The government offered the AstraZeneca vaccine to Malaysians aged 18 and above on a voluntary basis. (AP pic)

PETALING JAYA: It looks like rational heads have won the day after all.

Despite all the fear-mongering and the misgivings, the registration for AstraZeneca Covid-19 vaccine was overwhelmed within hours after bookings were opened up for Malaysians aged 18 and above to opt for the vaccine.

It was a show of confidence in the vaccine among Malaysians despite the earlier fears. Many took this as an opportunity to get their shots earlier.

The government’s decision to give adults the choice to opt for the AstraZeneca vaccine was announced on Wednesday. This was after the people took to social media to voice their concerns over rare blood clot cases that occurred after vaccination.

The confidence towards AstraZeneca vaccine had been shaken when several European Union countries, the UK and Australia reported unusual and severe blood clotting events associated with low platelet counts (thrombosis with thrombocytopenia syndrome [TTS]) in people who have received the vaccine since February.

The US had recently reported similar events with the Johnson & Johnson’s (J&J) vaccine.

Although rare, severe thrombocytopenia can cause bleeding in the brain, which can be fatal.

Earlier, health minister Dr Adham Baba had announced that the government had decided to use the AstraZeneca vaccine. The first batch of 268,800 doses that were received through the Covax facility on April 24, he said, would be given to those aged 60 and above under Phase Two of the national Covid-19 immunisation programme.

However, there was a change of plans after netizens cried foul. The confidence in the vaccine has, nevertheless, been restored with the response to the open registration for the vaccine.

There are good reasons to take the vaccine which has been granted emergency use in more than 70 countries.

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In the realm of vaccines, this risk of blood clot is considered very low. The World Health Organization (WHO) and the European Medicines Agency (EMA) had reviewed it and concluded that the benefits far outweigh the risk.

WHO said in a statement on April 16 that the link between the blood clots and the adenovirus-vectored vaccines was not certain but cannot be excluded. Yet, it said, risk was very low.

Data from the UK suggest the risk is approximately four cases per million adults (one case per 250,000), while the rate is estimated to be approximately one per 100,000 in the European Union (EU), it said.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) had found that 79 cases of blood clots occurred after 20 million doses were administered. Of the 79 cases, there were 19 deaths, which meant four in one million have the risk of developing a blood clot, with less than one in a million dying.

AstraZeneca had said that the number of blood clot cases was lower than the numbers occurring in the general population from other causes.

A review of all available safety data of more than 17 million people vaccinated in the European Union and the UK with its Covid-19 vaccine has shown no evidence of an increased risk of pulmonary embolism, deep vein thrombosis (DVT) or thrombocytopenia, in any defined age group, gender, batch or in any particular country, it said in a statement.

In clinical trials, these were lower. There has also been no evidence of increased bleeding in the over 60,000 participants enrolled.

If the risk is so low, why did some countries suspend or cancel it?

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Some news reports, such as those by Forbes and the New York Times, had cited various political factors contributing to several European countries suspending temporarily the use of the vaccine in mid-March, one of which was the pressure to conform with other European countries’ decision on the vaccine.

Unbeknown to many, the risk of blood clot is greater among those infected with the Covid-19 infection than those jabbed with AstraZeneca vaccine.

The health ministry revealed that in Covid-19 infection, the incidents of blood clots are 165,000 cases for every million infections (16.5%) compared with four in one million cases (0.0004%) in AstraZeneca vaccination.

We also need to weigh the low vaccination risk against the greater monster out there.

Healthcare workers have been fighting the pandemic for more than a year while the people face financial and economic catastrophe. There are more than 3,000 daily cases in Malaysia currently.

India’s healthcare system could not cope with the massive number of infections – more than 400,000 daily cases currently, and many people have died. It can happen to Malaysia.

Added to the dire situation, there are limited vaccine choices and supply currently.

While the blood clot issues are being investigated further, WHO advised countries to perform a benefit-risk analysis to assess the risk of TTS following Covid-19 vaccination while work is ongoing to understand risk factors for TTS.

It also advised clinicians to be alert to any new, severe, persistent headache or other significant symptoms, such as severe abdominal pain and shortness of breath, between four and 20 days after vaccination.

Meanwhile, the European Medicines Agency (EMA) announced that a possible link between unusual blood clots and low blood platelets should be listed as a very rare side effect of AstraZeneca Covid-19 vaccine.

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Although rare in all adult age groups, more blood clot cases were reported among younger people, and women below age 60. But WHO said gender and age risk factors require further analysis for confirmation.

Most of the countries that had put the AstraZeneca Covid-19 vaccination on hold have reinstated it (except for Denmark, Norway and Hong Kong), with some restricting it to older people.

Nevertheless, the UK’s MHRA advised that people under 30 be offered an alternative vaccine to AstraZeneca if one is available, while Italy, France and Germany recommended that AstraZeneca vaccine be used only for people above age 60.

In Canada, Quebec lowered its minimum age requirement for the AstraZeneca vaccine from 55 to 45 years, while British Columbia, Manitoba, Alberta and Ontario opened vaccine bookings to those aged 40 and older, according to the Global News.

Malaysian experts had recommended that the government start the AstraZeneca vaccination with those aged 60 and above, but the government decided to open it to all above 18 on a voluntary basis after much protest from the people.

Although the chance of blood clots occurring is very low, people who have received the vaccine are advised to seek medical assistance immediately if they develop symptoms in the weeks after injection, according to EMA.

The symptoms include shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms such as severe and persistent headaches or blurred vision, tiny blood spots under the skin beyond the site of the injection.

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