Damned if you do
Regulators face tough choices and communication challenges as more evidence of vaccine side effects comes to light
A week is a long time in politics – and it can be a long time in a pandemic too. Last week, I talked about some very preliminary reports that there had been blood clots associated with a second Covid-19 vaccine, this one the single dose Johnson & Johnson vaccine. But, by Wednesday, reports were coming in that the US government had "paused" use of the vaccine. By that time, there were six cases of a rare type of blood clot in women under 50. The clots occurred within two weeks of vaccination, and one woman had died.
The evidence is nicely summed up by epidemiologist and Substack writer, Dr Katelyn Jetelina. In short, while a link can’t be proven at this stage, the statistics suggest that the Johnson & Johnson vaccine did cause the clots. However it’s still at a very low level, because around 7.2 million people have received the vaccine.
But, this week, I’m not focusing on whether the vaccine is causing the side effects. What captured my attention this week is the way that people have been talking about the vaccine. In particular, I was struck by comments about whether or not pausing the use of the vaccine would increase what is called “vaccine hesitancy”, or a lack of confidence in the safety of vaccination. I’ve linked to an example here, but I heard many more.
The comments about vaccine hesitancy caught my attention because they seemed to be completely on the wrong track. Surely, the primary consideration should be whether or not the vaccine is safe? It’s not that simple, of course, because safety is not absolute. But concern about how people will perceive pausing the vaccine shouldn’t be a major consideration, in my view.
Nonetheless, if people are afraid to be vaccinated when faced with a deadly disease, that can be dangerous in itself. It’s a difficult situation for regulators – what is the right thing to do, given a deadly pandemic and emerging evidence of side effects from some vaccines? In my view, the answer isn’t just about the decision to suspend use of the vaccine. What they say about it also matters.
When it comes to talking about the risk, I learned most of what I know from a book called “Responding to Community Outrage”, by American risk communicator, Peter Sandman. I’ve mentioned this book before, when I was talking about vaccines and childhood diseases. Sandman’s book and additional material on his website have a few insights into what people have been saying about the risk of blood clots from the Oxford/ Astrazeneca and Johnson & Johnson vaccines.
One of the key points in Sandman’s book is that dilemmas about risk need to be acknowledged. Yes, it’s true that the risk of dying from Covid-19 in the USA is much greater than the risk of a dangerous blood clot from a vaccine, but it would be a mistake to try and gloss over the blood clot risk. Health regulators should admit that they have a difficult choice to make. Either they allow people to receive a vaccine that may have dangerous side effects, or they deny people the chance to receive an effective vaccine in the middle of a pandemic that’s killed at least three million people around the world. Yes, on average, the statistics favour vaccination, as I’ve said in a previous article, but it’s still a difficult call, especially when those most at risk of dangerous blood clots seem to be those at lower risk from the virus.
But communication isn’t just about what you say – it’s also about what you don’t say, or rather what you shouldn’t say. Peter Sandman has some good advice here too.
The first instinct of health regulators and medical professionals may be to give reassurance, perhaps by repeatedly reminding people of how rare the blood clots are, but that won’t help. If regulators put too much emphasis on how rare the side effects are, they will leave many people feeling as if the regulators don’t care about people dying from blood clots at all. To someone concerned about vaccine safety, and less concerned about Covid-19, reassurance is more likely to make them feel that the regulators aren’t listening or don’t care about their concerns.
Also unhelpful is making comparisons with other risks. One comparison popular in the media is comparing the risk of blood clots with the risk of being struck by lightning. If you are like me, and generally in favour of vaccination, that comparison might be interesting, and probably makes instinctive sense. But it won’t help someone who is already worried about vaccines. Instead, it will leave them feeling, once again, as if their concerns aren’t being heard.
Perhaps the least useful response is illustrated by this little gem. One US expert, quoted in this Radio New Zealand article, said that six cases of blood clots out of seven million doses is “nothing to panic about”. As far as I can tell, nobody is hyperventilating, running around screaming or frozen to one spot unable to move at the thought of vaccine induced blood clots. In short, nobody is panicking.
There’s clearly a lot more to come on the story of vaccines and blood clots, so I will continue to follow the story and will provide more information next week.
The Turnstone comes out once a week. Usually, I write an original article once a fortnight and on alternate weeks I share some of my older writing that’s not yet on Substack, or some links related to the previous week’s article.
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