By Alistair Smout and Douglas Busvine
LONDON/BERLIN - The shifts in guidance on the Anglo-Swedish drugmaker's vector-based shot demonstrate just how hard it is for policy makers to weigh its benefits against risks in the form of very rare - yet occasionally fatal - cases of blood clotting.
How choosy governments can afford to be depends to a large extent on how far they have progressed towards vaccinating enough people to drive down the spread of coronavirus infections and cut the number of resulting deaths.
In Britain, which has relied heavily on the AstraZeneca jab designed at Oxford University, 51% of people have received at least one vaccine dose and daily fatalities have fallen to the low double digits.
Against that backdrop, Britain's panel of vaccine advisers said people under 40 should be offered an alternative to AstraZeneca due to the small risk of blood clots, raising the age cut-off from 30 previously.
Anthony Harnden, deputy chairman of Britain's Joint Committee on Vaccination and Immunisation (JCVI), stressed that the decision to propose alternative vaccines for the under-40s was "based on the UK epidemiology".
He noted that the risk-benefit balance of the AstraZeneca vaccine was different in Germany due to higher infection rates there. In Germany, the seven-day incidence is 126 cases per 100,000 people and, although it is on a downward trend, it is nearly six times the rate in Britain, official data show.
AN ATTRACTIVE OFFER
Britain's new-found caution follows bold earlier decisions to issue emergency approval for the AstraZeneca vaccine, aggressive ordering and a strategic choice to administer first doses to as many people as possible.
Germany, by contrast, has relied on a European Union procurement process that has been troubled by a dispute with AstraZeneca after the company slashed its deliveries due to production problems.
On the regulatory side, Berlin first banned AstraZeneca for the elderly due to a lack of trial data, before saying people under that age shouldn't receive it after monitoring identified cases of blood clotting, in particular in younger women.
Now, Health Minister Jens Spahn is making the shot freely available to those who want it, on a doctor's advice, and allowing people to get a second shot as soon as four weeks after the first.
The move comes with an eye to the summer holidays and coincides with the rapid passage of legislation this week that would free those fully vaccinated from social distancing measures imposed by Berlin to fight the pandemic.
AstraZeneca vaccines stockpiled at vaccination centres will now be used mainly to give second shots. Future deliveries will be sent to family doctors, offering a hassle-free route for those wanting protection in time for their summer vacation.
"We are convinced this offer is attractive for those who would otherwise not get vaccinated so quickly," Spahn told a news conference.
Even as Germany loosened its handling of AstraZeneca, the EU's drug regulator said it was reviewing reports of a rare neurological condition called Guillain-Barre syndrome in people who had received the shot.
And, adding to confusion, the Spiegel news weekly reported that Germany's vaccine committee planned to restrict the one-dose vaccine from Johnson & Johnson to over-60s following similar reports of blood clotting.
IN THE FAST LANE
The decision by the federal government follows moves by several German states to make AstraZeneca more widely available and comes as the pace of giving shots of mainstay vaccines from BioNTech/Pfizer and Moderna picks up.
The share of the German population that has received a first vaccine shot has reached 31.5%, putting the country in line with the rest of Europe, where an official dashboard https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#uptake-tab shows that 31.3% of people have received a first dose.
Some German experts criticised the decision to allow people to receive the AstraZeneca vaccine at shorter intervals, saying studies had shown its efficacy to be only around 55% with a four-week gap and 80% with a 12-week delay to the second shot.
"We have to make it clear that if people shorten the gap between AstraZeneca doses to enjoy greater freedom of movement sooner, they are doing so at the cost of their immune protection," said Carsten Watzl, professor of immunology at the Dortmund Technical University.
(Writing by Douglas Busvine; Additional reporting by Kate Kelland, Paul Carrel, Riham Alkousaa and Maria SheahanEditing by Gareth Jones)