to not be is unAmerican, nonDemocracy

Western Warnings Tarnish Covid Vaccines the World Badly Needs

Amid a deep residue of mistrust, American and European cautions on the AstraZeneca and Johnson & Johnson vaccines risk igniting anti-vaccine fervor in countries that can’t afford to be particular.


85
In South Africa, health officials paused giving the Johnson & Johnson shot, the only one they have, a repeat blow after dropping AstraZeneca from their arsenal in February.
In South Africa, health officials paused giving the Johnson & Johnson shot, the only one they have, a repeat blow after dropping AstraZeneca from their arsenal in February.Credit...Joao Silva/The New York Times
Benjamin Mueller
By Benjamin Mueller
Published April 14, 2021
Updated April 15, 2021, 9:07 a.m. ET
Safety worries about the AstraZeneca and Johnson & Johnson Covid-19 vaccines have jeopardized inoculation campaigns far beyond the United States, undercutting faith in two sorely needed shots and threatening to prolong the coronavirus pandemic in countries that can ill afford to be choosy about vaccines.

With new infections surging on nearly every continent, signs that the vaccination drive is in peril are emerging, most disconcertingly in Africa.

In Malawi, people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine. And in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.

The sense of uncertainty deepened on Wednesday when an advisory committee to the U.S. Centers for Disease Control and Prevention delayed a decision for seven to 10 days on lifting a pause on the Johnson & Johnson vaccine, saying it wanted more data on a rare blood clotting disorder. Those shots were halted on Tuesday over concerns about the disorder, which emerged in six women, and on Wednesday the panel learned of two more examples.

ADVERTISEMENT

Continue reading the main story

Also on Wednesday, the European Union said it would not make any more purchases of the AstraZeneca or Johnson & Johnson vaccines, but would pivot to relying solely on those, like Pfizer’s and Moderna’s, that are based on a newer technology and have not raised similar safety concerns.

The actions of American and European officials reverberated around the world, stoking doubts in poorer countries where a history of colonialism and unethical medical practices have left a legacy of mistrust in vaccines. If the perception takes hold that rich countries are dumping second-rate shots on poorer nations, those suspicions could harden, slowing the worldwide rollout of desperately needed doses.

Dr. Sara Oliver of the C.D.C. told the advisory panel that prolonging the pause in using the Johnson & Johnson vaccine “could have global implications.”

Already, doctors say, the recent pauses have vindicated vaccine skeptics and made many others feel duped.

ADVERTISEMENT

Continue reading the main story

“People, especially those who were vaccinated, felt like they had been tricked in a way — they were asking, ‘How do we get rid of the vaccine in our body?’” said Precious Makiyi, a doctor and behavioral scientist in Malawi, where health workers have been racing to empty their shelves of nearly expired AstraZeneca doses. “We fought so hard with vaccine messaging, but what has happened this past week has brought us back to square zero.”

ImagePolice officers guarding AstraZeneca vaccines after a shipment arrived last month in Lilongwe, the capital of Malawi.
Police officers guarding AstraZeneca vaccines after a shipment arrived last month in Lilongwe, the capital of Malawi.Credit...Thoko Chikondi/Associated Press
African health officials have reacted with fury at the breezy reassurances of American and European lawmakers that people denied the AstraZeneca or Johnson & Johnson shots could be given another vaccine. In much of the world, there are no other vaccines.

YOUR CORONAVIRUS TRACKER: We’ll send you the latest data for places you care about each day.
Sign Up
And even as American health officials stressed that they paused use of the Johnson & Johnson vaccine on Tuesday in “an abundance of caution,” they forced global health officials to begin crafting the difficult case that shots that might not be safe enough for the world’s rich were still suited to its poor.

ADVERTISEMENT

Continue reading the main story

“It’s sending vaccine confidence into a crater,” Ayoade Alakija, a co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”

What rich countries call caution, poorer nations will experience as a devastating gamble with the survival of their citizens against Covid-19. “Out of an abundance of caution, let us not destroy vaccine confidence in places that only have access to one type of vaccine,” Dr. Alakija said.

The Johnson & Johnson and AstraZeneca shots have been considered especially crucial for less developed and hard-to-reach parts of the world, because they are less expensive and easier to store than Moderna’s or Pfizer’s, and the Johnson & Johnson vaccine requires just one dose.

AstraZeneca’s shot is being used in at least 118 countries. Lately, amid shortages of that vaccine, some regions have pivoted to Johnson & Johnson’s: Two weeks ago, the African Union acquired 400 million doses.

ADVERTISEMENT

Continue reading the main story

Together, the two vaccines account for a third of the portfolio of Covax, the international effort to procure and distribute vaccines.

The Coronavirus Outbreak ›
Latest Updates
Updated
April 15, 2021, 7:18 a.m. ET3 hours ago
3 hours ago
New coronavirus tests should still be able to detect variants, but health officials are vigilant.
Republicans remain more hesitant about getting a vaccine than Democrats.
As India logs 200,000 daily infections, a new exodus from cities has begun.
Is this helpful?



But it is becoming more apparent by the day that those shots are becoming afterthoughts in wealthy nations. After canceling Johnson & Johnson appointments, American states offered people the pricier Pfizer or Moderna vaccines instead.

The European Union said on Wednesday that it had acquired another 50 million doses of the Pfizer vaccine, allowing it to curb use of AstraZeneca’s vaccine and phase it out altogether next year. Many European nations have already restricted the use of that shot, after clotting problems emerged in a small number of recipients.

