> Public health bureaucrats have some weird habits in how they reason under uncertainty and how they communicate to the public. It might help if they sought out experts from economics, sociology, psychology, etc., instead of telling everyone to stay in the their lane.
* Hormonal birth control - years of research. Years of evidence and practice. Knowing what to do when this and that happens. Recommendations for women with known conditions not to take this and that hormonal birth control.
* Novel vaccination - barely month of research. Weeks of evidence and practice. We don't have best practices yet.
I'm fine with anyone to make a decision on them own to take these vaccinations. As someone with a not-so-uncommon mutation causing thrombosis easily, I'm happy I hesitated and haven't received either J&J or AstraZeneca.
> * Novel vaccination - barely month of research. Weeks of evidence and practice. We don't have best practices yet.
That is completely untrue. This vaccine has been through several clinical trials for months. We know that there are no side effects that are common enough to be of real concern. The reason we are only seeing this one now is that it is so rare.
The clinical trials have been for months on limited numbers of people. Given this seems to be a 1 in a million situation the odds are against those trials discovering them.
Actually they did notice extra blood clots during the trials, but didn't think it was statistically significant [0] (15 blood clots versus 10 in the placebo group, in a trial of 20k people).
Not a doctor, but from what I've heard from immunologists, vaccines in general are incredibly unlikely to have long-term side effects on the scales that you think about. When an immunologist talks about "long-term side effects" of a vaccination, they're usually considering time ranges on the order of 6-8 weeks. Meanwhile, the 10000s of patients from the big Phase 3 trials have been vaccinated for 6-9 months, so the usual scale of long-term side effects has long been registered.
That's not to say that it's completely out of the question that there will be long-long-term side effects. But if anything is going to cause long-term issues, my money is on the virus, not any vaccine.
Apparently there were studies on adenovirus 5 vector vaccines against HIV in 2007. The vaccine was not successful, but I cannot find any data on long-term adverse effects.
Plenty of replication deficient things cause cancer, for example asbestos or igf-1. I highly doubt you can rule out accidental crosstalk between elicited immune antibodies and every oncogenic human receptor.
mRNA vaccines are a new way to cause the body to develop an immune response - it's not using dead/deactivated tissue of the virus that the body detects and then its holistic system develops a response to. From my current understanding with this new type of vaccine it's skipping step(s), bypassing mechanisms, that leads to the body producing something that targets the "spike" of the virus - basically making it inoperable.
I don't think we know long-term how this may impact the immune system: does bypassing certain systems/mechanisms cause other problems with future immune response?
It took how long for us to realize as common sense that use of antibiotics allows superbugs to more likely evolve?
> Not a doctor, but from what I've heard from immunologists, vaccines in general are incredibly unlikely to have long-term side effects on the scales that you think about.
Fair enough, but the comment I responded to said: "We know that there are no side effects that are common enough to be of real concern."
Given this statement is not qualified for timescale, I want to know what the basis for it is.
How does the person who made it know there are no side effects on the order of six months or a year that are common enough to be a concern?
Look I am all happy chappy with the vaccine, I will inject that sweet MRNA Pfizer or Moderna vaccines as soon as someone lets me at it, but I still think we need to avoid what Fauci does, which is knowingly lie in order to get people to do what we want them to do.
There is blood clotting risk from AZ? Great, tell me what the risk is and I can deal with it, but lie to me and we are done talking.
You can never know anything for sure. This is why science, medicine and drug approvals are all about probabilities and calculated risks. If everyone suddenly dropped dead 10 years after taking a drug that was approved in 2015 there is no way we could know that right now. But we know it's very, very unlikely, so we accept that risk.
With vaccines we know from decades of experience that severe side effects tend to occur very shortly (days or maybe weeks) after the injection. So this is why vaccine trials observe participants for weeks or months, not years, before concluding that the vaccine is safe. Of course this doesn't guarantee that the Covid vaccine don't happen to be an exception. But if that was the approach we took then we would never be able to approve anything, and never get the benefits we know for sure it brings.
Fair enough, I clearly should have phrased that differently. I simplified the wording at the cost of accuracy. The correct wording would be "We know that it is highly unlikely that there are any side effects that ...".
Thanks, that is a much more reasonable statement, and I agree. On the one hand we don't know, but on the other hand a lack of knowledge does not mean everything has equal probabilities.
I personally don't see any good reason to think that the risk for long term side effects from the vaccine is higher for the vaccine than for COVID itself.
Your deficiency is that you're not a time traveller. You can't know what the long term consequences are no matter how many studies you do, until the long term has come to pass.
You can however guess, and make good guesses (I'm planning on getting the vaccine). But it does no one any good to fail to outline unknowns that are steelmanned by "we can't possibly know".
People need to remember that we're not taking the vaccine for fun, we're taking it because COVID is out there and we know for certain that it has some lethal side effects as well as non-lethal side effects and possibly other long-term side effects that we don't yet know about. We weigh that risk against the risk that there might be some long-term side effects of the vaccine. To the best of our knowledge, the risks posed by COVID are more dire than those posed by the vaccines and we basically have to choose one.
