The Republic became the latest country to restrict the use of the AstraZeneca Covid-19 vaccine amid concern over blood clots. The Department of Health said the vaccine should not be given to people aged under 60.
The decision came after the European Medicines Agency concluded unusual blood clots in the brain are a rare side effect, but benefits from protection AstraZeneca provides greatly outweigh the risks – especially in older people.
Those under 60 who already received one dose of the AstraZeneca vaccine should have the interval between their first and second doses extended to 16 weeks, from 12, to allow for further assessment of the benefits and risks of the vaccine, the National Immunisation Advisory Committee recommended.
So, what recommendations for the AstraZeneca vaccine are in place in other countries?
Australia
Australia said it doubled its order of Pfizer vaccines after health authorities recommended people under the age of 50 take the Pfizer jab instead of AstraZeneca.
Health authorities concluded that a second case of a rare blood clot syndrome “is likely” linked to the AstraZeneca vaccine, and some state vaccination programmes have been “paused or varied” to deal with the vaccine’s new warning.
The case occurred in a woman in her 40s who received the AstraZeneca Covid jab in Western Australia, the Therapeutic Goods Administration (TGA) announced on Tuesday. She is receiving treatment in hospital and is in a stable condition.
Health authorities estimate the syndrome affects four to six cases per million AstraZeneca vaccine recipients, but it can cause a death rate of up to 25 per cent when it occurs.
The Australian Technical Advisory Group on Immunisation, an independent group of medical experts that advises the health minister, said: "More cases can be expected to occur, albeit rarely."
“There have been about 700,000 doses of AstraZeneca Covid-19 vaccine administered in Australia to date, so while numbers are small, two cases equates to a frequency of one in 350,000,” the TGA said.
Minister for health Greg Hunt said 56,000 vaccinations had occurred in the past 24 hours despite some state programmes being "paused or varied" to deal with the new AstraZeneca warning.
Asked if the warning had caused a spike in vaccine hesitancy, Mr Hunt said health authorities “had anticipated potentially a significant drop but that is not what we have seen at this stage”.
He said the federal government was meeting with the states to revamp the vaccination programme for people aged under 50. “But what continues is the vaccination programme for the over-50s – that remains as vital as ever,” he said. “Vaccinations save lives. Vaccinations protect lives.”
Earlier on Tuesday, Mr Hunt’s office said Australia would not purchase Johnson & Johnson’s Covid-19 vaccine, citing concerns that it is an adenovirus vaccine of the same type as AstraZeneca.
Hong Kong
Hong Kong said on Friday it will delay shipments of AstraZeneca’s vaccine this year amid the mounting concerns over possible links between the shot and very rare cases of blood clots.
The Chinese-ruled city had ordered 7.5 million doses from the British-Swedish company, which were scheduled to arrive in the second half of 2021.
Health secretary Sophia Chan said the global financial centre had a sufficient supply of vaccines, with a total of 15 million doses of Germany’s BioNTech and China’s Sinovac – the only two vaccines available in the city.
“Even if we have signed a pre-purchase agreement with AstraZeneca, we believe that AstraZeneca vaccines will not need to be supplied to Hong Kong this year, so as not to cause a waste when the vaccine is still in short supply globally,” Ms Chan said.
The government was considering buying a new type of vaccine that may offer better protection, she added.
More than 700,000 Covid-19 vaccine doses have been administered to the city’s 7.5 million population so far, a figure Hong Kong leader Carrie Lam said was unsatisfactory.
The sluggish take-up comes amid dwindling confidence in the Sinovac vaccine and fears of adverse reactions, while BioNTech vaccines were temporarily halted due to packaging defects.
UK
The UK’s Medicines and Healthcare Products Regulatory Agency advised that people under the age of 30 should be offered an alternative vaccine to AstraZeneca, if one is available.
The UK has hit its target to offer a first vaccine shot to all people over the age of 50 ahead of schedule, a significant boost to prime minister Boris Johnson’s plans to unlock more parts of the economy.
The goal was to do so by April 15th, and people in their late 40s are expected to be invited to receive vaccines in the “coming days”, the department of health said.
