Norwegian Institute of Public Health's recommendation about AstraZeneca vaccine

Since use of the AstraZeneca vaccine was put on hold on 11th March, the Norwegian Institute of Public Health has considered further use of the AstraZeneca vaccine in Norway, together with other experts. 

"We now know significantly more about the association between the AstraZeneca vaccine and the rare but severe incidents with low platelet counts, blood clots and haemorrhages, than when Norway decided to pause use of the AstraZeneca-vaccine in March," says Geir Bukholm, Director of the Division of Infection Control and Environmental Health at the Norwegian Institute of Public Health. 

"Based on this knowledge, we come with a recommendation to remove the AstraZeneca vaccine from the Coronavirus Immunisation Programme in Norway," says Bukholm. 

Bukholm points out that this has not been an easy recommendation to make. It has a direct consequence for when the risk groups can receive a coronavirus vaccine, with subsequent protection, while also having an impact on when it will be possible to lift infection control measures. 

Higher risk associated with AstraZeneca vaccine than from COVID-19 disease in Norway 

Having come a long way in vaccinating the oldest citizens, Norway has reduced the risk of death for many of those most at risk. Since most of the elderly have either been vaccinated, or soon will be, this means that continued use of the vaccine would mainly be among the under-65 years age group if we were to use this vaccine in Norway.   

Calculations have been performed based on Norwegian data where the risk of dying from COVID-19 disease among the different age groups is compared with the risk of dying from the severe, but rare, condition with severe blood clots observed after AstraZeneca vaccination. 

"Since there are few people who die from COVID-19 in Norway, the risk of dying after vaccination with the AstraZeneca vaccine would be higher than the risk of dying from the disease, particularly for younger people," says Bukholm. 

In addition, there is reason to assume that there is scepticism about using the AstraZeneca vaccine in Norway, and it is uncertain how many people would have accepted an offer of this vaccine now. 

For those who have had the first dose 

People who have had the first dose of the AstraZeneca vaccine will be offered another coronavirus vaccine for their second dose. 

"We will come back with more specific information about when and how people who have had their first dose will get their second dose. One dose gives good protection against COVID-19 for at least 12 weeks," says Bukholm. 

Postponed rollout of Janssen vaccine 

The European Medicines Agency (EMA) announced on 9th April that they have begun signal management for the COVID-19 Vaccine Janssen to investigate whether there is an association between the vaccine and several reported cases of severe blood clots among vaccinated people. Janssen has announced a pause in deliveries to Europe after the US Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) recommended a temporary pause in the use of the Janssen vaccine, following reports of several cases of severe blood clots after vaccination in the USA.

"Use of the Janssen vaccine in Norway has been put on hold until more information becomes available from ongoing investigations," explains Bukholm. 

Consequences for vaccination progress 

The Norwegian Institute of Public Health estimates that removing the AstraZeneca vaccine from the immunisation programme would incur a delay of approximately two weeks.  

Not using the Janssen vaccine would delay the immunisation programme by up to 7 weeks for some age groups.  

Currently, there are under 200 000 doses of the AstraZeneca vaccine and 24 000 doses of the Janssen vaccine in storage in Norway. The doses are being stored in accordance to regulations until it is decided how these shall be used.