European countries may have to mix COVID-19 shots amid AstraZeneca crisis

By Matthias Blamont, Gwladys Fouche and Essi Lehto
PARIS, April 7th (Reuters). Several European countries are considering confusing COVID-19 vaccines for citizens who have received an initial dose of AstraZeneca's shot. This is an unprecedented move that highlights the challenges facing governments struggling to tame new rates of infection.
Vaccination programs were upset after a small number of reports found that recipients of the AstraZeneca vaccination had extremely rare blood clots, prompting some countries around the world to discontinue use out of caution.
A senior official from the European Medicines Agency (EMA) said in an interview published Tuesday that there is a link between the vaccine and rare blood clots in the brain, but the possible causes are still unknown.
The EMA later said in a statement that its review of the vaccine was still ongoing. She will keep up to date with her investigation on Wednesday afternoon.
AstraZeneca previously said its studies had not found an increased risk of clotting because of the vaccine, which has been given millions of doses around the world.
While many countries have resumed the use of the shot, some have imposed age restrictions.
In many cases, officers have scratched their heads on what to do for people who have received a first dose of AstraZeneca but are no longer eligible under the new rules.
Although the numbers are small compared to the millions vaccinated in the area, the decision matters because it hasn't been tested in late-stage human studies.
Any deviation from EMA's marketing authorization would also be considered "off-label use" which means it would not be approved by the regulator and would hold individual countries accountable for possible side effects.
The EMA had no immediate comment when asked about vaccine mixing and matching and referred to the briefing later on Wednesday.
Some experts say that since all vaccines target the same external "spike" protein of the virus, they could work together to prepare the body to fight the virus. There is no evidence that it will be that effective.
Germany was the first European country to recommend on April 1 that people under the age of 60 who received a first AstraZeneca shot should be given a different product for their second dose.
Norway will decide by April 15 whether to take AstraZeneca's vaccine again or to rely on alternatives.
"The result is that you either get a vaccine, the AstraZeneca vaccine ... or a booster vaccine with other types of vaccines," Sara Viksmoen Watle, a senior physician at the Norwegian Institute of Public Health, told Reuters.
The Norwegian authorities are also awaiting the results of a UK study launched in February to look at mixed doses of Pfizer and AstraZeneca vaccines. The timing of the data is unknown.
The UK said late last year it would allow people to get shots of various COVID-19 vaccines on rare occasions, but has not yet had to.
Finland, which resumed the AstraZeneca vaccine from March 29 but will only pass it on to people aged 65 and over, said it will wait for the EMA's conclusions before making a recommendation. The second dose must be given from mid-April.
In France, where the vaccine can only be used for people aged 55 and over, the problem affects hundreds of thousands of people.
One of the leading health counseling agencies responsible for defining vaccine use, the Haute Autorité de la Santé (HAS), is also considering using a messenger RNA (mRNA) vaccine made by Pfizer-BioNTech or Moderna as a second dose, according to two sources Knowledge of the organization's plans.
A formal decision has not yet been made, however, as experts await more data, particularly from the UK, one of the added sources. France has until the beginning of May, 12 weeks after the first doses have been given.
The HAS had no comment.
As early as February, there was no data to assess the interchangeability of the AstraZeneca vaccine, so it was recommended that those who had already received a first dose should not receive another shot at the second vaccination.
"We are only guessing, which is why I and other colleagues feel very uncomfortable," said Charlotte Senechal, a 52-year-old nurse who works in Strasbourg, eastern France.
(Additional reporting by Emilio Parodi in Milan; editing by Josephine Mason and Nick Macfie)
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