The curse of the incidental illness: Seen as side effects to Covid vaccinations, ailments may have little to do with them
December 28, 2020
s Covid-19 vaccines go into broad use, some rare side effects of vaccination will almost certainly emerge, like the reports of small numbers of people developing anaphylaxis. But so will medical events whose timing just comes down to random chance — and the potential ripple effects of those reports already have experts concerned.
Every single day, people die unexpectedly. They have strokes and heart attacks and seizures. On an average day, 110 people in this country may develop Bell’s palsy, a temporary facial paralysis, and another 274 will develop Guillain-Barré syndrome, a form of paralysis that usually resolves over time. The trigger for these medical events often isn’t known. But when they happen shortly after someone gets a vaccine — especially a new one — well, conclusions will be drawn.
“It is logical for people to say: That person had something done to them and something bad happened in the hours or days after that,” said Art Reingold, chair of the division of epidemiology and biostatistics at UC Berkeley’s School of Public Health. “And if it was you or your family member, you would be inconvincible that that wasn’t true.”
Except, of course, it often isn’t. Heart attacks occur most commonly in the morning, yet we don’t blame breakfast for causing them. A heart attack on the morning after a Covid-19 vaccine, though? That might be another matter.
But the public doesn’t have a great grasp of the concept that many problems that occur after vaccination probably aren’t tied to immunization itself. In part, that’s because that context has been missing from public health messaging about Covid-19 vaccinations.
“I think the lay public is fully, fully unprepared for understanding this,” said Kate O’Brien, director of the WHO’s immunization, vaccines, and biologics program.
Quickly distinguishing a true side effect signal from an abundance of noise will be critical to ease the alarm of a public already skittish about vaccines developed at “warp speed,” experts warned.
The risk of the public misinterpreting such anecdotal reports may be especially acute early on in the rollout, when elderly adults and people with health conditions have been prioritized to get the vaccine. Nursing home residents are in Phase 1a — currently ongoing — and seniors 75 and older are in Phase 1b. People aged 65 to 74 and those with medical conditions that increase the risk of severe Covid disease are in Phase 1c. These are people to whom medical events occur most commonly.
“Things are going to happen to them,” said O’Brien, though she noted that more medical misfortune would befall people in these groups if they were not vaccinated.
“The reason I think you need to think globally is that vaccine scares are global,” said Black, who is also co-director of the Global Vaccine Data Network, a 17-country collaboration that studies vaccine safety and effectiveness. “We know very well that misinformation spreads much more quickly than information, so that a couple deaths in Brazil or a death in Indonesia or whatever, the public outcry could cause lack of confidence and undermine the whole vaccine program.’’
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