Those decisions, intended for domestic audiences, have nevertheless resounded in countries where variants are spreading, physical distancing is a luxury and there is no choice of shots.

ADVERTISEMENT

Continue reading the main story

Health officials fear that any setbacks in vaccinations could sow the seeds of the next calamitous outbreak, one that deluges hospitals and exports new mutations around the world. In those places, doctors said, the math is obvious: Many more people will die without the AstraZeneca and Johnson & Johnson vaccines than with them.

Amid the clotting concerns, the World Health Organization and African Union have not wavered in recommending the use of the AstraZeneca and Johnson & Johnson’s vaccines. In Britain, AstraZeneca’s vaccine remains the backbone of the country’s speedy inoculation campaign, despite people under 30 being offered alternatives. Congo, after spurning the AstraZeneca shot in light of unease in Europe, said on Tuesday that it would start the much-delayed inoculations next week.

Image
A vaccination center inside Salisbury Cathedral, in Salisbury, England, in January. Britain has forged ahead with the AstraZeneca vaccine, though restricting its use to people aged 30 and above.
A vaccination center inside Salisbury Cathedral, in Salisbury, England, in January. Britain has forged ahead with the AstraZeneca vaccine, though restricting its use to people aged 30 and above.Credit...Andrew Testa for The New York Times
And in Dakar, the capital of Senegal, people continued to line up on wooden benches on Wednesday for the AstraZeneca shot as they watched their children run through the corridors of a medical center.

ADVERTISEMENT

Continue reading the main story

“We don’t have a choice,” said Alioune Badara Diagne, 34, who lives in the city’s lively Ouakam neighborhood. Despite talk of vaccination pauses in wealthy nations and rumors of vaccine makers using Africans as “guinea pigs,” he said, Westerners themselves were continuing to be injected. He added, “The vaccine is our only hope.”

What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S.
On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.
All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.

But in much of the world, the American regulators who endorsed Tuesday’s pause on Johnson & Johnson vaccinations act as sort of surrogate decision makers on drugs and vaccines, giving their hesitation extra weight in African nations.

“I became even more skeptical when I heard that the United States suspended Johnson & Johnson,” said Lawmond Lawse Nwehla, 32, an engineer in Dakar. “They said it was effective and then they stopped it. So I wonder why.”

In immediately pausing the use of Johnson & Johnson’s shot, American regulators reacted more aggressively than did their British counterparts, who backed the AstraZeneca vaccine even as they investigated clotting cases.

ADVERTISEMENT

Continue reading the main story

The costs of the American approach were already evident in Europe, where many nations stopped and then restarted AstraZeneca vaccinations, only to find that it had become a pariah. Most people in France, Germany and Spain distrusted the vaccine.

“Once you take the cork out of the bottle, I’m not sure you can get it back in particularly easily,” said Anthony Cox, a vaccines safety expert at the University of Birmingham in England.

South Africa immediately copied the American pause on Johnson & Johnson vaccinations, infuriating doctors who are still clamoring for shots, especially in remote parts of the country. In February, health officials dropped the AstraZeneca vaccine over its limited efficacy against a dangerous variant there.

To date, only half of 1 percent of the population is vaccinated, and a mere 10,000 shots are being given each day. At that rate, it could take weeks, if not longer, for a single rare blood clotting case to emerge, said Jeremy Nel, an infectious disease doctor in Johannesburg. He was dismayed by the decision to pause shots, given the risk to vaccine confidence in a country where two-fifths of the people say they have no intention of being vaccinated.

ADVERTISEMENT

Continue reading the main story

“The slower you go, that failure is measured in death,” Dr. Nel said. “Even if you delay for a week, there is a non-trivial chance that will cost lives.”

The solution in many European countries — to stop using seemingly riskier vaccines in younger people, who are at lower risk from Covid-19 — would be unworkable in Africa, where the median age in many countries is below 20.

And any further restrictions would compound the hurdles facing Covax, among them a paucity of funding for every part of inoculation programs beyond the touchdown of doses at airports.

Mali, in western Africa, has administered 7 percent of the AstraZeneca doses that Covax has delivered. Sudan, in eastern Africa, has given 8 percent of the doses it has received.

ADVERTISEMENT

Continue reading the main story

Skittishness over the AstraZeneca and Johnson & Johnson vaccines, analysts fear, could stoke demand for Russian- and Chinese-made shots about which far less is known. As it is, some global health officials have turned their attention to the Novavax vaccine, which is not yet authorized but makes up a third of Covax’s portfolio.

“Even at this stage of the pandemic, we have our fingers crossed that some vaccine will work to help vaccinate developing countries, instead of ramping up production of vaccines we know work,” said Zain Rizvi, an expert on medicines access at Public Citizen, an advocacy group.

In Kenya, where enthusiasm for vaccines is high in cities but perilously low in rural areas, “the story about blood clots from Europe could not have come at a worse time,” said Catherine Kyobutungi, the director of the African Population and Health Research Center there. “Even those who were perhaps on the fence, and leaning toward getting vaccinated, all of a sudden had second thoughts,” she said.

The American pause on Johnson & Johnson shots promised a second media furor.

“When the F.D.A. suspends, it makes headlines for days,” she said. “When it lifts the suspension, it doesn’t make as many headlines.”

Mady Camara contributed reporting from Dakar, Senegal.