Side effect worry grows for AstraZeneca vaccine
science.sciencemag.org
science.sciencemag.org
This is not how it's supposed to work, if we are supposed to be reasoning, thinking beings. Ideas are supposed to be ideas not tokens of affiliation!
I brought up Lysenkoism here a few years back. One notable reaction, upon hearing of this for the first time, was for that commenter to declare that "Lysenkoism" was then to be pattern matched as a talking point of political party W. No intellectual curiosity. No discussion on the philosophical or practical implications. Just knee-jerk us versus them.
I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
I will permit it to pass over me and through me.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing. Only I will remain.
- Mainstream news on the topic is inaccurate, *highly sensationalized*,
and is often pointedly emotionally manipulative
- The evidence is not one sided, and there is considerable signal in the
politically unpopular direction.
- Mainstream news dotes on just a few studies which support their narrative
and often don't talk about the problems with those studies, or even
when those studies are retracted
It turns out that Hydroxychloroquine isn't that great. However, Ivermectin seems to hold a lot of promise, last I checked in on research. What's more, ask yourself this: Many people expected governments and organizations to react to the pandemic by combing through huge amounts of data, to see if existing drugs might have some effect. This is what a lot of medical professionals expected would happen. This isn't what happened. Instead, independent parties and agencies in 3rd world countries had to push things like that through, seemingly despite opposition. Go and look up the underwhelming numbers from studies for Remdesivir, and then ask yourself why that drug was so pushed for awhile, when others with far better study numbers were seemingly ignored or talked down. (Could it be the price?)
My conclusion, is that even the intellectualism of our society and its science has been corrupted. The liberal values of the philosophe have been replaced with "us versus them" jingoism, dressed up in flowery language. This flowery language turns out to be all surface. It has no historical and practical substantive support, but instead has its basis on emotional appeal.
The way I read OP's comment was as a personal experience about what they've seen since joining HN 15 years ago. Are you suggesting that only "science based" comments should be top comments, and not personal experiences?
1. The general public are not scientists, yet they distrust institutions so now they want to interpret data themselves but have no training.
2. Data can be sliced and diced to tell all kinds of stories.
3. Few can look at data and know what it doesn’t answer, or what questions should be asked but aren’t being.
4. Correlation is not causation, but that escapes almost all of us.
5. The people who generally know the field the best are poor communicators generally or at least to the general public. The people who can (or do) communicate with the public are subject to a game of telephone and don’t understand the science, and don’t know how to properly communicate uncertainty or the boundaries of knowledge.
6. Ordinary people will get ordinary answers, but due to cognitive biases will few exceptional in their ability to go against the grain.
- Is there good evidence for the other side?
- If so, how does the mainstream press react to that?
- Are people trying to get others to not even look?
How the authorities react to questions, and to what degree they will try to avoid them, are themselves valuable indicators!
It's very true that the average science consumer is a lot like the average driver. There are lots of very bad ones out there. But it's only in an open society, where questions are encouraged, and where asking questions is acknowledged as speaking truth to power, where the truth will come out.
Remember when the semantic equivalent of "shut up and go along" was the very opposite of virtuous intellectualism? (And not mislabeled as intellectualism!)
Remember when we were proud of our freedom, of our societies where open inquiry was allowed and not suppressed?
The dream of the philosophe remains alive, and shall not die.
Sure. Now go and look up a dozen scientific journal articles on Hydroxychloroquine, then see if I'm pushing a false narrative about government and media pushing narratives, or if that's a pretty reasonable one. I'm fine with letting the numbers speak for themselves.
You're not even discussing the article at hand, just posting a lot of both-sides rhetoric and platitudes that will be popular because everyone that reads it will think you're talking about other people.
This both-sides stuff is actually true. Also, if everyone realizes I could just as well be talking about the other side, then they take that thinking a step further, then the philosophes win. Those who are so biased, that they can't see this, are probably unreachable anyways.
If just one person changes their mind because of actually looking at something they didn't see, or saw in a different way, we all win. I think that's very relevant.
In the long arc of history with regards to the truth, "sides" are irrelevant.
(Seriously, how is getting HN readers to ask some questions and do their own research a bad thing? That's kind of head scratchy.)
