Health experts have warned the media to be cautious about reporting links between blood clots and the covid vaccines.
Is this a case of messenger shooting, or a valid note of caution to the media?
Reporting of recent cases has prompted doctors and the government to ask media to be careful in their reporting.
Australian Medical Association vice president Chris Moy said highlighting unconfirmed vaccine side effects or complications without appropriate context could have a negative effect on public confidence and increase vaccine hesitancy.
News editors we spoke to about this issue, all of whom wanted to be off the record, had mixed responses.
Some thought it was hypocritical to blame the media for doing their job.
“If the problem is with the vaccine, why is it our problem,” asked one editor. “If confidence is being eroded, isn’t that more about the vaccine and its roll out than reporting of it? Why are they blaming the media?”
While others pointed to the fact that some reporting did indeed sensationalise each case without context, and the warning is timely.
“Good reporting is about communicating the whole story,” said one editor.
“It is absolutely valid and newsworthy to report the deaths from clotting, but it is also important to include the context in each report. Such an emotive issue can make people panic if they don’t hear all the information in the same story, we can’t rely on them hearing every report and creating the context themselves, we have a responsibility with issues like this to remember that people don’t always hear everything correctly. Each story has to have enough context to communicate the wider issue… that’s just good journalism.”
Medical officials fear that some reporting risks unnecessarily scaring vulnerable parts of the community, but they also acknowledge that there is a likely link to some of the blood clots and are continuing to investigate all cases carefully.
The latest case in point is the death of a 48-year-old woman in New South Wales who is believed to have died from blood clots after receiving the AstraZeneca vaccine. But additional information is needed to put her case in perspective, such as she is belived to have been diabetic and had other health issues.
The Therapeutic Goods Administration has also pointed out that common blood clots occur in around 50 Australians every day.
Investigations so far show that blood clots in people who have received the vaccine have only been confirmed in 2 cases out of over 700,000 people who received the AstraZeneca vaccine in Australia.
Moy says doctors fear that “media scrutiny, because of the heightened anxiety about the vaccines, is microscopic on every single thing that has gone on with the vaccine, whether or not it has anything to do with the vaccine.”
Negative news reporting about vaccine related clotting is also being used in disinformation campaigns by anti-vaccine lobbyists and others who have motives for causing destabilisation and division in society.
“The concern is that this over-analysis at the moment, without real knowledge, is essentially the media playing doctor and it’s actually causing a material effect on vaccine confidence, which really shouldn’t be the role of the media. Particularly if they’re actually having negative effects when they are reporting things which ultimately have nothing to do with the vaccine at all.”
All news editors we spoke to for this story, whether they agreed with Moy’s viewpoint or not, recognised that reporting should give wider context and that media should be careful not to sensationalise the issue.
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This commentary is not legal advice nor medical advice. See your legal advisor and/or AHPRA (Australian Health Practitioners Regulatory Authority) - registered evidence-based medical practitioner, not a quack nor a person consuming and regurgitating US shock jocks, anti-vaxxers or conspiratorialists.
Rather this is a commentary on risk and at the end we ask whether the media could do more about asking more questions about whether the medical authorities, medical profession and pharmaceutical industry can do to determine whether a patient is a candidate for a particular treatment.
The information presented by the media is on evidence-based medicine. By presenting evidence-based information to the public means that the public is informed based on scientific evidence, not snake oil merchants and quacks.
People are not adverse to risk. We drive cars or cross the road as a pedestrian, knowing that there is a risk of an accident.
Similarly in medicine, there is a risk of an adverse reaction to medication or surgical intervention including death. For example, if one has an cholocystectomy, there is a 0.5% fatal outcome. If there is no surgical intervention, it could be death by sepsis.
In the famous "failure to warn" case of the High Court of Australia, Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479 (19 November 1992), ref http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/HCA/1992/58.html?context=1;query=rogers%20v%20whitaker;mask_path= the practitioner, despite conducting the procedure with due diligence and professionalism, failed to warn the patient of the risks of undergoing a procedure. In that case, the patient was not warned of the risk of undertaking an operation on eye, could lead to sympathetic ophthalmia, resulting in total blindness, paras 2, 3, 4, per MASON C.J., BRENNAN, DAWSON, TOOHEY AND McHUGH JJ.
Warning the patient of the adverse risk is part of the overall duty of the practitioner to inform the patient such that the patient makes the right decision.
Though the benefit of the treatment which was to restore eyesight was greater than the adverse risk of total blindness, the risk to the patient becoming blind was one in fourteen thousand, para 3, per MASON C.J., BRENNAN, DAWSON, TOOHEY AND McHUGH JJ.
Had the patient known of the 'minute' risk of one in fourteen thousand, the patient would not have undergone the procedure. The patient did not want to risk being the one in fourteen thousand.
