Risk and blame of vaccine politics

There’s a running joke that the Oxford vaccine is a world-class scientific triumph whereas the AstraZeneca vaccine is associated with rare blood clots. I offer a few thoughts on some curious parochial aspects of the vaccine saga underlying the humour.

In 2020 Covid vaccine research became popularized as an international race. Would Russia’s Sputnik win? Perhaps China’s Sinopharm would seal first place?  Although concerns about efficacy abound, both saw domestic service before the Pfizer–BioNTech mRNA vaccine BNT162b2 was granted rapid approval in the UK in December 2020. Next to cross the tape, so to speak, was the Oxford, Astra Zeneca vaccine, an achievement greeted in the UK with much tub thumping. This was a creditable British victory especially in light of doubts on the credibility of both Russian and Chinese claims.

Vaxzevria, to give it its commercial name, is a vaccine co-developed by Oxford University and the global, pharmaceutical business AstraZeneca (AZ). The multinational was founded in 1999 through the merger of the Swedish Astra AB and the British Zeneca Group. So Vaxzevria clearly has some entitlement to wave the Union Jack and trumpet its Oxfordness.

Interestingly, after serious albeit rare risks became apparent, use of the Oxford prefix declined markedly as I noticed at the Aberdeen vaccination centre recently. ‘Perhaps they’re not too proud of it in Oxford anymore?’ my nurse offered, as I queried the Oxford-less-ness of the leaflet I had been given explaining Possible Side Effects. Not that the UK was particularly quick to expatriate Vaxzevria. The midnight oil burning UK Medicines and Healthcare products Regulatory Agency (MHRA) proudly approved Oxford/AZ ahead of all rival regulators anxious to avoid delay getting the jab into arms. But when it came to acknowledging the blood clot risk, the MHRA with The Joint Committee on Vaccination and Immunisation (JCVI) fell behind other regulators who were quicker to flag-up concerns and take a more precautionary approach.

The European Medicines Agency safety committee (PRAC) concluded in early April that unusual blood clots with low blood platelets should be listed as very rare side effects of Vaxzevria. A month later UK regulators came around to the same conclusion, advising against use of Vaxzevria for those under 40.

Vaccine wars

diseases are foreign…cures are home-grown

Nationalistic explanations were coined Vaccine Wars. In one skirmish EU Commission President, Ursula von der Leyen, was cast in a Machiavellian role, attempting to both torpedo the ‘British Vaccine’ as unsafe, allegedly motivated by envy connected with Brexit, whilst simultaneously seeking to commandeer millions of doses bound for the UK in a legal wrangle with AZ. On another front the Australian Health Minister Greg Hunt fired more ammunition at AZ going further than the EU by announcing Pfizer–BioNTech as the preferred jab for every Australian under 60 years old. Given that the UK has struck a shiny new trade deal with Australia, as opposed to acrimoniously exiting a long-standing relationship, Australian motivations seem unlikely to be Brexit-based whatever the case against President von der Leyen.

That the vaccine has become embroiled in nationalistic politics may come as a matter of no great surprise. Sceptical Scot’s regular readers might have seen a pre-Covid post of mine (Eggs Benelux 05.09.2017) detailing how epidemiological risk is consistently entangled in national identity politics. From German Measles and Spanish Flu to the so-called Indian variant of Covid 19, viruses are routinely nationalized as a hostile act of attribution often without compelling evidence. The so-called Spanish Flu may well have originated in the US, many experts believe. So it is that the truism about viruses not respecting borders is blatantly ignored when it comes to their naming and shaming.

Of course, the host country typically rejects unwelcome labels. One example is what Germans (amongst others) call the English variant. Despite a willingness to accept all other variant nationalities, UK narratives prefer to describe this unwelcome compatriot as the Kent or B117 variant. This nationalism dynamic is self-evident and widespread. The populist Donald Trump was keen to make Covid as Chinese as possible repeatedly referring to ‘the Chinese virus’ while in office. He appeared less successful in his efforts to claim the Pfizer vaccine as an American success story when the CEO of Pfizer was quick to contradict him. And herein lies a curious parallel. Just as diseases are blamed on foreigners often with little justification, so are cures claimed as home-grown, belying the international collaborations clearly underpinning the collective discovery of numerous vaccines in rapid fire time.