Maybe you responded to the wrong person. I am in no way suggesting it is better to not take the vaccine, or that there is good reason to think that the risks posed by COVID are less dire than those posed by the vaccines.
> Given this statement is not qualified for timescale
Keep in mind that we also don't know the long-term effects of COVID-19. It's possible that people who were infected with mild cases drop dead 1 year and 6 months after the infection. The disease hasn't been around that long, so we simply don't know.
mRNA has a short life span. It merely tricks the body into producing the spike protein. It breaks down in the body fairly rapidly. What long term effects would you anticipate from this?
There is a good chance for long term effects from covid. Completely the opposite for the vaccine.
I think the concerns would be around the delivery vehicle, which presumably is some big polycationic lipid thing.
From what I can gather, there’s not terribly much info on what’s known about what’s going into people’s bodies, and what info does exist has arisen from a thick soup of trade secrets and conflicts-of-interest.
> What long term effects would you anticipate from this?
Maybe you are responding to the wrong person? I never made any claims regarding what long term effects to anticipate. I asked how the person I responded to know there are no serious side effects on time scales longer than we have tested things on.
> There is a good chance for long term effects from covid. Completely the opposite for the vaccine.
You kind of answer your own question : only time will tell, ironically, and nobody else.
Also, to all those saying "clinical trials have succeeded", I strongly suggest them to read said published trial results and look at _measured_ sample sizes used in the results, not total inoculation numbers.
Applying the precautionary principle, particularly if you are not at risk, is a perfectly reasonable position, IMHO.
> We know that there are no side effects that are common enough to be of real concern
No, we can't know that. Some affects don't show up for a long time. One example is women.
Women's bodies are complex because they go through so many changes. These changes affect how they respond to medical treatments. In other words:
- Just because pre-menopause women respond well doesn't mean post-menopause women will.
- Just because pre- or post-menopause women respond well doesn't mean women who are going through menopause respond well.
- Just because non-pregnant women respond well to the vaccine for a month doesn't mean that pregnant women will respond well.
- Just because 6-month pregnant women respond well doesn't mean 3-month pregnant women will respond well.
- Any issues with the vaccine during pregnancy may not show up until after the child is born.
- Women's hormones are fluctuating wildly at the beginning and after pregnancy. These are also times that need a lot of representation in the study.
In fact, the amount of change women's bodies undergo affects medical treatment so much that many clinical trials deliberately under-represent women to simplify the study, and then use the results of the trial to recommend prescriptions for women.
Factor V Leiden gang represent. Afaik AZ clotting is caused through a different mechanism though. Have there been any official recommendations for us thick-blooded folk?
Citing "years of research" that nevertheless demonstrate a product has side effects as bad or worse as a reason something should be allowed is status quo bias.
It goes even deeper than that. I have seen that meme catch on in so many feminist Twitter and Instagram accounts that it is essential to look at the play here.
The "you woudn't care about women dying" narrative completely derails the essential discussion (aka when do we determine vaccine to be save) by selectively picking facts from a completely unrelated health area to turn it into an activist subject.
It reminds me on the magnet-troll-logic memes, only this one trying to come up with the completely insane narrative: "If you are concerned of a few more people dying because of a vaccine, you hate women."
The narrative - and I think it's a correct one - is "we accept far riskier interventions in our everyday lives already, of which birth control is one good example".
I'm not saying your calculus is wrong but this does make an assumption that all clots are created equal and I don't believe that is the case.
The specific issue being observed is "cerebral venous sinus thrombosis (CVST)" in combination with "low levels of blood platelets (thrombocytopenia)" per the Joint CDC and FDA statement (1).
Low blood platelets means anti-clotting treatments can pose a substantial bleeding increase, making this already dangerous condition difficult to treat.
To add, from the German Federal Institute for Vaccines (regarding AZ not J&J):
> Birth control pills can also cause thrombosis. So why is there all the fuss about the COVID-19 Vaccine AstraZeneca?
> It is true that for birth control pills thromboses, even with fatal outcome, are known as a very rare side effect. They are listed in the Summary of Product Characteristics (SmPC). The birth control pill is available only on prescription. Every woman must be informed of this risk by the prescribing physician. For the COVID-19 Vaccine AstraZeneca, there is currently a suspected very rare side effect of sinus vein thrombosis with accompanying platelet deficiency, sometimes fatal. It is not listed in the SmPC.
And we know adenoviruses interfere with the coagulation cascade through FX binding, so it’s well worth taking a pause and taking a closer look into what’s going on. With two well-tolerated and safe mRNA vaccines in the market, we can afford — to a degree! — to put Ad-based vaccines through additional scrutiny, especially since they’re likely to be the primary vaccine type on a global level.
I agree if you're in the US or in any other place with abundant supply of other vaccines. If you're in a place like the EU, like myself, every single dose counts and a setback can seriously screw things up.
