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Vaccines are amazing, life-saving innovations, and the COVID-19 vaccines are no different. As with any medical procedure, there are potential drawbacks to using them, but we know from massive pieces of scientific research that the COVID-19 vaccines are both safe and effective.

And yet, as you have probably heard on the news, for one specific vaccine most of Europe has stopped their rollout. Rather than giving millions of people the Astrazeneca/Oxford (AZ) vaccine against COVID-19, a dozen countries have decided to stop vaccinating due to fears of side-effects.

So I thought I would explain what’s happening, and why you probably don’t need to worry even if you’ve had the AZ vaccine.

How It All Works
The basic idea of vaccine rollouts is simple. You exclude common and dangerous side-effects in clinical trials, and identify all the common and moderate ones as well like headaches and pain at the vaccine site. However, even with mammoth studies, with 10,000s of people in them, it’s impossible to exclude things that happen really rarely. If a side-effect only happens to 1 in 200,000 people who get the vaccine, you’d need a clinical trial including literally millions of individuals to be certain to catch it in the numbers.

This raises an issue — we give vaccines at a population level, after all. Something that happens to 1 in 200,000 people might sound incredibly rare, and it is, but it will also happen dozens of times if you vaccinate 80 million people. And remember, it is vitally important to most of Europe that they vaccinate as many people as quickly as possible, given the vast COVID-19 outbreaks across the continent.

So, we do something clever. We set up monitoring systems that look at people in the general population who have been given the vaccine. That way, we can see if there are any signals of risk in the enormous group of people who get the vaccine after it is licensed for the general public.

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What’s happened to the AZ vaccine is that some countries have seen a very small but potentially significant increased risk of a rare type of blood clots in their monitoring data, and so have temporarily paused their vaccine rollouts to investigate it further.

Is this a good decision? Well, that depends on quite a few things.

Pausing Rollouts
The first question is pretty obvious — what is the signal of risk that has caused the worry in Germany, Norway, Spain, and elsewhere?

According to the regulatory agencies of the countries involved, it comes down to a rare but serious type of blood clot in the brain called venous sinus thrombosis. These have mostly been in quite young people (aged 20–55) which is part of the reason that there is a cause for concern. The German public health agency has published their findings, showing that there were a total of 7 of these blood clots in the vaccinated population of 1.6 million people aged 20–55 when they would’ve expected only 1 by chance.