When Oxford University developed the AstraZeneca vaccine, Dr Sue Pavord was so eager for it to succeed, she signed up for the medical trial herself. Photo / Bloomberg via Getty Images
When Oxford University developed the AstraZeneca vaccine, Dr Sue Pavord was so eager for it to succeed, she signed up for the medical trial herself. Photo / Bloomberg via Getty Images
Dr Sue Pavord identified vaccine-induced thrombocytopenia and thrombosis (VITT) linked to the AstraZeneca vaccine.
Pavord and colleagues reduced the VITT fatality rate from 75% to 22% through diagnostic and treatment plans.
The AstraZeneca vaccine was withdrawn after over three billion doses were distributed, citing commercial reasons.
When Oxford University developed the AstraZeneca vaccine, Dr Sue Pavord, a consultant haematologist, was so eager for it to succeed, she signed up for the medical trial herself. She even persuaded her adult daughter to join her.
“I said to Molly, come on, let’s go and participate. Because we were trying to develop the science and we’re trying to fight this pandemic.
“And Molly said, ‘Yes, I’ll do it’.”
Looking back, Pavord’s feelings about helping to get the AstraZeneca jab on to the market are somewhat mixed. The jab was heralded as “the vaccine for the world” on the basis that unlike the Pfizer jab, which had to be stored at ultra-low temperatures, it could be kept in fridges, making it easier to transport and roll out in developing countries. Boris Johnson described it as “a triumph for British science”.
We now know that the AstraZeneca vaccine could lead to a condition known as vaccine-induced thrombocytopenia and thrombosis (VITT), which can kill patients or result in life-changing injuries. Photo / Bevan Conley
But nine weeks after the vaccine finally started being administered to the public in January 2021, Pavord became one of the first doctors in the UK to realise something may be amiss.
A young man came to see her as an outpatient on March 15, 2021. He had developed deep vein thrombosis – a type of blood clot – around a week after being vaccinated against Covid. He also had low platelets.
We now know the AstraZeneca vaccine could lead to a condition known as vaccine-induced thrombocytopenia and thrombosis (VITT), which can kill patients or result in life-changing injuries.
But at the time, VITT had not even been named as a condition, and Pavord – a consultant at Oxford University Hospitals – knew the combination of blood clots and low platelets was highly unusual.
“We see thrombosis commonly and we see low platelets commonly, but the two together really only have a select number of causes, quite rare and serious conditions,” she recalls.
The young man had already recovered by the time Pavord saw him, but his case continued to play on her mind.
Two days after meeting the patient, Pavord attended a virtual meeting, where three other consultants in Britain said they had seen patients with the same combination of symptoms. Photo / 123RF
Two days later, Pavord attended a virtual meeting with the medicines regulator, the MHRA (Medicines and Healthcare products Regulatory Agency), where – to her alarm – three other consultants in Britain said they had seen patients with the same combination of symptoms.
Those cases were more severe, and the colleagues in question had had various tests carried out that established the patients had developed an antibody called “anti-platelet factor four antibody”, which is more commonly associated with a very serious immune reaction to a blood thinner called heparin.
“What they were saying, and the patient that I had seen, made me very concerned indeed,” Pavord recalls. “We started to think, could this be a Covid vaccination or could it be something else? Could it be Covid infection? … We were all on guard and alert.”
Pavord contacted four other haematologists, who established a daily open meeting for clinicians up and down the country to compare notes. It soon became clear Covid jabs were the common thread.
Three in every four patients died
In the beginning, Pavord says, the death rate from VITT was so severe that three in every four patients with the condition lost their lives. But over the following months, Pavord and her colleagues worked together on diagnostic and treatment plans that helped to reduce the fatality rate.
“We brought that down to 22%. But if you think that [means that] one in five people die ... it’s such an aggressive disease,” Pavord says.
When she realised the risks that her children had taken by getting vaccinated – and in Molly’s case by participating in the AstraZeneca trial – she felt a combination of “massive relief” that they hadn’t suffered with VITT, and “retrospective anxiety”.
