The UK-EU vaccine war is a failure of empathy, writes Tony Hockley (LSE). He argues that the current blame game is a manifestation of deep-rooted political challenges originating from Brexit

Hockley, Tony

English

LSE Research Online

The	Brexit	vaccine	war	is	a	failure	of	empathyThe	UK-EU	vaccine	war	is	a	failure	of	empathy,	writes	Tony	Hockley	(LSE).	He	argues	that	the	current	blamegame	is	a	manifestation	of	deep-rooted	political	challenges	originating	from	Brexit.The	UK	and	EU	are	still	tightly	bound	by	the	complexities	of	vaccine	supply	chains.	They	are,	however,	divided	byemotions.	To	many	Britons,	the	EU	looks	to	be	driven	crazy	by	envy	at	a	vaccination	programme	in	which	it	actedon	the	maxim	to	“take	back	control”,	and	that	this	craziness	had	led	EU	politicians	to	commit	the	self-harm	ofdestroying	confidence	in	the	“British	vaccine”.	To	many	Europeans,	the	UK	looks	like	to	be	living	up	to	the	Brexitstereotype	of	blinkered	self-interest,	blithely	detached	from	a	continent	being	ravaged	by	a	“British”	variant	ofCOVID-19.	The	binary	rhetoric	that	emerges	from	these	two	world	views	is	generating	a	dangerous	empathy	gapbetween	political	leaders,	with	potentially	serious	and	lasting	consequences.	On	both	sides,	there	are	deep-rootedpolitical	challenges	that	will	be	complex	to	resolve,	and	for	which	the	simplest	solution	is	to	deposit	blame	on	theother	side	of	the	English	Channel.	Closing	the	empathy	gap	should	be	a	high	priority.When	European	countries	decided	in	March	2021	to	pause	vaccination	with	the	Oxford-AstraZeneca	“UK”	COVID-19	vaccine	(AZ)	over	safety	concerns	it	provoked	almost	universal	outrage	and	indignation	within	the	UK.	Manycommentators	saw	it	as	direct	retribution	for	Brexit	and	the	result	of	irritation	at	the	UK’s	relative	success	in	vaccinedeployment.	These	malevolent	interpretations	may	reflect	more	on	a	Brexit-dominated	worldview	within	the	UK	thanon	the	real	motivations	behind	EU	Member	State	decisions	to	invoke	the	Precautionary	Principle	following	dataassociated	the	AZ	vaccine	with	a	very	rare	condition	involving	blood	clots.	A	pause	in	the	deployment	of	the	AZvaccine	was	an	almost	unthinkable	solution	…	for	the	UK.	It	is	what	would	be	described	in	behavioural	science	asan	“aversive	solution”,	that	renders	the	problem	it	is	attached	to	almost	invisible	to	some.	Sometimes	we	are	simplyincapable	of	seeing	the	complexities	of	the	world	when	the	response	to	these	complexities	conflicts	with	ourworldview.	An	“empathy	gap”	separates	two	completely	different	perspectives.LSE Brexit: The Brexit vaccine war is a failure of empathy Page 1 of 5		Date originally posted: 2021-03-24Permalink: https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/Blog homepage: https://blogs.lse.ac.uk/brexit/For	the	UK	with	a	seemingly	credible	“roadmap”	out	of	lockdown	the	idea	of	pausing	the	AZ	vaccine,	even	briefly,seems	insane.	Seen	through	a	different	lens	this	may	not	be	the	case.	There	are	two	core	reasons,	for	context,	thatmay	account	for	this	gap:The	UK	is	unusually	reliant	upon	the	AZ	vaccine.	It	appears	that	the	AZ	product	may	now	account	for	3	in	4vaccinations	in	the	UK[1]	(or	more),	with	the	Pfizer-Moderna	product	reserved	for	certain	groups,	particularly	thosewho	received	it	for	their	first	dose	because	it	was	the	first	product	authorised	and	distributed.	The	opposite	may	betrue	in	other	countries,	with	very	little	reliance	to	date	on	the	AZ	product,	due	to	availability	and	choice.	Withvaccination	at	much	lower	levels	than	in	the	UK	and	with	a	much	lower	AZ	share	within	this	total	a	short	pause	of	itsuse	would	have	limited	direct	impact.	Additionally,	some	of	those	affected	by	the	pause	will	have	been	waiting	ontheir	second	dose	(which	emerging	evidence	suggests	is	not	harmful	in	the	case	of	the	AZ	product).LSE Brexit: The Brexit vaccine war is a failure of empathy Page 2 of 5		Date originally posted: 2021-03-24Permalink: https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/Blog homepage: https://blogs.lse.ac.uk/brexit/The	UK	has	unusually	high	levels	of	confidence	in	vaccination.	Much	of	the	recent	commentary	brings	to	mind	thejoke	about	the	tourist	in	Ireland	asking	for	directions,	who	was	told:	“I	wouldn’t	start	from	here”.	