Why the concern about vaccine blood clotting?
The AstraZeneca vaccine causes an unusual blood clotting syndrome in about 10 out of a million recipients, and it’s not entirely clear whether the J&J vaccine also does and at what frequency. Those are small numbers, compared to other risks. In particular, if you’re in a country with Covid, they are small compared to the risk of getting Covid and having some serious harm as a result. So why has there been so much concern?
There are a few components to the concern, but one underlying commonality: the clotting is unexpected and poorly understood. Patients turn up with blood clots in unusual places and a shortage of platelets (which you’d normally think of as going with not enough clotting). Some obvious treatments — a standard anticlotting drug (heparin) or a transfusion of platelets — are likely to make things worse, so doctors need to know. There isn’t a really compelling model for how the vaccine causes the problem.
If the risk is 10 in a million, taking the vaccine would still be way safer than not taking it, but a lot of the concerns prompting further urgent investigation would have been whether it’s really only 10 in a million, since we don’t understand (in any detail) what’s going on
- have we missed a bunch of cases — remember that initially the risk was thought to be only about 1 in a million?
- are these just the most serious cases, the tip of the iceberg, with many more milder, but still serious, cases that haven’t been noticed yet?
- are these just the earliest-developing cases, with many more on the way?
- is this a batch problem, with some batches of vaccine potentially having a much higher risk?
- does the problem occur in an identifiable small group of people, who would thus be at much higher risk?
There’s been enough data and enough time now to start being confident that the answer to all these questions is ‘no’. One might rationally prefer the mRNA vaccines, which don’t have this problem, but if you live somewhere with an active outbreak and the choice was the AZ vaccine now or the Moderna vaccine in a month or two, the clotting risk shouldn’t change your decision — and the fact that it wasn’t kept secret should be reassuring.