Yeah, that “to a degree” is US-centric and, even then, doing a lot of work — in the US, J&J is probably about 1/3 of the total vaccinations when accounting for the prime/boost mRNA protocol, so even here it’s a mess, and we’re in much better shape than the rest of the world.
Sorry, what’s the effect adenoviruses have on FX? I’m a male with a mild hypercoag disorder and history of DVT. Am scheduled to get the JJ vax today and will be skipping and seeking out mRNA instead.
Not a doctor, so talk to your hematologist! Ads bind to blood factors (Ad5s to FX, HAdVs to FIX, etc), which facilitates organ uptake and interferes with the coagulation cascade and triggers complement activation. Thrombotic thrombocytopenia is a known complication from gene therapy studies, so it’s not surprising, but concerning, that rare but serious coagulatory disorders are appearing in the widespread use of a zoonotic adenovirus. I’m certain quite a few other folks on here are better-informed than me, so hopefully we’ll get some more discussions going on this topic.
I’ll also say that the most significant risk is probably mistreatment of clots, since most doctors probably wouldn’t go right to non-heparin/warfarin DTIs unless they had reason to suspect HIT or had gotten a CBC back.
> Cerebral venous sinus thrombosis is rare, with an estimated 3-4 cases per million annual incidence in adults. While it may occur in all age groups, it is most common in the third decade. 75% are female. [0]
6 cases in 7 million over 3 months with mostly women being affected is exactly what we'd expect to see.
There's lots of other things to compare it to as well. It's a roughly 1 in a million chance of dying - which is called a Micromort https://en.wikipedia.org/wiki/Micromort
We 'spend' about one micromort of risk per day of being alive. Or you can spend one walking for 6 hours, or driving 250 miles (or 6 miles on a motorbike)
I just made a website to show all the other stuff we do all the time without worrying with the same (extremely low) level of risk
One caution here; at least with AZ, apparent rate of clots varied dramatically by country, and rates generally went up once people knew what they were looking for. It's plausible that a lot of early ones were missed entirely or misattributed.
That's 6 unusual/dangerous cerebral clots per 7 million doses, not all blood clots. There were 50% more clots of any types in the vaccine trials of 20k people [0] (15 blood clots in vaccinated group versus 10 in the placebo group).
Ah yes, that is true! This site is based on AZ, but you're right it might be a different story with J+J. I wonder if as well, they'll get better at spotting the blood clots and treating which could also be happening - but that's just conjecture / hopeful thinking at this point.
I see IPv4 A records. I am guessing what's happening is that when you look up the DNS over IPv6, it gives you AAAA records instead of A records. Or, it can depend on locality. Cloudflare is not a DNS provider that gives the same answer to everyone -- its goal is to direct traffic to the cache that's closest to the end user.
Edit: I looked into it more and I can get IPv6 and IPv4 DNS servers to serve me both A and AAAA records. The site is now down, however :)
It meant that anyone not using IPv6 or a dual stack provider wouldn't be able to view the site through the non-www domain. However, they look identical now, so you're good.
Note that in EU it also started with 7 cases ~1 month ago. Then doctors went through the records and now there are 200+ sick, 25 people dead from CVST alone (clotting that causes bleeding in the brain) with incidence in Norway 5 out of 130000 vaccinated. If you look at women only it will probably go even higher. And if you compare that to CFR from COVID for person <50 years old without diabetes and hypertension it will be within an order of magnitude
> Then doctors went through the records and now there are 200+ sick, 25 people dead from CVST alone (clotting that causes bleeding in the brain) with incidence in Norway 5 out of 130000 vaccinated.
The point he’s trying to make is that if you’re in a low risk group (let’s say under 30 for example) maybe it’s a better idea to just skip the vaccine.
I would still take the vaccine but the point I'm making is that it's serious enough to offer younger people some other vaccine, investigate why is it happening, how to fix it (use a different vector, adjuvant or dosage?) and roll it out safely. Call it version 1.1
1 in a million chance of vaccine death for AZ. Maybe 1 in 10m for JJ. 0 in 10 for the mrna vaccines.
10 in a million chance of death from covid in the 5-9 age group (the lowest risk group)
This is the perfect example of anti-vacc logic. They pick the latter because they heighten the risk of the former in their mind, while ignoring or downplaying the risk of the latter. Looking at the actual numbers, it makes no sense for anyone at any age to take their chances with covid over the vaccine.
Can't you still spread covid if you are vaccinated? Don't you still have to wear a mask and social distance? That doesn't add up with what we are being told.
> Can't you still spread covid if you are vaccinated? Don't you still have to wear a mask and social distance?
There's been jumbled messaging on this.
The "you still need to wear a mask" thing was, if you dig in on the actual statements instead of the media headlines, "because we don't know yet". An abundance of caution.
Since then, we've gotten quite a bit of good data on that front.
> Data analysis in a study by the Israeli Health Ministry and Pfizer Inc found the Pfizer vaccine developed with Germany’s BioNTech reduces infection, including in asymptomatic cases, by 89.4% and in syptomatic cases by 93.7%.
