Out of order: Risks, relatively speaking

To be clear, any adverse event is always one too many. But in the real world, these things happen and often through no intrinsic fault of the therapeutic intervention

May 01, 2021
Randall C Willis
Out of order: Risks, relatively speaking

It seems that some of my friends hadn’t read my last DDN column, so I spent about an hour last night walking a 64-year-old friend through the Oxford/AstraZeneca COVID-19 vaccine data and concerns.

As elsewhere, there have been serious questions in Canada about the use of this particular vaccine in subjects over the age of 65. What was a more pressing concern for my friend—who reminded me he was 64 but in his 65th year of life—however, was the emergence of recent reports that some countries in Europe had put a hold on immunizations with this vaccine due to concerns about blood clots.

My friend was nervous about his upcoming vaccination but trusts me to help get him through what appears to be conflicting or complete lack of information from the media and his doctors. He even provided me with the numbers that he had heard—roughly 30 events after five million injections.

Randall C. Willis

Slowly, I picked my way through what I understood about the 65+ concerns and why regions were taking precautions in light of the adverse events.

He listened. He asked questions. And he reframed what I told him to make sure he understood correctly.

By the end of the conversation, he seemed more confident about getting his first shot this coming weekend. He understood that this was a numbers game; that it was about statistics and comparative risk.

I’ll be honest, I have never had a good grasp of statistics beyond the obvious, but after years of medical writing, I at least understand the concept of absolute risk and relative risk.

To be clear, any adverse event is always one too many. But in the real world, these things happen and often through no intrinsic fault of the therapeutic intervention. And even when the event is related to the intervention, the event may not have occurred but for a confluence of factors in that individual patient or group of patients.

I appreciate that I am preaching to the choir here, but only to encourage you to preach—well, talk—to your families and your communities.

Thirty blood clotting events over five million injections are tantamount to zero events, unless you are one of those 30 subjects or their families. And it is literally not nothing to those terrified of uncertainty, to those seeking guarantees of safety.

The rational mind can look at 30 events in five million and recognize that the absolute risk of me suffering the same thing is likely incredibly low. But in a mind and media landscape primed to be skeptical—or worse, fearful—all I am likely to see is 30 people experiencing blood clots. And the understandable precautions of national health authorities only help to fuel those fears.

The rational mind would also look at more than 500,000 deaths in the United States alone and understand the seriousness of SARS-CoV-2 infection. But as I have frustratingly learned through conversations with friends and observations online, that number simply isn’t fathomable for some until they have first-hand experience with a friend or loved one being stricken or worse with COVID-19.

500,000 deaths in 328 million people versus 30 clotting events in five million immunizations. Incidence rates of 0.15 percent versus 0.0006 percent.

As much as we publicly tout the efficacy rates of the different vaccines—and the inherent confusions already therein—we need to also be highlighting the relative risks of vaccination versus infection, and we must make it as personal as we possibly can.

It isn’t enough to issue blanket guidance from public health authorities, although those are important resources. It isn’t enough to simply expect individuals—our family and neighbors—to be rational as we explain the science.

We—all of us—need to be engaged in conversations with individuals or small groups of people. And these conversations need to be dialogues, not lessons. We need to hear their fears, listen to their questions, and then provide the answers they need in ways that are meaningful to them.

I appreciate that some of my arguments may seem muddled. That is likely because the challenge remains somewhat muddled in my head.

And as I laid out in March, I also appreciate how exhausting this effort is. I have yet, however, to find an alternative approach that works as effectively as one-on-one conversations, whether we’re talking COVID-19 immunizations or any other health topic.

I wish each of you much luck as you find your path forward.

Subscribe to our eNewsletters

Stay connected with all the latest DDN news!

Latest Issue's Magazine Cover

Latest Issue  

• Volume 17 • Issue 9 • September 2021

September 2021

September 2021 Issue