Critical learning points for political, health governance of Covid-19

 

There are many key take away messages from the excellent management and governance of the US Centre for Disease Control and Prevention (CDC) in relation to the Thrombosis Thrombocytopenia Syndrome (TTS) aka blood clots, associated with the viral vector-based Covid-19 vaccine from Johnson and Johnson (J&J). 

1. The proactive action of the CDC and FDA to pause the use of the J&J vaccine, following reports of six cases (one fatal) of cerebral venous sinus thrombosis (CVST) with thrombocytopenia on April 13 and promptly issued a health alert. 

2. The Advisory Committee on Immunisation Practices (ACIP) meeting the following day, again illustrates a sense of urgency to investigate this association of the J&J vaccine with the TTS.

3. Ten days later, the ACIP recommended to the CDC to lift the pause on the J&J vaccine for use in adults. The reason for the 10 days delay was to allow the ACIP to collect more information on the cases and to investigate other plausible mechanisms for this association. 

4. The transparency of the decision-making process is such that the press was able to tally the poll. The vote was 10-4, with one abstention. They were even able to identify that the ACIP chairperson voted “yes”.

5. The “no” votes did not object to the lifting per se. They just felt that women less than 50 years old were not being adequately informed by this vote, of the increased but rare AEFI (Adverse Events Following Immunisation) of blood clots. And of their option to choose a different authorised Covid-19 vaccine.

6. Some of the “yes” votes rationalised that the qualifier demanded would be confusing and complicated especially for the local authorities to execute and would only erode vaccine confidence. Besides, the one-dose J&J vaccine would enormously benefit the vulnerable populations, namely the homeless, refugees, indigenous communities and those incarcerated in prisons or detention centres.

7. The CDC estimated that the rate of TTS was 7.0 per million doses in women below 50 years old and 0.9 per million in older women.

8. The fast track and open deliberations of the ACIP has inspired confidence from the US medical fraternity with the American Medical Association (AMA) hailing the decision and promising to assist the CDC to inform physicians and patients of the rare risk of TTS in women below 50 years, and the available treatment should it occur. 

Many have written profusely on multiple instances when a sense of emergency and a culture of transparency were sorely amiss in our political and health governance when managing the Covid-19 pandemic.

Until and unless these back to basics of health and political management are protected and practised, namely the preservation of the pristine values of competency, justice, fairness, evidence-based, sense of urgency, transparency and parliamentary/health check and balance, our beloved nation is doomed to a vicious cycle of Covid-19.

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DR MUSA MOHD NORDIN is a paediatrician and chairperson of the Federation of Islamic Medical Associations advisory council.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.