I was just riding a government-run subway, and they had an automated announcement saying “Masks are required over the mouth and nose even for fully vaccinated people as vaccinated people can still spread coronavirus.” There was nothing muddled at all about the message. (Of course the message itself is probably wrong, but the public messaging itself is pretty clear.)
If I'm vaccinated, I'm protected. I don't really care if anyone else is vaccinated or not, as I'm not at risk from their decision. Or is this not true?
No, vaccines effectiveness can be substantially lower than 100%, so if you're vaccinated, depending on the vaccine type, you still might not be protected. It's much like the normal vaccines for the normal diseases, you don't always know if you're fully protected yourself so you end up relying on other people being vaccinated too.
We have been told we have to wear masks and socially distance with or without vaccine, so you can ABSOLUTELY still spread it even if fully vaccinated. Please follow the health guidelines and do not spread disinformation.
> "It may be that we will show that if the level of virus in your nasopharynx because you're vaccinated is so low that you don't have to worry about transmitting, that's going to be a game changer for what a vaccinated person can or cannot do," Fauci said.
> The doctor explained that if the findings are corroborated, Americans will likely see a pulling back on some restrictions, but emphasized "we're not there yet."
Note that other vaccine's that prevent infection also reduce your risk of spreading the disease (measles etc).
So the fact that COVID spreads (not just in rare cases, but enough we all have to remain masked AND socially distant even if vaccinated) is a CRAZY big difference here.
The messaging has been clear - even if vaccinated you MUST wear masks and socially distance - which shows how different this is then other viruses. Given that, it's understandable that people are a bit more meh on the vaccines - because you can still spread it to others either way.
I do wonder about the experts messaging at times. Initially I thought airbone virus, began wearing my leftover N95's from wildfire season. Then they said those don't stop this airborne virus and to take them off. Then they said put them back on. and on it goes.
It's highly likely that natural infection provides worse protection that vaccination and we have real world evidence that already suggests this.
1. Two exposures to the spike protein are likely to create a much better long term immune response simply because of multiple exposures in a short period of time.
2. The spike protein produced by the mRNA and J&J vaccines is engineered to produce better response against variants.
3. We've already seen evidence of natural infection performing poorly in rural parts of Brazil with very high initial infection rates (> 70% which is near the herd immunity threshold) like Manaus where we're seeing significant evidence of reinfection where it should be have been difficult for COVID to spread.
1. The current mRNA vaccine, only produces antibodies to the spike protein. A natural immunity produces antibodies to several components of the virus. If the virus mutates its spike, a natural immunity will still provide some protection.
2. A vaccine producing (IIRC) two orders of magnitude more antibodies than natural immunity is not necessarily a good thing.
Put your life on the line for the community, comrade! And sign away your right to legal recourse should you die as a result. You're on your own! You owe the community your life, and the community owes you nothing!
I think there's a really big difference between being FORCED to get the vaccine, and being reminded that your actions have consequences on other people and not just on yourself. Nobody is saying that you should be required to get vaccinated. So really this is just a straw man that you're burning down.
I'd rather all the people gaslighting the public by saying the vaccines are completely safe, totally worth any risk, "trust the experts", etc - when in reality young people seem to have a better chance of dying from CVT than COVID - move to a deserted island.
If the real argument is "the cure has a better chance of killing you than the disease, but please risk your life for the community", I'd rather people be honest and say that in the first place.
Please link results of the study that supports your statements of mortality among young people. In USA alone more than 10k young people died from COVID so far. JJ vaccine has one potentially linked death after 6 million doses.
Possibly they are nervous because it could signal deeper problems. If there is anything people should have learned from the pandemic is that it takes a few months for the medical profession to sort themselves out when new data appears on the scene.
This is the thing. A similar issue was seen with heparin a decade or so back. Basically the heparin molecule (an impurity I believe) was causing an immune reaction that cross reacted with a protein that activates platelets. Not a minor side effect and until the full extent of the issue is known (who is at high risk? How do we treat if it happens) I don’t blame them for being cautious.
Your sympathy for them being cautious begs the question of whether the vaccine, with its uncertainty, is worth using. The cost of waiting to use it is significant - people will die from COVID.
It's not enough to say you're being cautious. You have to explain why you think it is better to be cautious about administering the vaccine with its attendant risks or to pay the QALYs incurred by the delay when people who would have received this vaccine don't.
Pausing this one vaccine type to collect data and determine appropriate actions to mitigate this side effect is reasonable.
This is a low probability event, and the appropriate mitigation may be to do nothing; but there may be some common factor for these patients that might indicate use of a different vaccine or maybe informing people of symptoms of blood clots and what to do if they see symptoms.
The real risk here is eroding confidence in government health sources in general, and vaccines in specific. There were certainly unknown risks before, but now there is a known risk which deserves some study.
