United Kingdom

Experts back UK age limit for rollout of AstraZeneca jab

The stark contrast between the UK’s approach for the use of the Oxford/AstraZeneca vaccine and many other countries became clear on Thursday morning.

As UK health secretary Matt Hancock toured broadcasting studios to defend the decision only to restrict people under the age of 30 from having the jab, his counterparts in other countries from Spain and Italy to the Philippines were limiting its use to anyone over 60.

“I think people can take confidence in the fact that we have a world class regulator that is totally transparent with the data and then takes a cautious approach to making sure this vaccine rollout goes as safely as possible,” Hancock told BBC Radio.

Observers said the UK’s “cautious approach” took account not only of the risks and benefits of the AstraZeneca vaccine itself — balancing the chance of developing an extremely rare blood disorder after the jab against the harm caused by a serious case of Covid-19 — but also the need to keep its vaccination programme on course to offer a jab to every adult by the end of July.

The government expects to have enough supplies available to substitute either the BioNTech/Pfizer or Moderna vaccines for AstraZeneca in people under 30. The 18 to 29 age group are due to receive their jabs from the start of June, though the timeline might slip slightly.

But the rollout, which is having a notable impact in reducing the UK’s Covid-19 death toll, would be knocked completely off course if the AstraZeneca jab were only permitted in people over 55 or 60 — most of whom have already been vaccinated in the UK — as is the case in many other countries, including Germany and France.

“The UK has got the vaccine rollout as spot on as it could have,” said Michael Head, senior research fellow in global health at Southampton university. “The UK does not have a high level of vaccine hesitancy compared to other European countries and it is right to continue the rollout while safety signals are investigated.”

A study by the Winton Centre for Risk and Evidence Communication at Cambridge university showed that people in their 30s who are at moderate risk of exposure to Covid-19 are 10 times more likely to be admitted to intensive care with the disease than to suffer serious harm from the AstraZeneca vaccine. For people in their 60s the risk of severe Covid-19 is 200 times greater than serious harm from the jab. Only for those adults under 30 are the risks posed by Covid-19 and the jab comparable depending on infection rates.

Chart of ICU admissions prevented per blood clot caused, by age and exposure risk showing that the potential benefits of the AstraZeneca vaccine outweigh the harm in all but one scenario - under 30s in a low exposure environment. Based on research carried out by the Winton Centre for Risk and Evidence Communication

Sir Kent Woods, former chief executive of the UK Medicines and Healthcare products Regulatory Agency, said he was “very convinced” by the “carefully and clearly argued” presentation on Wednesday by the regulator he used to lead and the subsequent explanation by the Joint Committee on Vaccination and Immunisation why it had decided to recommend under-30s receive an alternative jab to AstraZeneca.

“I haven’t seen any such evidence-based analysis on the continent; you get the sense that they’ve pulled the figures out of the air,” he said. “The decision-making process in France, Germany and elsewhere has been disorderly in many respects,” he added. “There has been a disconnect between the European Medicines Agency and national member state activities.”

The MHRA and the EMA are regulators working closely together and coming to similar conclusions about AstraZeneca vaccine side effects. But the JCVI and its counterparts in other countries are advisory bodies which take account of national circumstances in their recommendations to governments.

Simon Kroll, professor of paediatrics and molecular infectious disease at Imperial College London and a JCVI member, said the MHRA moved as quickly as it could to investigate cases of dangerous blood clotting accompanied by low platelet counts following AstraZeneca vaccination. Up to March 31, 79 cases were reported in the UK, including 19 deaths.

“One imagines that the solution to these medical conundrums happens like it does on the telly,” Kroll said. “But gathering the data and understanding the case records around the country, putting it all together, takes time.”

Chart of forecast UK vaccinations (first doses) which shows that the change in guidance for the under-30s to not receive the AstraZeneca vaccine could set the UK's vaccination programme back by a month

He said the decisions by authorities in other countries might reflect different perceptions of risk there. “We have an NHS that is very well trusted and is seen to act in people’s interests. It’s an NHS that’s behind vaccination, which has given us on the whole a population that accepts advice that is given conscientiously,” Kroll said.

“If [other countries] are working on the same data that is being presented in the UK, we have to assume that their conclusions have been directed by other considerations than simply the figures of risk.”

Johannes Oldenburg, professor of transfusion medicine at the University of Bonn, noted that the German equivalent of the JCVI, the Permanent Vaccination Committee, is comparatively “very conservative” and tends to act with an abundance of caution.

The German regulator has now advised that anyone under the age of 60 who has received a first shot of the AstraZeneca vaccine should not be given a second, even if they had no adverse reaction.

Oldenburg said that this “may be OK” in Germany, which is not heavily dependent on the AstraZeneca vaccine for its inoculation programme, “but other countries can’t be so conservative”.

In the US, Lawrence Gostin, professor in public health law at Georgetown University, called on regulators to take a global view or risk undermining the public’s trust in vaccines further. The AstraZeneca jab is seen as key for vaccination programmes for poorer countries as it is cheaper and easier to store and handle than many of the others.

“We have a dizzying array of different judgments from different regulatory agencies. Each country going its own way can be very destructive,” Gostin said. This might have a particularly bad impact on lower-income countries, which look to Western regulators for seals of approval. “This is a global mess, not just a European mess.”

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