Ana Moore* is a woman in her late 60s. After receiving her invitation to get her first jab, she arranged an appointment early this week at the vaccination centre in Limpertsberg.

Her first impression? “It was well organised, in terms of logistics,” she told Delano.

When it came her turn, Moore said the woman who was to administer her vaccine asked her whether she’d had allergic reactions, or other medical issues. “I told them I had a history of mini-strokes,” Moore explained, adding that she had been taking aspirin to help prevent them in future and sometimes has issues with her legs swelling. Based on her medical history, Moore was surprised that the jab offered to her was the AstraZeneca vaccine. When Moore pushed back, the woman at the centre “told me, with a blank stare, ‘Today I have AstraZeneca.’”

Moore left the centre--without getting her first dose--troubled by the experience. She submitted a formal explanation that she refused the vaccination for medical reasons with the covid-19 hotline and is now awaiting a response.

“I would have been very upset if I had taken [the AstraZeneca vaccine],” she said. “I felt it was a very authoritarian way of doing things.”

She is expecting her place in the queue to be reactivated, but she has no idea when that will be. Moore is relieved her husband has received his vaccination (Pfizer/Biontech), and friends in other EU countries in her same age group are receiving theirs, but for now she is still waiting.

Not all clots are alike

For those who have had a deep-vein thrombosis (DVT) or pulmonary embolism (PE) in the past, it can be hard to move past the fear of getting another one.

According to Stop The Clot operated by the US National Blood Clot Alliance, the likelihood of having another incident, however, depends very much on circumstances. If a first clot or embolism occurred as a result of surgery or trauma with a temporary risk factor, the risk of having another DVT or PE may be very low, the group says. Someone developing a clot spontaneously, with no risk factors present, is at 30% risk of another clot over the next ten years, with the risk higher in patients with thrombophilia or cancer, it adds.

In some cases, those who have had a previous DVT or PE may be put on blood thinners and asked to wear compression stockings--or at least it may be suggested to them if they take long-haul flights or during pregnancy, for example.

But experts warn not to compare different types of thromboses as the clots linked to the coronavirus vaccine are likely caused by a specific immune response.

This is the caveat--and it’s a pretty big one. When Delano reached out on Tuesday to a local medical doctor--who agreed to talk on the basis of anonymity--they explained, “The information is changing every day, but we have just had further messages from the ministry of health stating that these rare cases of specific types of thrombosis...are not associated with normal risk factors for thrombosis, or a prior history of thrombosis. Therefore, there is no reason to recommend a specific vaccination for patients where there is no history of thrombosis, and there is also no indication to give people preventative treatment for their vaccine, especially in view of the fact that this rare side effect is associated with low platelets.”

The University of Oxford, which helped develop the AstraZeneca jab, on Thursday said the risk of developing a rare blood clot from contracting the coronavirus was about eight times higher than that of the AstraZeneca vaccine. The risk of a blood clot from covid-19 is about 100 times higher than in a person who doesn’t contract the virus, it said.

The study states that cerebral venous thrombosis (CVT) also occurs in patients who received the Pfizer/Biontech or Moderna vaccines. “In over 480,000 people receiving a covid-19 mRNA vaccine (Pfizer or Moderna), CVT occurred in 4 in a million,” it said. “CVT has been reported to occur in about 5 in a million people after first dose of the AZ-Oxford covid-19 vaccine.” But the research also warned that “all comparisons must be interpreted cautiously as data are still accruing.”

US chief medical advisor Anthony Fauci in a hearing with US lawmakers on 15 April questioned the results of the comparison, saying: “It is impossible, the way this study was designed and conducted, to make that determination.”

Pfizer in a statement on 13 April said: “With a vast number of people vaccinated to date, no thrombotic medical observations have modified the safety profile of our vaccine observed in phase 3 clinial trials.” The company’s analysis was based on data of adverse events received through 27 March 2021.

Around one in four people who developed CVT after receiving the AstraZeneca vaccine died. In its review of the vaccine’s safety, the European Medicines Agency analysed data on 62 cases of CVT and 24 cases of splanchnic vein thrombosis reported, 18 of which were fatal, out of around 25m people who had received the vaccine.

Health ministry, patients’ rights group weigh in

People who refuse a vaccine on site can request to be added to a waiting list, the health ministry confirmed to Delano. But there is no guarantee that a different vaccine will be used at the next appointment, and it is only possible to add one’s name to the waiting list once.

The health ministry told Delano that around 1.4% of people currently refuse the AstraZeneca vaccine on site, although adding that this number is similar across different vaccines and fluctuates from day to day.

The Patientevertriedung, a patients’ rights group, this week had demanded that doctors’ opinions on which vaccine their patients should receive be respected by vaccination centres.

“The treating physicians issue an opinion which takes into account the person's current state of health and indicates, based on all the relevant medical data, which vaccine offers the best protection and which causes the least side effects,” the group said in a statement.

“However, neither the advice of the attending physician nor the medical history is taken into account; it is the doctor on site who decides which vaccine to administer. This decision seems arbitrary,” it added, echoing Moore’s own concerns.

Close to home

Despite the health ministry’s statements and ongoing medical research on the issue, the announcement on Wednesday that Luxembourg was investigating the death of a 74-year-old woman who passed away two weeks after receiving the AstraZeneca vaccine has brought the issue closer to home. An autopsy has been carried out to determine the exact cause of death, but its results have not yet been made public.

Denmark on Wednesday removed the AstraZeneca inoculation from its vaccination programme. Germany meanwhile will give the AstraZeneca vaccine only to people aged 60 or over. The UK decided to offer an alternative jab to under 30s. The EMA has issued no specific recommendation on age or sex for the use of the vaccine.

Even if Luxembourg is later than other European countries, it seems to finally be taking note: during a Friday afternoon press conference, prime minister Xavier Bettel (DP) announced the grand duchy’s move to give people a choice with the AstraZeneca jab.

Those who have already received the first jab of the Vaxzevria vaccine will also receive their second. But starting next week, people aged 30 to 54 will be able to sign up to receive the AstraZeneca jab. For Moore, this change in policy would not have made a difference, however, as older age groups aren’t included in the voluntary sign-up scheme.

A similar type of blood clot has been observed in people who received the Johnson & Johnson vaccine. US authorities this week called for a pause on using the vaccine while reviewing six reported thrombosis cases out of more than 6.8m doses administered. The European Medicines Agency is probing whether regulatory action might be necessary. The company as a result halted shipment of its coronavirus vaccine to Europe. It was supposed to deliver 55m doses by end of June.

Luxembourg this week began administering the first batch of the Johnson & Johnson vaccine, which it received on Monday. The CSMI has issued no particular guidance on the J&J jab but the issue could be revisited pending the US and EMA reviews and once the company restarts deliveries.

*Name changed at the interviewee’s request

Updated on 16 April at 7.45pm to include the statement by Pfizer about its review of thrombotic medical obversations.