We've now got a known risk that's quantifiable, but hasn't been quantified. You can estimate the risk based on the current information, but now that it's a known risk, I would expect to have more complete information in a few weeks.
If this turns out to be about what it looks like now, unpause and go forward. If it turns out to be much more significant, all the better for having stopped; maybe restrict this vaccine to populations at higher risk of COVID or lower risk of blood clots (if that risk can be determined). Both mRNA vaccines and modified adenovirus vaccines are new types of vaccines not used before on a wide scale; pausing to get clarity on a major negative side effect is warranted.
You've hinted at a framework for making a decision but left out an important component.
A credible decision would give your estimates of harm/benefit for delaying vaccinating people. You seem all too willing to ignore the people who will become sick or die because of delaying the vaccine. You are only looking at potential harm from not delaying the vaccine. Unfortunately, you have a lot of company.
> A credible decision would give your estimates of harm/benefit for delaying vaccinating people.
It seems to me that the delay imposed by a pause in use of the J&J vaccine to make sure healthcare providers are informed of and have appropriately updated diagnostic and treatment protocols is minor, its basically pulling forward by a few days the effects of the 80% week-over-week drop in J&J vaccine supply that was just in the news.
The risk isn't just the blood clots, it's that the vaccine is perceived as rushed (it was) and warning signs were ignored, so maybe other things were ignored.
Leading to more people delaying their vaccination. Supply is currently at a level that all doses available are administered, but to the extent lost confidence results in longer delay for high risk patients, that has a cost. When supply exceeds demand, lost confidence will have a cost for those low risk people who delay, as well as the general population which loses out on wider immunity. Delaying the vaccine now certainly also has some cost of the same type, but it's bounded. Another case of a vaccine campaign ignoring warning signs and proceeding without pausing to consider appropriate response to issues as they arise will affect this campaign as well as future campaigns.
I don't think anyone would disagree that if there were no cost to delaying supplies of the vaccine then we should do that. But that's simply not credible. The governor of Michigan seems to think that additional vaccine doses would be helpful.[1]
Suggesting that effects on the order of the ones seen here is a good reason to delay the vaccine should make people doubt the ability of our public health authorities to make reasonable tradeoffs.
All of a sudden we need a QALY analysis to justify an immediate reaction from the government? Things sure have changed in the past couple hours when it comes to What people think is required of America’s COVID19 response.
I doubt the correct communication strategy is obvious. Rumors about people dying from a vaccine can be worse than a pause.
A legitimate reason for the pause is to assess whether the people impacted have anything else in common. There are alternative vaccines that can be used if a commonality is identified.
As far as hesitancy, the idiot media already does a story for every vaccinated person that gets sick, this isn't going to tip huge swaths of people in either direction.
People keep saying this will add to vaccine hesitancy but I'm not convinced. The vaccine-hesitant are already skeptical of authorities and aren't going to be especially reassured just because US agencies say it's fine, when it's already hit the news that European agencies have halted J&J.
Seeing US agencies halting J&J while continuing the other vaccines could even be reassuring. It shows that US agencies really are pretty cautious, and are willing to halt vaccines that show signs of problems.
What we've seen in the US is that the J&J was the choice of people who legitimately wanted a vaccine but were leery of the novelty of the mRNA vaccines. This is going to crush that group of candidates and some non-zero number of them will wind up in the camp of people who don't get vaccinated at all.
What you will find is that the vaccine-hesitant are perfectly happy to take the word of authorities who say "this vaccine is unsafe" and only have trouble accepting the word of authorities who say "this vaccine is safe".
I think that is likely because the two states have different levels of confidence, similar to how "not guilty" is not the same state as "innocent". It is relatively easy to identify unsafe, especially when negative effects arise quickly. It is harder to reliably determine safe as it may just be a matter of time before negative effects arise.
For people who won't accept the vaccine regardless, it doesn't matter either way. For people who can be convinced, I think that obvious evidence of caution may be helpful in convincing them.
Seems like a “damned if you do, damned if you don’t” kind of scenario. If you don’t pause the rollout, there will be news articles that the government ignored deadly side effects, resulting in lack of trust and vaccine hesitancy. If you do pause the rollout, you get vaccine hesitancy.
Agreed that if everyone is rational/good at math the optimal outcome is proceed with dosing, but sadly that is not the world we live in and the “broken trust” scenario might be more damaging.
This is a highly unusual situation insofar as phase III monitoring is far from complete and there is no 'phase IV' (confirmatory) trial data at all yet. In the normal course of research, this is how we'd catch rare but consistent adverse effects.
So, if we had complete trials on a normal timeframe, then obviously there's a different calculus to apply.
But given what we know at this moment, these six incidents might actually be far more normal than the crude use of six as numerator and seven million as a denominator.
A pause to assess the data and allow any lag to resolve seems prudent.
And, while this will be very difficult to quantify until much later, if then, I surmise that this will only create temporary vaccine hesitancy and only outside the high-risk tier, which is perfectly rational.
