What do we know about the relationship between risks and benefits of AstraZeneca's Covid vaccine

The case of the unfortunate eighteen year old from Sestri Levante Camilla Canepa, died of a serious thrombosis after receiving the first dose of Vaxzevria, swooped (again) the Covid vaccine of AstraZeneca in a flurry of controversy, which prompted the government to permanently suspend its administration in all those under the age of 60. The Italian Medicines Agency (AIFA) actually recommended the use of the a vaccine for some time adenoviral vector only in the over 60s, exactly as it happens for the single-dose of Johnson & Johnson, precisely because of the association with the very rare thromboembolic events. It was the emergence of the first cases – and in particular of the dangerous thrombosis of the sinus vein – to determine months ago the first temporary suspensions and the consequent remodulations of the vaccination campaigns. Despite AIFA’s recommendations, however, many Italian regions have continued to administer adenoviral vector vaccines to young people, especially during the Open Days which have found enormous success. But the death of the young Ligurian, whose exact causes are being examined by experts, has changed the cards on the table leading to the definitive block for AstraZeneca under 60 (not for Johnson & Johnson).

This decision was followed by statements in favor and against, among which one of the most discussed (because they were misinterpreted) was that of Dr. Marco Cavaleri, head of the Task Force on vaccines of the European Medicines Agency (EMA). The scientist pointed out in a statement to Reuters that the AstraZeneca vaccine “maintains a favorable risk – benefit profile in all ages, but especially in the elderly over 60”. It is precisely on the delicate balance between benefits and serious adverse reactions that the game of adenoviral vector vaccines is being played, that in a context of low circulation of the coronavirus SARS-CoV-2 like the current one, in younger age groups it may not be clearly favorable. The British Medicines and Health Products Regulatory Agency (MHRA) has also announced this several times in its bulletin on epidemiological surveillance (the “Yellow Card”). Moreover it is known that the youngest get seriously ill with COVID-19 in significantly lower percentages than the more mature age groups, and where the virus circulates little, allocating certain vaccines based on age can be a winning strategy. Professor Nino Cartabellotta, president of the Gimbe Foundation also stated on Twitter: “With a low viral circulation, in people under the age of 30, the risks of Astrazeneca may be greater than the benefits”. The EMA, on the other hand, which has never indicated age, gender or other limits for the AstraZeneca vaccine, continues to reiterate that “the benefit / risk balance of the AstraZeneca # COVID19 vaccine is positive and remains authorized for all populations ”, also underlining that disinformation is being done on the case.

In a report published some time ago it was the European Medicines Agency (EMA) that underlined the actual relationship between risks and benefits of the vaccine of the Anglo-Swedish society. In the range between 20 and 29 years, for example, they are 4 odds out of 100 thousand of avoid hospitalization for SARS-CoV-2 coronavirus infection compared to 1.9 probability out of 100 thousand to develop one thrombosis after AstraZeneca inoculation. In the 60 to 69 age group, on the other hand, there are 19 chances in 100 thousand of avoiding hospitalization and only one of being affected by thrombosis. The clear advantage of the Anglo-Swedish vaccine for the more mature groups is therefore evident, although it remains significant even among the youngest according to EMA data. Less incisive for another Oxford University survey, according to which there are for those between 20 and 29 years old 0.8 probability out of 100 thousand to avoid intensive care e 1.1 probability to have a thrombosis after the dose of Vaxzevria. Between the ages of 60 and 69, there are 14.1 probabilities of avoiding hospitalization and 0.2 cases of thromboembolism, which highlights the advantage of vaccination for the elderly.

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