It takes significantly more time to sort though an article like this one, figure out what it's talking about and why it's just been published, pick up corroborating and/or refuting sources and articles, and turn it all into a digestible comment. Someone else can post a hot take in 5 minutes that develops into a Sierpinski Comment Tree by the time something more measured shows up.
Of course. They'll lose trust the soonest when they see political statements coming out of the WHO, etc. And they should. An organization that can't stay neutral can't do good work in a politicized climate.
> Few can look at data and know what it doesn’t answer, or what questions should be asked but aren’t being
No, this is actually one of the easiest things to teach. "If you were paid to sneak in and ruin this team's research, what simple bias could you add? If it was the other way around, how would you protect against this?"
Teaching people to recognize a poorly controlled study is not difficult. But it's not PC these days because people are supposed to shut up when told that all scientists agree! We did this to ourselves a decade ago by tolerating the climate change debacle attacking dissent, now everything is fought through fake consensus.
> Correlation is not causation, but that escapes almost all of us
When it's not it almost always means there's an unseen factor though, so that wonderfully dismissive statement is usually just a red herring.
> The people who can (or do) communicate with the public are ...
Lying. They're lying. They're saying things they can't know as if they're fact. The WHO isn't saying that a lab leak seems less likely than other things, they're saying it didn't happen. Unless they can point to what did happen then logically they're not able to make that claim.
People might be scientifically illiterate, but luckily spotting lies is much easier and gets you mostly halfway there, able to spot when you're being manipulated even if you can't tell what the truth is. The real problem the media is having is that people aren't quite as dumb as expected.
Lying. They're lying. They're saying things they can't know as if they're fact. The WHO isn't saying that a lab leak seems less likely than other things, they're saying it didn't happen. Unless they can point to what did happen then logically they're not able to make that claim.
It's very funny that Dr. Fauci came out and said the virus wasn't produced in a lab because we don't have the computational resources to model it. Full stop. That eliminates one way it could have been produced in a lab, but not all of them. Gain of Function research is often conducted by inducing mutations, then seeing how that changed the virus' capabilities. In fact, Dr. Fauci himself signed off on gain of function research in the very lab in Wuhan!
Dr. Fauci basically admitted in public that he as good as lied to the public, saying that masks were not useful, because he wanted to keep them for health workers. I think the press should be asking a lot more questions around here.
The real problem the media is having is that people aren't quite as dumb as expected.
It's almost as if the media believed the bigoted nonsense they say about some segments of the populace, and were disconnected from reality. Of course, that wouldn't be the case. Otherwise, we'd start to see things like public opinion polls that are systematically inaccurate, political consultants making huge miscalculations, or media companies doing things completely contrary to what fans of their products want and what profitability would demand. We'd see media companies suppressing things like downvotes, or having difficulty getting traction with their channels on YouTube.
If that were the case, then you wouldn't see evidence of groupthink and enforced groupthink in leaked journalist mailing lists and forums. If that were the case, there would be leaks of higher-ups dictating news narratives on conference calls -- which would then be systematically suppressed by journalists across the board.
We don't see any of that now, do we?
See: "JAQing off" or https://rationalwiki.org/wiki/Just_asking_questions
Can be used a DoS to eat up someone's time in responding to things:
> Sealioning (also spelled sea-lioning and sea lioning) is a type of trolling or harassment that consists of pursuing people with persistent requests for evidence or repeated questions, while maintaining a pretense of civility and sincerity.[1][2][3][4] It may take the form of "incessant, bad-faith invitations to engage in debate".[5]
Ask yourself this: Would a policy automatically labelling any question as conspiracy nut rhetoric, be acting in good faith? Such a policy could easily be exploited by a bad faith actor to silence actual substantive questions.
IMO, and from what I have seen, rationalwiki has a poor record, when it comes to intellectual integrity.
We are humans not Vulcans. There is a spectrum of ability in various skills and abilities, including reasoning.
Reminder: there are people who honestly believe the world is flat.
This guy gets it. You won’t win over sceptics by trying to brush seemingly real problems under the rug.
Hopefully the EMA will follow his example.
To me it strikes me that, even considering these rare side effects, the odds are still very much in favor for getting vaccinated.