For people in the low-risk tier, there's nothing wrong with waiting until the conclusion of the RCT monitoring in the first place, even if adverse events weren't the basis of that decision.
I don't disagree. But I will observe that many people in the low(er) risk tier are going to be traveling, eating out, having parties, etc. sooner rather than later--vaccine or not. In my very Blue state people are very obviously relaxing a whole lot more. So the question isn't whether things open up or not. It's whether people are vaccinated when they do. (Which doesn't mean all vaccines are equally safe.)
It seems like people in the low-risk tier might be more likely to get J&J. Firstly, it's just the one shot and secondly, people who are worried about COVID are vaccine shopping because they want the perceived "higher efficacy" of the mRNA vaccines vs J&J (whereas lower-risk people might be more interested in vaccine passports than preventing symptoms).
Maybe. In a lot of places you don't really have a choice and, in the US, AFAIK the mRNA vaccines are more common. Also, while "vaccine passports" have started being discussed, they're not really a factor yet--given how many people still need to vaccinated--and may never be outside of scenarios like schools. (That said, I have heard people who see getting a vaccine as more pro forma saying they prefer J&J because it's just a single shot.)
It's pretty easy to "vaccine shop" (if you care about it) at least in the US with all of the scheduling being done online. Sure, if you go to one of the big vaccination sites, you may not get a choice, but it seems that sites offering J&J have been advertising that and ones that don't indicate seem to be Pfizer & Moderna (or if J&J, give you a choice, at least around Massachusetts).
J&J is also widely used in the US for people who might have issues with scheduling a second shot, for example people who are homeless, or are home-bound.
Fair enough. It was still quite hard to get one when I scheduled and I was going to take whatever I could get even if I favored the mRNA ones. That said, if I didn't really care about getting a vaccine but was going to get one anyway, I'd probably just choose whatever I could get most easily.
None of our societal systems are setup to do rational cost-benefit trade-offs in a pandemic.
“Don’t wear masks.” “No, no: wear masks.” “COVID kills over 10%.” “COVID kills less than 0.1%.” Once we realized the difference in makeup between the over-10% and sub-0.1% populations, we still couldn’t bring ourselves to make data-backed differentiations for many, many months (and still today have many small businesses closed or restricted based on what they do rather than the risk profile of their owners and employees).
These are difficult decisions to be sure, but when being seen as on the “safe side” confers benefits without a commensurate charge for the risk of the “safe” action, you get a society which moves in the direction of perceived safety (and where perceived safety may be strongly sub-optimal).
> 'These are difficult decisions to be sure, but when being seen as on the “safe side” confers benefits without a commensurate charge for the risk of the “safe” action, you get a society which moves in the direction of perceived safety (and where perceived safety may be strongly sub-optimal).'
yes, security theater abounds. it's a multidimensional optimization problem with no absolutely safe side in the long run, only relatively, but often initially unintuitively, safer non-linearly intertwined sets of actions. it's hypocritical to discount the tiny risk of vaccines while dramatizing the tiny (but larger) risk of death by covid. further, it's myopic to look at the risks of covid in isolation (which is what all the frenzy around it has been doing for over a year) rather than in relation to all the similar risks in our lives and couching our responses now within our existing responses to those other ongoing risks.
That's the thing. Pausing the vaccine will kill people. Judging by the numbers so far - probably more people. But different and older people.
How does one do that math ethically? There are risks if you do and risks if you don't. The FDA is the wrong group to make that call, because they're only concerned with the first kind of risk.
In Canada we reserved the Astra Zenica vaccine for people over 55 because of the blood clot issue. I think that's probably the right call.
This article [0] mentions 50% more blood clots observed during vaccine trials, which at the time was characterized as a slight numerical imbalance (15 blood clots versus 10 in the placebo group, in a trial of 20k people)
The obvious difference is that the vaccine is being forced upon people. A woman can talk to her doctor, understand the risk, and decide to take birth control or not.
The vaccine was given to people, under threat of exclusion from society, without knowledge of the side effects. Not comparable.
Why is it relevant? So far nobody forces me to take birth control and threatens for exclude me from the society if I refuse to do so (UK wants to require vaccine passports to go to cinema, for example). Nobody paints me as stupid anti-vaxxer if I just say I don't want to take BC pills. Nobody tells me that I won't be able to travel unless I agree to take BC.
I am a guy, so maybe I don't know what I am talking about. But I have a strong suspicion that the consequences for young women that chose not to take birth control pills can be felt as well and that they often feel quite a pressure from friends, boyfriends, parents, etc. to take the pill.
I am sorry, this is the whole other level. First of all, you are not obliged to discuss your medication with friends or parents. Second, your reply is pretty much like:
>> In China you disappear if you publicly say bad things about CCP.
> Yeah, I know what you mean, I called somebody motherfucker and got banned on HN. Freedom of speech is nowhere these days.
People keep repeating this myth of birth control. I don't know how doctors do their job in other countries but if they look at the patients health history this number is a myth. Luckily health officials here (ETA: Denmark) inform about these myths on television whenever the government holds a press conference about new Covid-19 measures but this isn't so everywhere so please stop spreading FUD.