Unfortunately. the patient became blind because of a lack of knowledge of the risk.
When it comes to the adverse risk of the covid-19 vaccine, according to the European Medicines Agency, data from the UK and European Economic Area (EEA) indicates that out of 20 million vaccinations, 7 had an adverse reaction, that's one chance in 2.9 million for disseminated intravascular coagulation (DIC) and 18 cases for cerebral venous sinus thrombosis (CVST), that's one chance in 1.1 million.
There has not been a proven link, sources https://www.ema.europa.eu/en/news/covid-19-vaccine-astrazeneca-benefits-still-outweigh-risks-despite-possible-link-rare-blood-clots and https://www.health.gov.au/news/atagi-statement-for-health-care-providers-on-suitability-of-covid-19-vaccination-in-people-with-history-of-clotting-conditions
Meanwhile, the Australian Technical Advisory Group on Immunisation (ATAGI), cautions by deferring administration of the vaccine on patients with a history with CVST and Human Induced Thrombocytopenia (HIT) where a blood thinner, heparin may risk causing clots, source, https://www.health.gov.au/news/atagi-statement-for-health-care-providers-on-suitability-of-covid-19-vaccination-in-people-with-history-of-clotting-conditions .
So, if people are informed about the risk, it's the patient's decision to not take the treatment as the patient in the High Court of Australia case of 1992 would have had the patient been informed. Alternatively, unlike the patient in the High Court case, the patient may well take a risk/benefit analysis.
But the argument posed by the medical adminstrators, accusing the media of adversely influencing public confidence in the vaccination program may well be true.
It may be that the benefits of the vaccine far outweigh the adverse risks which prima facie is between one chance in 1.1 to 2.9 million. The public may well be informed they don't want to be the one in 1.1 or 2.9 million in a similar way that the patient in the High Court Case did not want to be the one in fourteen thousand.
The news of the side effects of the Astra Zeneca side effects are on evidence based side effects as reported in the Daily Telegragh, https://www.dailytelegraph.com.au/coronavirus/why-under-50s-can-still-get-the-astrazeneca-vaccine/news-story/c1ac800d13d12b9028cd5496efe31445 - this is a rolling news item and it also publishes the statistics.
From the AusVaxSafety website, while 51.8% report an adverse reaction, 1.2% of patients attended their doctor or ED, source https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines.
People are well informed. The media are not sourcing their news from snake oil merchants and anti-vaxxers.
It is not as simple to assert that people are not taking the vaccine because of clots, even if the adverse effects provoke fear in the public. There are patients like the one in the High Court Case who would not have proceeded if the risks are known. There may well be situations where the patient knows the risks being minor yet proceed with the treatment.
For example, the risk of developing clots by consuming the contraceptive pill is 1 in 1000, which is a 1000 times higher risk than developing clots from the vaccine, https://www.abc.net.au/news/2021-04-15/covid-vaccines-answered-questions-blood-clots-astrazeneca/100072386. Of those 1 in 1000 clots, 6% of those who obtain clots by consuming the pill will die, source https://www.abc.net.au/news/2021-04-08/covid19-vaccine-blood-clotting-az-explainer/100055638 . Using mathematics, if 100 in 100000 patients develop clots from consuming the pill, 6 of those 100 will die.
That is there is a risk of consuming the pill for contraceptive or therapeutic purposes, reference for other purposes https://www.healthdirect.gov.au/contraception-options, https://endometriosis.org/treatments/oral-contraceptive-pill/
Again, the issue raised by the medical authorities about the media reporting adverse or alleged reactions to the vaccine may not explain the apprehension held my members of the public. People will use their own risk/benefit analysis from the information presented by the media and evidence-based articles. On the other hand, people may not approach the taking the vaccine as a risk/benefit but not prefer not being the person who is the 1 in a 1.1 million or the 1 in 14000 as the patient from the High Court case.
It is irrelevant whether the magnitude of the risk is 1 in a million, 1 in 14000 or even 1 in 1000. People will make their decision to take or not take a treatment based on risk/benefit or the patient being apprehensive of being unlucky.
In conclusion, the media should ask the questions and report the questions and answers to the medical authorities, the medical profession and pharmaceutical industry as well as university researchers as to what are the causes of the adverse reaction to a treatment and if there are diagnostic tests available to determine whether a patient is a suitable candidate to take a treatment.
Furthermore the other factor in people not taking the vaccine is not the risk/benefit analysis nor proceeding with the treatment knowing the risks, BUT patients being apprehensive of whether there will be a supply of the vaccine for the second shot in the recommended time after the first shot.
Another question the media should ask is whether the time difference between the first shot and the second affects the immune response.
Thus the issue of risk and the issue of vaccine supply should apply to all kinds of treatments and interventions.
Thank you,
Anbthony of thinking Belfield