Am I wrong here? If not, wouldn’t it then be irrational to be shutting down these vaccination programs?
It would certainly appear that if we assume the risk of vaccination is relatively constant, (The risk actually appears to be greater for younger, <55 y/o people), then it makes a lot of sense to prioritize the older populations.
https://www.alberta.ca/stats/covid-19-alberta-statistics.htm... -- scroll to the bottom for age distributions.
Edit: FWIW, I don't particularly support delaying vaccination for any age group, however it should be recognized that the risk is apparently non-zero. I for one will be getting mine as soon as it is available to me.
I'm trying to go through the rough numbers of risk/reward: Consider the potentially affected group with the lowest COVID death rate - women 20-29 years old. If all get the AZ vaccine, ~10 per million would have a CVST , and 3 would die, using the German numbers, which are higher than other countries. [1] (double these numbers to assume the side effect only affects women, and doses have been evenly distributed. Double them again to assume that this side effect only affects <65 years old, and doses have been split between the elderly and younger medical workers [2]).
If the COVID IFR is for 20-29 year olds is 0.01% [3], that's 100 per million that would die if infected. Maybe the IFR is lower for women, and with some effective treatments (dexamethasone, early recombinant antibodies) becoming available, but maybe it will be ~50% higher with prevailing variants.
So this vaccine may kill 12 per million women but save 100 per million. But the 100 per million is an unfair comparison - presumably less than the entire population will be infected while waiting for a different vaccine. Assuming 1/4 of infections are detected, there are 1000 new infections per million in Germany each day. It would take 120 days to infect 12% of the population and kill as many with this side effect as would have been saved by the vaccine, so if it will be a delay of less than four months to switch vaccines for this group, stop giving AZ and wait for another vaccine!
Huh, I didn't really expect this result, and for older age groups, the crossover point will come much sooner. Germany has decided that it only makes sense to only for 60+ year-olds, and maybe that's the right call, but I really wish they would be transparent about the reasoning.
[1] https://www.pei.de/EN/newsroom/hp-news/2021/210319-covid-19-... [2] https://www.statista.com/statistics/1195611/coronavirus-covi... [3] https://pubmed.ncbi.nlm.nih.gov/33289900/
The question isn’t is it better to get vaccinated with AZ or not vaccinated, but to get vaccinated with the AZ vaccine vs. a different vaccine with the delay that would be involved if AZ were pulled. That’s a tougher question that involves questions of relative risks and effectiveness and the logistical factors that dictate the timing differences.
If COVID rates in a country are low and the patient is young, then that patients personal risk from it is very low (low chance of catching it, low chance of harm if caught). If the vaccine has higher risks of harmful side effects, it would be unethical to administer it.
Medical ethics in general does not support harming one person to help another (eg. Giving one person a risky vaccine to help protect their grandmother who is vulnerable)
> I think the concern is that medical ethics say (roughly) you cannot give anyone a treatment which, based on odds, harms them
This is clearly not true as we do medical interventions all the time that we know may harm the patient on the assumption that most people will gain a benefit. It's naive and dangerous to spread the idea that the good medical intervention is a 100 percent safe one. That's the pitch of the "alternative" medical industry and only possible for 100 percent ineffective medication.
There is no effect without side effects and no benefit without risk.
Unfortunately I'm not expecting much calm rational debate on the nuances of getting the vaccine. This whole pandemic has felt like an emotional rollercoast void of logic.
(and please don't take my vaccine numbers as an authoritative risk assessment - there's a lot that goes into assessing such a number and I don't want to sound like I'm confident those numbers are correct)
Of course, your argument is still valid even with the lower estimate, I just think it becomes more complicated. Unfortunately, this case is quite a bit more complicated because COVID fatalities are heavily weighted to older ages, while this purported VIPIT is appearing largely in younger, otherwise healthy people.
[1]: https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v...
[2]: https://sciencebasedmedicine.org/what-the-heck-happened-to-j...
What's funny, not amusing is the Chinese said they thought the IFR was about 0.7% back in Feb 2020. Lots of people decided to not believe that for reasons. But here we are. And yet people still refuse. For 'reasons'
If you get infected, or did you account for the risk of getting covid in the first place ?