Past	comments	byEU	Member	State	have	reinforced	vaccine	hesitancy	in	relation	to	the	AZ	product.	This	was	already	fertile	ground.A	large	gap	in	headline	efficacy	outcomes	from	clinical	trials	(with	AZ’s	competitors	achieving	levels	close	to	100%)put	the	product	on	the	back	foot	in	terms	of	public	perceptions.	Being	the	cheapest	of	the	available	vaccinesreinforces	this	prejudice,	regardless	of	the	technical	differences	that	make	direct	comparisons	difficult.	These	basicdata	have	real	salience	with	the	public.	They	are,	unfortunately,	very	simple	and	very	clear.The	politicians’	“miss-speaks”	happened:	Like	it	or	not,	these	countries	are	where	they	are	today	with	high	(evenmajority)	levels	of	hesitancy.	The	politicians	were	playing	to	this	audience,	and	decisions	must	continue	to	be	alertto	the	challenge	they	face.	Ignoring	data	on	potential	side	effects,	even	very	rare	ones,	is	not	a	viable	option	giventhe	state	of	public	opinion.The	President	of	France,	for	example,	faces	another	presidential	election	in	Spring	2022.	The	National	Front	couldwell	maintain	its	steady	progress	towards	a	win.	Vaccine	fears	form	part	of	the	anti-establishment	sentiment	withinthe	broadening	base	of	support	for	the	National	Front.	This	cannot	be	ignored.LSE Brexit: The Brexit vaccine war is a failure of empathy Page 3 of 5		Date originally posted: 2021-03-24Permalink: https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/Blog homepage: https://blogs.lse.ac.uk/brexit/It	may	be	in	Macron’s	interest	both	to	woo	a	vaccine-hesitant	population	by	diverting	blame	for	vaccinationproblems	onto	Britain	and	its	vaccine.	The	same	is	true	for	a	European	Commission	alert	to	increasing	nationalconcerns	at	the	failure	of	a	centralised	vaccination	strategy,	with	some	looking	to	Russia	for	support.	Howeverdangerous	and	distasteful	these	are	the	“nested	games”	that	politicians	play,	but	whose	complexity	is	too	easilymissed.	Briton’s	attacking	Macron	for	his	“dangerous”	comments	may	make	this	particular	play	more	effective,	notless.	Similarly,	European	leaders	seem	to	miss	the	fact	that	UK	vaccination	success	is	the	only	way	for	the	PrimeMinister	to	redeem	a	reputation	marred	by	more	than	125,000	deaths	and	to	keep	his	party’s	lockdown	sceptics	atbay.The	extraordinarily	high	levels	of	vaccine	support	enjoyed	by	the	UK	has	meant	that	its	regulators	have	been	ableto	take	valuable	calculated	gambles	in	its	vaccine	strategy.	This	was	particularly	true	in	its	extraordinary	decision	toextend	the	dosing	interval	from	days	to	months.	High	levels	of	general	vaccine	hesitancy	in	some	other	countriesmean	that	extreme	caution	is	essential	in	order	to	nurture	public	confidence.	Copying	the	UK	approach	to	dosinginterval	may	have	been	more	disastrous	for	vaccine	confidence	than	a	few	misguided	statements	by	politicalleaders	about	one	product.In	this	context	it	was	probably	right	for	the	German	regulator,	for	example,	to	advise	pausing	use	of	the	AZ	vaccinesafter	it	noted	an	accumulation	of	cases	of	a	very	rare	clotting	disorder	in	some	people	vaccinated	with	the	AZproduct.	Whilst	proof	of	causation	is	very	difficult	to	obtain	in	health	policy	an	association	such	as	this	cannot	beignored	or	wished	away.	Being	seen	to	err	on	the	side	of	caution	should	be	a	core	part	of	a	strategy	of	confidence-building	if	the	cross-Channel	blame	game	is	stopped.	It	is	interesting	to	note	that	polling	suggested	that	there	wasno	contagion	from	the	blood	clot	scare	from	the	AZ	vaccine	to	the	others	in	current	use.Amidst	some	of	the	more	simplistic	comparisons	with	other	risk	scenarios	“#paracetamol”	was	trending	in	UK	socialmedia,	as	part	of	the	ridicule	of	the	precautionary	pause.	This	reminded	me	of	a	policy	crisis	many	years	ago	that	Ihandled	as	Special	Adviser	in	the	Department	of	Health,	which	also	highlighted	the	importance	of	empathy	inregulatory	decisions.	Ireland	had	proposed	limits	on	the	size	of	paracetamol	pack	that	could	be	bought	without	aprescription.	This	was	a	measure	to	tackle	the	awful	problem	of	suicide	by	overdose.	Paracetamol	is	very	safe	andeffective	–	within	the	set	daily	limits.	In	England,	we	felt	bound	to	follow.	