This anxiety led “to the hours that I and my colleagues put in to try and understand and manage this disease and stop it in its tracks”.
It was, unsurprisingly, an exhausting period. Alongside the daily meetings, they spoke regularly with Sir Chris Whitty, the chief medical officer, and received phone calls and emails day and night from doctors asking for clinical advice.
“We had not managed to clear our day jobs to give us time to deal with this new phenomenon. We were all working around the clock to try and understand what was going on, how we could save the lives of these individuals, what was causing it, and just how to diagnose it and manage it … I absolutely didn’t sleep for three months.”
It wasn’t just the workload keeping Pavord awake at night, however. She was also shocked by the age of many of the victims, and how severely they were affected. Their organs, she says, were sometimes “peppered” with clots.
“It was scary. I was a mother of three kids in their 20s, and these were the people we were seeing dying.”
We now know that one in 100,000 over-50s who received the AstraZeneca vaccine were at risk of VITT, with the figure dropping to one in 50,000 for the under-50s. Pavord and her colleagues estimate the risk for those in their 20s is one in 10,000.
The group held talks with Public Health England, the Joint Committee on Vaccination and Immunisation (JCVI) and the Medical Healthcare products and Regulatory Agency (MHRA) about whether there should be a lower age limit for those given the AstraZeneca jab – and if they could identify an age where the risk of the vaccine was worse than the risk of dying from Covid.
Even before Pavord and her colleagues began their daily meetings, several European countries – led by Austria – had been suspending the rollout of the AstraZeneca vaccine amid similar fears of adverse side effects. At the time, many people in the UK saw it as a political move, tied up with antipathy towards Britain caused by Brexit.
But on April 7, 2021, Britain was also forced into action. The MHRA said people under the age of 30 should be offered an alternative to the AstraZeneca jab. One month later it increased the cut-off to 40.
Pavord – who is now the president of the British Society for Haematology alongside her other roles – is extremely positive about the speed of Britain’s reaction both to the pandemic and to signs the AstraZeneca vaccine could have adverse effects. But behind the scenes, she also lobbied for anyone under the age of 50 to be offered an AstraZeneca alternative.
“We were seeing cases [among people] under 50. And it was when the vaccine rollout had reached the 50s that we started to notice the cases,” she reflects. “I was kind of pushing: we’ve got to stop the vaccine for people under 50. But then there were others going, ‘Well, these people are dying of Covid and we need the vaccine’.”
Knowing what we know now, many people would feel angry this view was not given greater weight.
The JCVI’s deputy chairman, Professor Wei Shen Lim, says its priority is safety and that Pavord’s “valuable advice” was considered alongside “scientific evidence from a number of sources”. Some of this “indicated that restricting access to the AstraZenecaZ vaccine would lead to substantially more deaths if there was slower uptake in the under-50-year-olds prior to the third wave,” he said.
Looking back, Pavord seems sanguine. She recognises that the AstraZeneca jab “was really an amazing accomplishment”, which undoubtedly saved a lot of lives. “They worked together to create a life-saving vaccine, and it was rolled out so quickly ... in terms of statistics, [VITT] is incredibly rare and we mustn’t forget that,” she says.
But she is also clear-eyed about the fact the work she undertook with her colleagues was instrumental in saving lives, too.
“I have absolutely no doubt about that,” she says. “Sometimes, when I look at young people in their 20s or younger, I think to myself, ‘Gosh, there’s probably a one in 10,000 chance that we saved your life'.”
Last May, having distributed more than three billion doses of the vaccine, AstraZeneca announced it was withdrawing its product. The company insisted the decision was a commercial one: the vaccine had been superseded by updated vaccines that tackle new variants. It was “incredibly proud” of the role the jab “played in ending the global pandemic”.
Pavord may have been rooting for the AstraZeneca vaccine from the start, but after witnessing its terrible potential side effects at close quarters, how does she feel now that it will no longer be used in Britain?
She reflects, and says a little hesitantly: “I’m relieved”.
