The Observer is one of Britain’s oldest newspapers. It is published Sundays (effectively as the Sunday edition of The Guardian). Its science and environment editor Robin McKie has an article about vaccination and “political folly”  He considers the brouhaha surrounding Covid-19 Vaccine AstraZeneca (as it is now called. It used to be AZD1222. I shall call it VaccAZ here.)

McKie calls Germany’s and other European lands’ latest restrictions on VaccAZ a “dangerous act of political folly“. Strong words. He better have a good argument. But he doesn’t. In fact, he flubs it, as I shall explain.

There are many things about his article worth commenting.

First, his figures. “….. seven deaths among a total of 30 rare blood-clotting cases ….. that occurred among 18 million recipients of the AstraZeneca jab……..”

I don’t know where those figures come from. In Germany it was, as of early last week, 31 cases of CSVT in 2.6m jabs. End of last week, GB revised its figures up from 4 in 13.7m VaccAZ jabs to “22 CSVTs and 8 others”  (figures from private correspondence with a senior scientist). Wow, surprising what you find when you look harder. And that doesn’t yet take into account NL, DK, AT or Iceland, other countries which have seen cases and reacted.

Second, it is not CSVT alone that is of concern. It is CSVT+thrombocytopenia, two phenomena that are physiological opposites. Thrombocytopenia is associated with bleeding disorder, not with clotting. But in these cases clotting is happening as well. It was fingered by Andreas Greinacher, Sabine Eichinger and colleagues at the Uni Greifswald, Uni Vienna, McMaster Uni in Ontario, and the Paul Ehlich Institute (Germany’s vaccine authority). There is a fuller story by Kai Kupferschmidt and Gretchen Vogel in AAAS Science on 2021-03-27, as well as a helpful physiological commentary by Derek Lowe.

Third, the PIT phenomenon, as I shall call it, is not reified in the statistics. (Professor Greinacher seems to want to call it VIPIT, “VI” standing for vaccine-induced. As I read it, I don’t think he or anyone knows that yet. I’d be happier with VAPIT, for “vaccine-associated”, but here I’ll just write PIT.)  Some Danish researchers undertook a thorough study of Danish records of thrombotic events and found nothing that deviates from background in this Correspondence article published in The Lancet on 2021-03-30. That is partly because of classification. PIT doesn’t exist yet. They also didn’t mention anything about HIT (a similar phenomenon which Professor Greinacher has been researching for decades). Many odd and rare conditions won’t necessarily be effectively diagnosed and so only make it into the numbers in a general way. Consequently no one knows what background rates are. This is related to the fourth point.

Fourth, medicine is ontologically malleable. Most things exist, or they don’t. Your car. You. The cup of tea you are drinking. Other “things” are less clear. Does a Zeitgeist exist, or does it not? You can say there is “something” going on, mention phenomena which seem to explain that “something”, and read essays about it that make sense and seem to explain a lot about people’s behaviour in your neighbourhood. But, when you try to be more specific, everything disappears into the ether. Zeitgeist is ontologically malleable.

So can diseases be. CE/MFS is now reified, but for many years it was not. There were/are no organic manifestations. The profile of people presenting with it, and the obvious fact that many or most of them are neither dissimulating nor malingering, as well as its prevalence, finally got it reified. It is now “a disease” and you can “have it”, whereas 25 years ago it wasn’t and you couldn’t. There are once-only diseases such as encephalitis lethargica, which occurred once only in time and place, but whose sufferers were institutionalised well into the 1980’s. And there is now long-Covid.

Fifth, whatever one’s attitude towards it, a phenomenology is being notated, that of PIT, and that phenomenology is not illusory. PIT may stay, or vanish. My current guess is that it will stay, but the understanding of it may well change considerably. As far as I can tell, any association with VaccAZ is at time of writing wide open. Medics everywhere are now phenomenologically sensitised, through experience with Covid. There are plenty of never-before-seen phenomena, such as MIS-C, and it may be that people have started noticing something with PIT that had not yet been well classified. Kupferschmidt and Vogel’s story in Science reads like classical medical detective work.

Sixth, politics cannot ignore the situation with PIT. Here, I suggest McKie is exhibiting his cultural straightjacket by calling European reactions “political folly“. It is not a pure matter of existing statistics and calculation of “risk”. A French minister could be criminally prosecuted for hesitant lockdown decisions that some people believe cost 20,000 lives (some senior British scientists have proposed that waiting a week on the March 2020 lockdown  led to 20,000 more deaths). I don’t think such a process is available in English law (but IANAL). Similarly, in Germany, if a new medical phenomenon such as PIT has been identified and government ministers do not take it into account, the Government could be held liable and ministers be prosecuted, quite apart from any civil liability. Again, not in English law.  Germany’s senior politicians are (mostly) not stupid. Neither do they want to end up in jail.

Finally:
Concerning alleged “political folly”, there is in fact loud clamour in Germany for proceeding with vaccination as fast as one can, including with VaccAZ. I don’t know any leading politician who has not proposed it. (There is, of course, a difference between proposing something and putting the legal and logistical structures in place to have it happen. One can well say one thing and do another.)  The main problem still seems to be supply.

I would rather suggest that, in fact, a political opportunity arose and has been taken. Within a week, the German vaccination strategies have become much more liberal (yes, plural: there are 16 of them, one for each state, nominally “coordinated” by the Fed). A week ago, it was “over-70’s first from April 8 on“. On Wednesday my state of Nordrhein-Westfalen (NRW) changed to “anyone over 60 can get an AZ jab from April 4 on“. NRW received 450,000 extra AZ doses and has 3.8m inhabitants between the ages of 60 and 70, of whom I am one. Now, that is a sensible strategy for getting VaccAZ into people’s arms. My appointment is Easter Monday morning, early. The WWW booking site was enabled yesterday (Easter Saturday) morning at 0900 (actually about ten minutes before that) and was instantly overloaded.  My local newspaper is saying  that in my local region just over 113,000 appointments were made on Saturday, and NRW-wide just over 213,000. Not bad for one day. So much for vaccine hesitancy.