ETA: I see you made ninja edits to your comment....
Edit 2: So now you replied that you only added a word or two and then deleted you comment while I were replying. Your comment was only half as long when I replied (all the Twitter stuff wasn't there for example).
> The former is rarely lethal, the latter most often is.
Again, we're looking at one in a million stats for getting the clots, and one in six deaths amongst that tiny group of cases - without information yet on their comorbidities.
COVID itself causes clots. A lot more than 1/1,000,000. If you're afraid of clots, get the vaccines. Even the J&J one.
Seriously I can't believe this is that simple. There is no way public health bureaucrats don't understand this common sense logic. Otherwise they would all become vaccine deniers.
Healthcare is extremely weak on science. The profession existed before the scientific method so there is a tendency to value authority over science.
Even today Physicians still think the body is Art, or a combination of Art and Science.
And the only reason we don't have a science based alternative to the Physician cartel is that they spent literally $400,000,000 on lobbying/bribery in the last 30 years.
Edit- for further reading look up "evidence based medicine debate"
> The profession existed before the scientific method so there is a tendency to value authority over science.
Anecdotally, my pediatrician has an inverted "trust pyramid" in some of their examination rooms. At the bottom—least trust—is "expert opinion."
> Even today Physicians still think the body is Art, or a combination of Art and Science.
I'm not sure why you would think these two things are opposed?
Science most broadly speaking means knowledge, and the scientific method is a means (but certainly not the only means) of acquiring knowledge. But what you do with it is art/craft. Separating the two seems unnecessarily dualistic.
I agree that on the surface these numbers are not alarming. That said I trust that the government agencies know what they are doing here. If anything there is tremendous political pressure to NOT scrutinize the vaccines.
There is enough anti-vaccine & Covid rhetoric that we should all cool it a little bit and let the experts do their jobs.
They're letting perfect -- even a single death is too many -- get in the way of good -- a small number may have shitty outcomes, but the overwhelming majority will not.
Same framework that's lead to all of the poor policy decisions over the past year.
> That said I trust that the government agencies know what they are doing here.
If 2020 didn't finally shatter that trust, is there anything that can? FDA was already obviously a regulatory capture vehicle for pharma. And CDC got nearly everything wrong in the ebola outbreak of 2014. Then, both of them blundered their way through this pandemic.
For example, we know from the email leaks that FDA felt it was under pressure from Trump to approve vaccines[0], and then never disclosed this fact to the public. That doesn't seem like dispassionate science and expertise to me.
By contrast, many of the medical journals, preprint houses, and academic institutions have looked like far more stable sources of knowledge.
It seems to me that the internet age asks us to replace our state institutions of expertise with something more thoughtful and genuinely connected to science.
Something that has fascinated me about the last year is that the pandemic has sped up the feedback loop on decisions like this. Seeing the impact of this decision won't take years and the outcome won't be unclear. In another few weeks, we'll very likely know that this was an overly cautious call that directly led to even more vaccine hesitancy, and lives lost as a result.
Paraphrasing one famous science commenter, we're playing Pandemic Trolley Problem and running over hundreds of people because we're not sure if the other path has one or two persons.
It may be ridiculous, but it seems necessary if you're managing populations of people:
Build a dam, which if it broke would kill hundreds-of-thousands, or let millions die for lack of water? Oh, we'll just over-engineer it, now we can't afford to buy food to keep the people alive long enough to need the dam; or the lead engineering firm embezzles the money and installs dodgy iron.
We can't wait around for long term studies, whatever point we decide to start vaccines - where they can still be effective for the current population - it's always possible we should have waited a bit longer.
Deaths by COVID implies that those at risk will forego all other options to decrease risk of infection, such as masks, distancing, etc. Those options are opt in the same as a vaccine, though the vaccine is 2x and done.
Nonetheless, just because version 1/2 COVID vaccines are good enough for you does not others should just jump on board when other options exist that can vastly reduce risk of infectionand/or death.
In short, blowing the death problem our of proportion unless the options are only nothing vs vaccine.
> Deaths by COVID implies that those at risk will forego all other options to decrease risk of infection, such as masks, distancing, etc.
Masks are supposed to protect others from you. Wearing a mask is not meant to help a person who may be at risk decrease his/her own risk of infection.
In any event, now that spring weather is here in the northern hemisphere and the vaccination campaign has given people hope, social-distancing rules are being flaunted in many countries and at-risk populations may find it hard to properly distance when they leave their homes for e.g. basic shopping. So, since the "other options" don’t always work, keeping up the vaccination campaign is very important to reducing infections.
While mask effectiveness may be skewed the direction you state, you can't tell me that wearing one along with other precautions has no positive impact on your own infection risk.
For those willing to receive vaccination right now under informed consent, I'm all for it. I agree people are over the pandemic and making the situation worse. I disagree with many commenters here that are shaming and/or implying that people like myself are anti-vax vs simply being willing to wait for much more evidence before jumping on board with incredibly widespread usage of an incredibly not well understood treatment.