Meanwhile, mayor of London Sadiq Khan urged people who live, work or study in two city boroughs to be tested following an outbreak of new cases linked to the South African variant.
Italy, France, Germany, Philippines and South Korea
Italy followed Germany and France by recommending the AstraZeneca vaccine only for people over the age of 60.
The moves to limit the vaccine’s use came just hours after the European Medicines Agency said it found a “strong association” with blood clots. The regulator didn’t issue any guidelines about usage, leaving the implementation up to member states.
The Philippines and South Korea have also restricted use of the vaccine to people aged over 60 only.
Greece
Greece has limited the use of the AstraZeneca vaccine to people above the age of 30, its national vaccinations committee said on Friday.
The risk of a serious illness and death from Covid-19 “overwhelmingly” outweighed the risk of a possible blood clot following vaccination, especially for people aged over 30, it said.
Greece administered 378,997 doses of the AstraZeneca vaccine so far and ordered another 1.35 million doses.
It has also used the Pfizer and Moderna vaccines to inoculate more than 2 million people.
Portugal
Portugal wrote to the European Union's health ministers proposing a common approach for the use of the AstraZeneca vaccine.
In the letter, seen by Bloomberg, the country suggested a joint position that would see the AstraZeneca shot limited to people over the age of 60.
"There are many ways through which we can attempt to establish a shared European position and restricting the administration of the AstraZeneca vaccine to the same age groups might be a good starting point," said the letter, which is signed by Portuguese minister of health Marta Temido and dated April 9th.
The proposal came after ministers failed to form a united response last week to links between AstraZeneca’s Covid-19 vaccine and a rare type of blood clotting.
The letter acknowledged that “going into the meeting, but particularly during its course, member states were deeply divided on what to do.” It said that “the sensitivity of the matter left many of us frustrated and this was clear as member states took the floor”.
Despite the risks associated with the AstraZeneca vaccine, the EU drugs regulator insisted that the jab’s benefits outweighed the risks and that the shot should remain a vital tool in the pandemic fight.
United States
Infectious disease official Anthony Fauci said the AstraZeneca vaccine might not be needed in the US because of supplies of other shots.
"I think that the AstraZeneca vaccine from a standpoint of efficacy is a good vaccine, and if the safety issue gets straightened out in the European Union. the efficacy of that vaccine is really quite good," he told BBC radio on Tuesday.
“Whether or not we ever use AZ is unclear but it looks right now at this point in time that we will not need it. It’s not a negative indictment of AZ, it is just possible that given the supply that we have from other companies that we may not need to use an AZ vaccine.”
The AstraZeneca vaccine has not yet been approved in the United States.
Indonesia
Indonesia will continue use of the AstraZeneca vaccine and the jab developed by China's Sinovac Biotech Ltd because they met the standards set by the World Health Organisation (WHO), according to the government.
"We can assure you that the vaccines are safe, beneficial and able to boost our immunity," spokeswoman for the ministry of health Siti Nadia Tarmizi said.
Concern is mounting that China's Covid-19 vaccines are less effective in quelling the coronavirus disease than other products, after remarks by the head of the Chinese Centre for Disease Control and Prevention about their lower protection rate went viral on social media. Research released on Sunday showed the efficacy rate for Sinovac's vaccine, deployed in Indonesia and Brazil, was just above 50 per cent.
Indonesia, the worst infected country in southeast Asia, is counting on the shots to be able to inoculate more than 180 million people within a year to achieve herd immunity levels.
No significant side effect has been reported from the use of the AstraZeneca vaccine in Indonesia, said Ms Tarmizi.
Indonesia’s food and drug regulator “will continue to monitor the vaccines, but the best vaccine is the one that’s available,” she said.
Botswana
Botswana’s health ministry asked the country’s health regulator to probe two deaths of people who had recently taken a Covid-19 vaccine made by the Serum Institute of India Ltd on behalf of AstraZeneca.
The regulator has been tasked with finding out if the deaths are linked to taking the vaccine, the ministry said in a statement on Monday.– Reuters, Guardian, Bloomberg