Don’t treat us like children

“Pausing” the use of the AstraZeneca vaccine for first doses in Ontario and other provinces may well be the right decision.

The public health authorities who must weigh a host of factors — the risk of rare blood clots, the supply of other vaccines, the overall progress in the fight against COVID-19 — no doubt are doing their level best in a complicated and fast-moving situation.

The facts on the ground change, and their advice changes accordingly. Science, as we’ve all learned, is far from static. It evolves as more information becomes available.

So why do so many people feel whip-sawed, betrayed even, by the sudden announcement that the AstraZeneca vaccine is now considered risky enough that it won’t be used for first doses (and maybe not at all, pending further data)?

In large part because those same public health authorities didn’t really trust us with the whole picture. Science may be nuanced and evolving, but the public health message in February, March and April was anything but nuanced.

It was simple, in retrospect overly simple: all vaccines approved by Health Canada were “safe and effective.” The best vaccine, everyone from Prime Minister Justin Trudeau on down repeated endlessly, was the first one you’re offered. “Vaccine shopping,” or holding out for Pfizer or Moderna, was condemned as the height of selfishness.

Yet the fact that AstraZeneca came with a risk of blood clots, rare but potentially very dangerous, was hardly a secret. The National Advisory Committee on Immunization (NACI), kept flagging that risk, eventually labelling Pfizer and Moderna vaccines as “preferred.”

Yet far from welcoming NACI’s input, many public health experts jumped on it for muddying the waters and promoting vaccine hesitancy. Rather than trusting the public with the complete picture, some of them preferred to stick with the simple (though misleading) statement that all vaccines are created equal.

Yes, we know the situation has changed. There’s new data on the risk of blood clots. And a few weeks ago, Canada didn’t have the luxury of ditching AstraZeneca and turning to plentiful supplies of Pfizer and Moderna. That’s a practical, real issue. But it’s not the same as insisting that there was no good reason to pass on AstraZeneca.

And yes, it’s important to acknowledge that Trudeau and other top leaders are in the same boat as the two million Canadians who got a first dose of AstraZeneca and are now wondering what’s next. It’s not as if they inflicted the secondbest stuff on others and grabbed “preferred” vaccines for themselves.

But can’t we learn from this episode and stop over-simplifying the public health message on vaccines?

Everyone wants clarity, but the AstraZeneca switch shows that clarity at the expense of nuance can leave thousands of people with a feeling of being had.

Public health authorities and politicians could start by ceasing to talk to us as if we were children who need to be reassured that we’ve been good boys and girls by getting jabbed with AstraZeneca. Anyone who got AstraZeneca “did the right thing,” Ontario Health Minister Christine Elliott said on Wednesday, speaking with the kind of exaggerated slowness appropriate to addressing a kindergarten class.

Those of us who got AstraZeneca need answers, not a pat on the head. For example, what will become of the 254,000 doses of AstraZeneca expected to arrive in Ontario next week?

Listening to provincial officials on Wednesday, the answer seemed to be that they’ll be used for second doses. That makes sense, since evidence from Britain is that the risk of blood clots from a second dose of AstraZeneca is vanishingly small — about one in a million. But the health minister herself couldn’t or wouldn’t give a straight answer to the question. The true answer seems to be: nobody knows.

That’s not the answer we’d like when the stakes are literally life and death. But at least it would be refreshingly frank. Better that than another round of comforting simplicities that leave us with a sour taste once the more complicated reality becomes apparent.

Those of us who got the AstraZeneca vaccine need answers, not a pat on the head