Pole position 

Nations are quick to publicly appoint and honour their own disease-busting pioneers. In The Pasteurisation of France Bruno Latour charts the convoluted story of how its eponymous hero, Louis Pasteur, entered the pantheon of French national heroes being made a Grand Cross of the Légion d’Honneur in 1881. Latour’s book is a sociological account of the process by which diverse interests, including patriotic narratives, were woven together to combat the scourge of Listeria in France. Likewise, nations are keen to differentiate their approaches to disease risk management from those of other nations. In the UK we witness(ed) a stream of favourable comparisons with other nations despite higher death tolls: Sweden was not severe enough in their lockdown, Japan  fragmented in response and lacking leadership, and Bolsonaro’s Brazil  grossly negligent in its risk assessment, to name but three.

Within the UK the devolved nations jostled to find points of departure from one another. Lockdown measures were brought in and phased out on different dates from one jurisdiction to another. Travel guidance and quarantine periods were inconsistent. Even the numbering system for representing the risk levels could not be agreed upon with Scotland’s five tiers designated 0-4 while England’s five-level, colour-coded alert system adopted 1-5. The increasingly confused public witnessed persistent efforts by its different administrations to demonstrate their superiority by going one better than their rivals.

None of what I describe above would be remarkable at all were it not for the deafening mantra that the decisions being made in our name have been science-based, data driven, expert-led and, by implication, as devoid of the heat and grime of politics as it is possible to imagine. In reality, politicians have behaved as they always do, seeking public approval, jockeying for position, point scoring, and indulging in populist rhetoric to gain political advantage. That they have done so against the backdrop of the gravest of post-war risks confirms a long-standing social theory of risk .

Circling the wagons 

a tribe, community, nation or party with strong common values is more likely to cast blame on outsiders when danger arises

One of the first to challenge the idea that societal risk management is apolitical was the anthropologist Mary Douglas who, long before Covid imperilled the world, proposed that risk and blame politics are inseparable. It is natural for the group, community or nation to blame outsiders for existential risks. Risk, which she strongly associated with danger, is fundamental in group formation and social cohesion. To be a member of a group, community or nation is, in part, about sharing its values about existential threats, who is responsible for them and how to deal with them.

When the group is under threat, blame acts as a defence mechanism like circling the wagons to keep the murderous enemy at bay. Furthermore, the blame game is not entered into consciously, according to Douglas, but rather:  “…dangers affecting life and limb are drawn into the constitutional dialogue spontaneously…“. It is as though the very stuff of social solidarity, the glue that holds us together, automatically responds to danger, binding the group and excluding outsiders in equal measure. Douglas, as an exponent of the Cultural Theory of Risk, goes on to argue that, “…the stronger the solidarity of a community, the more readily will natural disasters be coded as signs of reprehensible behaviour…”.

In other words, a tribe, community, nation or party with strong common values is more likely to cast blame on outsiders when danger arises. Brexiteers, or conversely European unionists, might be more likely to attribute reprehensible, risky behaviour to their adversaries precisely because the ties that bind them are tighter. For Douglas, this fact of social organisation isn’t necessarily a bad thing. Democracy works through public discourse. Experts and scientists are not in charge of decisions although it might be convenient to pretend that they are. Our political leaders are ultimately tasked with risk management and theirs is not primarily a scientific approach and never will be.

Douglas goes on to warn us: “Each culture is designed to use dangers as a bargaining weapon”. We have seen proof of this in ongoing wrangles over vaccines and we urgently need to recognise that this global pandemic will have many more losers than winners as we enter into these dangerous negotiations. We must hold our political leaders to account as they deliberate equitable and efficacious strategies, and we need to remember where the power lies as they wheel out their advisors to hide behind. The curious nationalism we see displayed in claiming credit for cures and casting blame for ailments has a long history and we need to recognise it in ourselves and in our leaders and try to see beyond it as we coordinate an international response to the global pandemic.

Images via Creative Commons – thumbnail an unlabelled vaccine bottle; main a US soldier holding the Pfizer–BioNTech vaccine CC BY 2.0

Further Reading:

Douglas, M. (1992). Risk and blame : essays in cultural theory. London ; New York, NY, Routledge.

https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/ Tony Hockley

Latour, B. (1988). The Pasteurisation of France. Cambridge, MA, Harvard University Press.