> shaming and/or implying that people like myself are anti-vax.
I'm in a low risk bracket. My country saw an uptick in people canceling vaccination appointments. 40% of 60+ people here are now 'unsure' of taking the vaccine.
I've done nothing but work and follow the rules since this whole thing began. Young people without partners, or young people in general, that are active, have a social life did a complete 180* in their "allowed lifestyles".
I've paid with money, time, a year of my otherwise busy life, for people in risky age brackets, at _little_ benefit to myself. *
But I'm so done, don't tell me you're asking people like me to be stuck in our anti-social and unhealthy living arrangements, while there's a solution that's _safer_ than going to a covid shower?
People like me are done paying, I'm not going to wait around another year, you take the vaccine or you take covid for all I care.
Also: losing weight, getting more exercise, improving your diet, getting proper amounts of vitamins. All things that will greatly reduce your risk of death from many causes, not just COVID. But requires some effort compared to taking a pill or a shot.
Who cares how many clots birth controls produce? What matters is the outcome compared to the thing birth controls prevent - pregnancy.
Do you get more blood clots from being pregnant or from being on the pill? It's order of magnitudes more from being pregnant, therefore if you're sexually active it's safer to be on the pill compared to not.
How is this the top post? People have no knowledge of basic Bayesian statistics.
No, because there are other vaccines that don't give you blood clots at all. Your entire point is moot. Pausing temporarily to investigate is hardly controversial. The comparison with birth control is nonsensical.
A vaccination for COVID is not the same as getting birth control. Even if it was, why would you get J&J if you could get Pfizer that doesn't have the same issue?
If all vaccinations had the same blood clotting issue then perhaps you and the original poster would have a point. Given a huge disparity between them with regards to blood clotting taking a moment to investigate this is simply prudent. Making nonsensical comparisons to birth control, well, is not.
Sure, but J&J isn't being permanently discontinued. Why are you against simply pausing vaccinations to investigate this? If the USA was this prudent with COVID in its beginning we wouldn't even be having this conversation.
Your argument would be reasonable if it was being permanently suspended.
> The skepticism shows no sign of slowing, YouGov reports. While trust for the Pfizer and Moderna vaccines rose in all country surveys between December and March, trust for the AZ vaccine slipped in Germany over that span. By early March, 40% said the AZ vaccine was unsafe, an increase of 10% since its earlier December poll.
> The result? Anecdotal reports in Germany and across Europe of people refusing the AZ vaccine and supplies sitting unused in warehouse, YouGov reported—real-world evidence of “the extent of the damage done to the perceived safety of AstraZeneca vaccine.”
> The AstraZeneca jab, which is cheaper to produce and easier to store and distribute than the vaccines currently being administered across Europe from Pfizer-BioNTech and Moderna, was meant to be a workhorse of the continent’s vaccination drive. That plan could be in trouble, however, if citizens across Europe continue to believe that the AstraZeneca vaccine is unsafe and, as a result, refuse to bare their arms for it.
I believe there are significant public health implications to how information is released to the public that need to be considered better than they have been in the case of this pause and the similar case with the AZ vaccine.
I believe, as with software, that immediate release of unvetted, incomplete, and still-being-investigated information can be actively harmful to people.
J&J is paused because there are alternatives that don't have clotting to the same degree.
A comparison with birth control makes no sense. Is there some magical birth control that's used orders of magnitude more (Pfizer) and orders of magnitude safer with respect to blood clotting and also prevents pregnancy?
There currently isn't enough vaccine to meet demand. Pausing J&J distribution will cause a larger gap between supply and demand. The 7 day average of deaths from Covid in the U.S. is 985. Even a week's delay in getting to full deployment of the vaccine thus means thousands of deaths.
I am not saying outright that the pause is not justified. But it has a substantial cost, and it would be good to see that our health authorities have considered this and weighed the balance of costs and benefits. e.g. it might have made sense to pause J&J for under age X and continue it for over age X, based on relative risk.
I don't agree with your analysis, I think you can see it entirely the other way, that both this pause and the initial "wait and see" attitude towards Covid are the result of an excessive bias towards the status quo. I remember back in January-February 2020 when people were saying it would be crazy to just shut down air travel, think of the massive economic cost.
The primary concern people have here isn't the review, it's the immediate withdrawal. People who had appointments to get the J&J vaccine will now go vaccine-less until they can be rescheduled, even if they would have been happy to take it knowing about the blood clots.
Meanwhile, hormonal birth control causes clots in 1/1,000 women. No one blinks an eye.
The vaccine hesitancy this engenders is likely gonna kill more than that one person.
https://twitter.com/NateSilver538/status/1381936112311148548
> Public health bureaucrats have some weird habits in how they reason under uncertainty and how they communicate to the public. It might help if they sought out experts from economics, sociology, psychology, etc., instead of telling everyone to stay in the their lane.