due to Covid because of it. Part of the reason that the Covid risk is low at the moment for those who haven't been vaccinated is because of those that have.

@QueenStromba - have you read the entire article you linked? Your sweeping statement is not justified scientifically, it’s patently just your personal opinion based on extremely minimal data that the AZ vaccine is worse than nothing. The article you linked also doesn’t justify waiting around for the likes of Novavax.
The S African variant is a variant of concern with respect to all current vaccines and I don’t think you are proposing we all wait until there are vaccines against the current variants of concern before we have any vaccination at all, are you?

If it did cause the same risk on second dose then for 40-49 women the vax risk would be twice the covid icu in 16w risk.

But i note that the pill does actually increase women cvst risk.

Even if fewer but some women get cvst on second dose then that would put up individual risk. Though per dose would go down

Clearly women should have been offered an alternative from a higher age.
And women have a 1/10k risk of death i think during pregnancy etc.

No one can know if not using AZ on people under 50 from say 1 April and perhaps delaying / prolonging the rollout by 3 weeks or so would really have resulted in more COVID deaths. It’s just speculation.

What we DO know though is continuing to jab younger people with AZ will result in more clot deaths.