And with all that COVID has easily identifiable risk factors that impact the probability of severe outcome by order of magnitude, do vaccine side effects have comparable risk predictors ?
So, from where I'm standing, if you're young, healthy and able to avoid high risk COVID areas you're much better off skipping vaccination till they figure out the risk factors or vaccinate enough higher risk groups that it's no longer an issue.
[1] https://twitter.com/GidMK/status/1376304539897237508 [2] https://twitter.com/AtomsksSanakan/status/137593538213983437...
Also, fwiw I followed antibody testing studies for the better part of a year and anything over 0.004 IFR was rare. I was surprised to see it as low as 0.0014 from this review expecting close to 0.002-0.003 but 0.0068 is incredibly high.
Ioannidis published something extremely controversial (if not even flawed) and one of the main authors he attacked responded with a lengthy explanation so that this manuscript would not remain unchallenged. I found that aspect way more important than the venue of response. Would you prefer to leave Ioannidis' work unchallenged for potentially months instead?
edit: do you recall the paper that made waves in the U.S. claiming covid causes heart damage? That paper was published and editted prior to peer review based on criticism multiple times within a week or two IIRC - the appropriate way to handle conflict in science isn't by trying to get twitter to chime in and make things personal. Ioannidis "attacks" were unprofessional - in my mind, though, they were absolutely not on the level of trying to call out an author on twitter.
Also, I've heard of friends and colleagues who felt pretty rough for a couple of days.
But one thing I don't hear enough of, is the comparison with all the long lists of potential side-effects stated on normal, over-the-counter medicines. Paracetamol, Aspirin etc.
Have you listened to the fast-talking voices at the end of medicine adverts, disclaiming a litany of possible side-effects? It's quite amazing. (Some disclaimers at the end of pharmaceutical ads on US TV particularly, have always shocked me.)
"Take this. It'll help your problem" (* warning: may cause ... )
There was another study that showed that taking 5000 IU or 10000 IU would result in levels well below 210 ng/ml in average people, which is around the level where we'd expect side effects. This is not medical advice. I am not a doctor, just a random guy on the Internet. However, I take 5000 IU daily, and I intend to raise this to 10000 IU when I get vaccine doses. Again, this is not medical advice. Look up the studies yourself, and do your own research.
EDIT: negatively correlated
https://retractionwatch.com/2021/02/19/widely-shared-vitamin...
https://www.medrxiv.org/content/10.1101/2020.09.04.20188268v...
(Also, thanks. I didn't realize the one you cited as retracted, though there's some nuance there too.)
I am not a doctor. You are not a doctor. 'There was another study' is a terrible way to self-medicate. Consequently, 'look up the studies yourself' is bad advice for self-medication.
If you do not have a deficiency, you can severely damage your health by taking high doses, like destroying your kidneys. I guess that happens because those kidneys need to wash out all the crap you feed your body that it doesn't want nor need.
5000 IU is not a low dose and should only be taken if you have a diagnosed vitamin D deficiency.
The FDA adjusted their guidelines in 2015 in response to this (https://www.chicagotribune.com/business/ct-confusing-drug-ad...).
That, together with the fact that this group has minimal risk from the disease means it’s concerning. You don’t want to give someone a vaccine with risks of the same order as the disease.
Giving AZ to 60+ is still almost no concern even with this rate of adverse effects because they show a lower thrombosis risk and of course a massively higher risk of severe illness or death from the disease.
Countries with a mix of AZ and mRNA vaccines like many EU countries can probably use AZ for 60+ and since AZ underdelivers, the rest can take mRNA. Countries that have only or mostly AZ are in a more difficult situation.
- The recent development that might have spurred this sciencemag article is a proposed mechanism for the AZ vaccine to be causing blood clotting in some individuals. This was previously covered a couple of weeks ago. [1]
- The number of people who have suffered serious effects as a result of the AZ vaccine are still much lower than the number of people who could have suffered serious Covid symptoms in the same population. [1]
- However, the demographics don't line up perfectly. The blood clotting seems to be a greater risk for younger individuals, whereas serious Covid symptoms are more of a problem for older individuals, on average.
- It's entirely reasonable for people who are at low risk of Covid symptoms to have concerns at this point about taking the AZ vaccine.