The	campaigners’	case	for	restriction	waspowerful	and	deeply	human.LSE Brexit: The Brexit vaccine war is a failure of empathy Page 4 of 5		Date originally posted: 2021-03-24Permalink: https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/Blog homepage: https://blogs.lse.ac.uk/brexit/The	product	manufacturers	rightly	highlighted	the	irrationality	of	this	decision.	It	would	restrict	access	to	a	safemedicine	in	widespread	use;	increase	demand	for	NHS-funded	prescriptions	of	larger	packs;	prompt	people	to	useless	safe	forms	of	pain	relief;	and	would	be	unlikely	to	have	any	direct	effect	on	the	overall	number	of	suicides.Nonetheless,	the	human	context	made	action	important.	We	were	where	we	were,	not	in	a	situation	of	coldrationality	but	of	emotion.	The	case	for	a	clampdown	was	clear	and	simple:	Restricting	paracetamol	availabilitywould	limit	the	opportunity	for	paracetamol-related	suicide.		By	any	standard	risk-benefit	test	it	was	wrong.In	much	the	same	way	that	regulators	in	vaccine-hesitant	countries	risk	fuelling	fears	by	not	acting	on	reportedsafety	concerns,	inaction	on	paracetamol	would	have	risked	increasing	its	use	in	suicide	simply	because	the	Irishdecision	had	put	it	in	the	headlines.	These	decisions	are	as	much	about	the	context	as	they	are	about	directanalysis	of	the	individual	decision.If	the	empathy	gap	between	the	UK	and	its	neighbours	is	not	closed	then	further	damaging	arguments	areinevitable.	The	risk	of	vaccine	hesitancy	contagion	is	high.	Data	always	emerge	in	the	real-world	use	of	medicinesat	scale,	which	would	have	never	shown	up	in	a	clinical	trial.	These	vaccines	are	being	used	at	an	extraordinaryscale.	If	new	concerns	become	diplomatic	incidents	then	their	divisive	impact	will	be	amplified,	and	in	the	case	ofvaccine	hesitancy,	the	risks	will	be	amplified	by	the	headlines.	This	will	be	increasingly	relevant	as	the	globalvaccination	effort	builds.	Whilst	Astra	Zeneca’s	report	of	its	US	vaccine	trial	appear	positive,	a	licensing	decision	bythe	US	Food	and	Drug	Administration	may	yet	require	a	shared	communications	strategy	in	response,	not	a	battleof	words	on	this	side	of	the	Atlantic.In	the	end,	the	outcome	of	the	blood	clot	scare	was	exactly	as	would	be	expected.	The	European	MedicinesAgency	quickly	reviewed	the	data,	assessed	the	risk-benefit	profile	of	the	vaccine	(with	an	almost	inevitableconclusion)	and	committed	to	updating	the	product	literature	in	relation	to	a	possible	causal	link	with	the	rareclotting	incidents	and	to	initiate	further	research.	That	some	countries	opted	to	pause	the	use	of	the	AZ	vaccinewhilst	the	blood	clot	cases	were	quickly	investigated	was	entirely	understandable	within	the	circumstances	that	theyface.The	best	strategy	to	address	vaccine	supply	issues	and	issues	of	vaccine	confidence	is	not	mutual	denigration	butempathetic	diplomacy.	The	UK	is	already	building	post-Brexit	bridges	with	the	US	Biden	administration	with	climatechange	as	a	binding	cause.	It	must	quickly	find	a	similar	common	cause	with	its	continental	neighbours.	Vaccinationrhetoric	is	making	this	a	tough	challenge.	Efforts	on	all	sides	to	close	the	empathy	gap	are	of	vital	importance.It	is	as	important	that	the	UK	can	export	its	vaccine	confidence	as	export	its	vaccine.	In	the	coming	months,	itshould	have	an	ample	supply	of	both	to	make	a	positive	difference.This	post	represents	the	views	of	the	author(s)	and	not	those	of	the	Brexit	blog,	nor	of	the	LSE.	[1]	The	UK	authorities	do	not	release	data	on	each	vaccine’s	use.	The	“blood	clot”	scare	led	to	the	release	of	data	on	“Yellow	Card”	reports	relating	to	the	twovaccines	in	use.	The	indicated	that	the	ratio	of	Yellow	Card	alerts	between	the	Pfizer-Biontech	and	Oxford	AstraZeneca	was	increased	significantly	between	the	threemonths	up	to	7th	March	and	the	weeks	thereafter,	from	around	1:2	to	1:3.5,	alongside	a	claim	that	both	vaccines	have	similar	reporting	rates	of	3-6	Yellow	Cards	per1000	treated.LSE Brexit: The Brexit vaccine war is a failure of empathy Page 5 of 5		Date originally posted: 2021-03-24Permalink: https://blogs.lse.ac.uk/brexit/2021/03/24/the-brexit-vaccine-war-is-a-failure-of-empathy/Blog homepage: https://blogs.lse.ac.uk/brexit/

The Brexit vaccine war is a failure of empathy

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The Brexit vaccine war is a failure of empathy

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