Update Aug 16, 2021: If I were still unvaccinated today (or even weeks ago), I would of course have a completely different view of the risk: the risk of me getting COVID is now much higher, and hugely outweighs the risk of blood clots. Risk is always relative.

---

First, let’s get a few possible misconceptions out of the way:

I’m not an anti-vaxxer

I already got my flu shot, as I do every year. I have been vaccinated frequently throughout my life, having lived in many “exotic” countries when you had to travel with a vaccination record to show you weren’t carrying yellow fever, typhoid, etc. I raised my daughter in Italy, where kids cannot go to school without being fully vaccinated. I had no problem with this, in fact I considered it a favor when we were reminded to get her childhood vaccines on time and it was easy to do so with the family GP. Her entire school was once given Hepatitis B vaccines without parents even being informed. I had no problem with that, either. I am grateful that vaccines exist and have even gotten better over time.

I’m not terribly worried about the efficacy of AZ

I’m reasonably persuaded that it’s good enough, though there are big question marks about its effectiveness against some of the new variants. At any rate, I wouldn’t turn it down only on that basis. Being protected against some variants would be better than none, for the time being (as long as it doesn’t lead us into a false sense of security).

I am strongly motivated to open “Fortress Australia.”

We moved to Aus in December, 2020, after 10 months of near-total lockdown in San Jose, California. During that time we saw only a few friends in carefully-distanced visits in our front garden. I last saw my grown daughter Rossella in December, 2019, when we visited her in New York. I attended her wedding last October via Zoom, and it broke my heart not to be there in person.

If the earliest we can expect to welcome foreign visitors into Australia is mid-2022, it will have been far too long since I’ve seen Ross, or many others who are dear to me. We’re all well and have a reasonable expectation of seeing each other again sometime, but it hurts viscerally not to be able to hug my daughter or my friends, or even to know for sure when I might expect to. So, yes, I’m really fucking motivated to get these borders open!

I have underlying health conditions 

…that make me more vulnerable to COVID: a primary IgA deficiency which throughout my life has made me more likely to get respiratory infections of all kinds, and to suffer from them more severely. My body is just not good at fighting off respiratory stuff. This is why we as a household went into self-imposed hard lockdown even before it was declared for Santa Clara county, California, where we lived – which was the first place in the US to lock down. 

I don’t enjoy lockdown

By the time we left the US on December 20th, we had not set foot in any establishment other than medical (and then only for strictly necessary visits) in 10 months. We had all our groceries delivered, or picked them up when they could be delivered into the trunk of the car without any human contact. From March through September, when everyone was afraid of the virus being transmitted on food packaging or in food, we never even ordered meals delivered. (We would wipe down groceries upon arrival with antiseptic wipes, or quarantine them in the garage for a few days.) I was cooking all our food myself, and even growing much of it in the garden. Worst of all was not being able to see friends, and being afraid of strangers who might transmit a deadly disease to me. I don’t want to go through any of that again.

I want to do my part

So, yes, I’d love to be vaccinated. I have for a long time been looking forward to feeling a little bit safer for myself and my family, and that I’d be contributing to the overall safety of my community. I was eligible early in Australia, because with that immune deficiency I’m considered category 1b. I signed up at a local clinic to get the vaccine – at the time I’d have accepted any vaccine, but what was on offer was AstraZeneca. By the time they called me back to say they had it in stock, the news stories about blood clots had begun to appear, and I said I’d have to think about it.

That was weeks ago, and I’m still thinking.

What am I afraid of?

New syndrome

The thrombosis with thrombocytopenia syndrome (TTS) that occurs with AZ is a new syndrome. There has not been sufficient time or enough cases to be certain how to treat it, or even recognize it. Two cases in Australia got much worse than they might have because the patients were turned away from emergency rooms by doctors insisting that they had something else – even after being told that those patients had recently been given AZ. This does not give me high confidence that, if I did develop clots, they would be recognized in time to ensure rapid treatment and the best possible outcome. 

Predisposing factors unknown

With the relatively few cases that have occurred, it has not yet been possible to determine whether there is some common factor that predisposed those patients to develop TTS. Some people have been advised by their GPs not to get AZ because of a history of blood clots or possible other factors, but since this is “merely” the GP’s opinion, those administering the vaccine are free to ignore it – and refuse other vaccines to these patients.

Blood clots anywhere

What we do appear to know so far is that TTS can cause blood clots just about anywhere in the body – some people have risked or lost limbs or sections of bowel or their lives. Some have had pulmonary embolisms or clots in the brain. Did the latter have strokes? Did they lose mental or physical function? I’m not finding many details, so I can only assume terrible possibilities, in spite of reassurances from politicos that they’re “recovering safely at home” and some are even back at work. 

Too much hand-waving, not enough solid information

I realize that TTS is new and medical responses to it are evolving. They’ve learned the hard way not to treat it with heparin, for example. But I’m not reassured to be told: “We know how to diagnose them and we know how to treat them. We did not know that six weeks ago and that’s why we are seeing milder presentations now and there will be better patient outcomes.” (Professor Sharon Lewin quoted in the Sydney Morning Herald) Uh, better than what? Better than dead? 

What I want to know is: what are the possible long-term effects if I am one of those lucky few who gets blood clots? I recognize that these will vary depending on where the clots occur and how appropriately and quickly they are treated, but I think it’s reasonable to ask for more information about exactly the scale of the risk you’re asking me to take on.