- However, governments are facing the broader issue of stopping the pandemic as quickly as possible and reducing vaccine hesitancy, especially with the vast amounts of misinformation that have been washing through social media. For that reason, while research continues on this potential clotting issue, most governments have resumed AZ vaccinations [2].
- This is arguably not the most intersting AstraZeneca-related thing happening right now. They have also botched several other aspects of their vaccine development and roll-out [3] [4].
- Clotting issues have not been observed in the mRNA vaccines. Those vaccines use a different mechanism to trigger an immune response, and so far all of the indicators for these vaccines have been overwhelmingly positive. Almost one-third of Americans have received at least one dose of a vaccine so far and there are good reasons to be optimistic that the pandemic will soon start coming to an end for some of us.
- Vaccinating the rest of the world is still a large and very important problem. If we don't do that, then vaccine-resistant variants may develop in other countries. From that standpoint, the AZ vaccine, despite its flaws, is still better than no vaccine at all.
[1]: https://www.npr.org/sections/coronavirus-live-updates/2021/0...
[2] https://www.sciencemag.org/news/2021/03/european-countries-r...
[3]: https://twitter.com/zeynep/status/1374349620533411840?lang=e...
* Estimates of death or serious complications of COVID, divided by age group.
* Estimates of death or serious complications of this vaccine, again by age group.
Then it should be easy for anyone to see that the benefits outweigh the risks (if they do!)
Anyway I think we should not lump the mild/expected side effects and the serious and life threatening ones together. Unfortunately it's quite difficult to find reliable numbers for probability of e.g. blood clots after vaccine compared to the general population.
As a physicist, I'd also like to see the probability in the general population, but this population reweighted to match the population that has been given the vaccine. (E.g. if 0.1% of the population are nurses and 2% of the vaccinated are, then multiply their frequency by 20). When I just see a number, I never know how much they take this kind of confounding factors into account.
i am not saying we should not talk about them, but should we exercise caution with the way we formulate it. there are a lot of antivaxers out there and they don’t read beyond the title. if their number increases it will be bad for the entire society.
There might be problems with this one particular COVID-19 vaccine. Let’s not play that straight into the antivaxxers hands by being obviously dishonest about it.
If there’s causes for concern, we obviously need to investigate those concerns and be open about it.
I wonder what the threshold is. You want people to make informed decisions, but you don't want them to panic about tiny risks, because otherwise you'll get a lot less vaccinations.
Anti-vaccination is reasonable if one says "any potential side effect means I won't take it". But that seems neither individually wise nor collectively desired, though we don't really talk about the individual's responsibility as a carrier/spreader of something like influenza. Maybe we will in the future, now that it has been on everyone's mind with Covid.
On the other hand, it's hard for me to quantify the risks of the vaccines. AFAIK the only trials were performed by the companies themselves who have less than stellar track records and have no liability exposure. And while mRNA technology has been around for some time, AIUI, it's never been used en masse for vaccination purposes and we aren't really sure what to expect on longer timescales. While I suspect it's probably fine, I don't currently assign a lot of trust to public health officials due to their behavior over the past year. They've reversed their opinions/prescriptions multiple times and have proven themselves to not be above mixing politics with their health advice. It's an unfortunate reality.
My plan is to wait and see how things progress and if we get more data about both the efficacy of the vaccines and possible side-effects from more objective channels.
Is that what you meant to write?
I thought their problem was they didn't have access to vaccines over in Europe, not that they had a large stock to pick and choose from.
A few thousand dead bodies at the current rate.
Wait - I thought France said AztraZeneca wasn't effective for people over 65? Are they just giving it to people 55-65 therefore? And shouldn't those people have already been vaccinated by now anyway?
Hang on that’s not not actually what the French said is it? They actually said there was data and that the data said it was ineffective.
> Everything points to thinking it is quasi-ineffective on people older than 65, some say those 60 years or older.
So they said there was data that said it was ineffective, not that there wasn't enough data.
Edit to add: ... and while Stiko, ie. the vaccination board, was quite clear on it, I'm sure there were like two dozen high ranking politicians in Germany in January who either didn't read or were unable to understand the Stiko recommendation and claimed that AZ is known to be ineffective. Most politicians aren't trained scientists, and unfortunately it shows.