Other countries have stopped using it

“The South African Government abandoned their rollout of the AstraZeneca vaccine. Denmark stopped using AstraZeneca in April. Seychelles, which has fully vaccinated the highest proportion of its population than any country at 61 per cent – 40 per cent of these with a version of the AstraZeneca vaccine made under license in India – is now facing a surge of cases in which the South African variant appears to be playing a role. New Zealand changed its vaccination rollout in March and is now using Pfizer exclusively because of its higher efficacy over AstraZeneca.”

Asia and the Pacific Policy Forum

I realize that this is an extremely privileged position to be in. In countries such as India, where the odds of getting COVID are very, very high right now, a risky vaccine is better than none. (I shrink from saying in public what I am saying here, because it seems disrespectful to the many people I care about who are in India right now, who are losing their own loved ones at a horrific rate.)

Relative risk

If COVID were rampant in Australia, I would be racing to get whatever vaccine was available, as it would then be more likely that I’d get COVID than that I’d get blood clots from the vaccine. But that is not the correct way to assess my risk in Australia’s current situation of very low exposure.

Why age 50?

“The continued use of AstraZeneca for older Australians is based on the recommendations in April of the Australian Technical Advisory Group on Immunisation (ATAGI)… In justifying its decision, ATAGI compared the risks of severe blood clots with the risk of intensive care unit admission due to COVID-19 by age group under two scenarios over the next 16 weeks… if the ATAGI had used the revised and higher estimates of blood clot risks, and its scenario one COVID-19 outbreak, it would have also recommended against AstraZeneca for those aged between 50 and 60.” [A few weeks later, after a second death in Australia, of a 52-year-old woman, ATAGI changed its guidance to “Pfizer for everyone under 60.” Apparently they had been discussing this for weeks before finally making the new decision public. Now the Prime Minister has thrown that into confusion by saying anyone who wants AZ can get it – not everyone agrees with that.]

Asia and the Pacific Policy Forum

After the blood clots first began appearing in Australia, the government (ATAGI) decided that people under 50 should receive Pfizer instead. The age 50 cutoff was based on a scale of risks by age group which has since changed based on further clotting cases. That scale was questionable from the beginning as it was based on the incidence of clotting among people who had received the vaccine early on, which appeared to skew towards younger people and women. But many of the first people to receive any vaccine were frontline health workers – a population that also skews to being younger and female. Now that AZ is being more widely administered, the risk profile is changing: many of Australia’s recent TTS cases are older and men.

It is also hard to ignore the fact that many of the people currently urging us to take AZ have already received or will receive Pfizer – even some who would have been in the over-50 age group once that criterion was applied.

I have enough physical crap to deal with

Thanks to the above-mentioned IgA deficiency, and breast cancer six years ago, and the general fun of getting older (I’m 58), I already have more than enough things wrong with my body. I’m not keen to add possibly catastrophic damage from blood clots, and/or a need for emergency surgery, or long-term treatment with heavy duty medications such as blood thinners. Anyone looking at me as an individual patient, rather than a member of the broad over-50 population, might reasonably reach the same conclusion.

“Talk to your GP”*

I’ve been in Australia only since December and my Medicare card has yet to arrive (I messed up the paperwork the first time I submitted it, and was not informed that it had been rejected). I still have access to medical care since I’m able to pay for it up front. I’ve seen a local GP once for a sinus infection, but can hardly be said to have a long-standing, trusting relationship with him. I’ll certainly start having this conversation with him or someone as soon as I’m in the system and feel like I can really start using it. But any GP will need a deep understanding of my entire medical history before I’d trust them to have an opinion on whether I should have this vaccine.

So, all in all… yes, I’d love to be vaccinated. But please give me some alternative to AstraZeneca. I’ll jump at that as soon as it’s offered.

Recommended reading:

• The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors
• Australia’s COVID-19 vaccination strategy must change

Update May 29: My Medicare enrollment was completed soon after I published this, and I was able to visit a GP about this and a number of other issues. The outcome of that discussion is that, on my GP’s advice, I’m going to wait for Pfizer, and may be able to get it as soon as July or August.

Update July 1: Brendan and I both got our first Pfizer jabs this week, at the Sydney vaccination hub at Olympic Park. We had signed up a couple of weeks ago via a “secret” URL that was nonetheless widely circulated. At the time I signed up, I was not technically eligible for Pfizer, as ATAGI guidance still said “AZ for everyone over 50.” That guidance changed in the intervening weeks to “Pfizer for everyone under 60,” so I did not have any hassles getting my preferred vaccine on the day. The process was easy and efficient. We lined up about 11:45 for our noon appointment, and were completely done and out by 12:30. We both have our second jabs scheduled within a month.

Update August 5: Would I feel differently today, given that Delta is spreading in Sydney and we’re under lockdown again? Yes, of course – risk is always relative, in this case relative to the likelihood of getting COVID. I were still unvaccinated today, I’d be scrambling to get whatever vaccine I could get quickest. As it is, we got very, very lucky with timing – I got Pfizer in the brief window before the guidance on AstraZeneca changed again.

In the meantime, another reason has arisen for me to prefer Pfizer: it may make travel easier, whenever that becomes possible again.