Expected vaccine deliveries for Germany (pop. 80m):
Q1: Biontech 12.4m, Moderna 1.8m, AZ 5.7m
Q2: Biontech 40.2m, Moderna 6.4m, AZ 12.4-15.m, JJ: 10.1m, Curevac 1.4m
2021 (total): Biontech 100.7m, Moderna 78m, AZ: 56.3m, JJ: 36.7m, Curevac: 24.5m, Sanofi: 27.5
Source: https://www.bundesgesundheitsministerium.de/fileadmin/Dateie...
I guess it's a permanent problem if you're dead because of it.
https://wonder.cdc.gov/controller/saved/D8/D137F981
I think it would be better to be honest about the risks, rather than hide them. Sure, less people may take the vaccine, but covid19 is an easily transmissible airborne illness (per the cdc and who). Given that, herd immunity is unlikely to be achieved and regular vaccines would be suggested (like the flu). Of course, that means we need to trust the vaccines... lying about risks isn’t a good start.
A leader who can say they screwed up and then try and fix it is better than one who won't admit they are wrong and keeps to the wrong position just to save face. Bolsanaro in Brazil comes to mind.
It shouldn't be that hard to not say things you can't support. Fauci should have told the truth, which is that however effective masks are they were in short supply and would do more good for doctors/etc.
At some point, being more concerned with controlling people than educating them is maliciousness. He wanted masks for doctors but was willing to give bad advice to citizens to make it happen.
We deserve honest scientists, not politicians, making policy.
Later on aerosole scientists made the correct analysis that the more important path was to prevent the small droplets from infected people spreading over shirt distances and then any old mask is better than none. Once this was realised the messaging changed.
Was it an error not to know this up front? Yes! Was it malicious? Unlikely. The malicious activity came from the trump administration who till the end kept ridiculing the scientists and telling its supporters all is fine just to win votes. Fauci and the CDC and the scientists are not the fall guy here.
I wasn't when I criticized it the day I heard it. It was obviously not right.
> Later on aerosole scientists made the correct analysis that the more important path was to prevent the small droplets from infected people spreading over shirt distances
(I quoted this just because I laughed at 'shirt distances' in this context.)
> Was it malicious? Unlikely.
Was using his authority to say something absolutely unproven and implausible malicious? Or just extremely obviously going to have negative consequences which he ignored?
> the trump administration [...] Fauci and the CDC and the scientists are not the fall guy here.
Fauci and the WHO both go out of their way to say things that they can't know. Sure, Trump is also awful, but that's not relevant to our "scientists" overstepping. At this point Fauci is a politician. Better than some, but still.
I also was arguing with people on Facebook weeks before the CDC and who changed their position and I predicted masks would become mandatory. But that was my personal opinion and not proof that Fauci acted in bad faith. You and are I anecdotal data points with no responsibility to anybody . Nobody got it "right" but the scientists were at least putting the effort in the right direction instead of right wing politicians.
Typing on a mobile without my glasses so autocorrect will have its day!
To be fair, malicious was someone else's word. It's close enough I ran with it, but perfidy and incompetence might be better. We're trusting the guy to be a chief scientist and he's making political statements.
> You can't pick and choose only part of the message and
I'm not. I'm picking on the whole message as being something he could not have known and thus was damaging to claim.
> But that was my personal opinion and not proof that Fauci acted in bad faith.
His job is to not say unsupportable things so that we can base policy off of his words. What is it other than bad faith to conflate your politics and your job?
> You and are I anecdotal data points with no responsibility to anybody
Speak for yourself. I've got family.
> Nobody got it "right" but the scientists were at least putting the effort in the right direction instead of right wing politicians.
Nobody made him fight the lab leak hypothesis, etc. He's borrowing partisan fights. The WHO hasn't officially investigated so it can't know, and if it doesn't know, he doesn't know.
Also, just fyi, there's no such thing as right wing anymore. The term means royalist. Left means communist, which there sadly is no lack of. Perhaps breaking free of these antiquated labels will give some clarity.
Also, I have heard rumors that the only things recorded as adverse reactions to the vaccine are things that begin in the 15/30 minutes before the person leaves the vaccine facility. Can anyone confirm or refute that?