For ten months, from January to October 2021, Dutch citizens were vaccinated with the controversial AstraZeneca (AZ) vaccine. Even before the first injection was administered, the Ministry of Health, Welfare and Sport (VWS) and the National Institute for Public Health and the Environment (RIVM) already knew that the vaccine would hardly prevent the transmission of the coronavirus among the elderly. When it became clear two months later that AZ could cause serious side effects, government institutes prioritized vaccination uptake over public health, according to an analysis of government documents under the Freedom of Information Act by researcher Cees van den Bos.
On October 31, 2021, GGD Ghor Nederland announced a definitive halt to the use of AZ, but doubts about the vaccine had already arisen nearly a year earlier, on December 22, 2020. Research published in the scientific journal The Lancet showed that the AZ vaccine did little to prevent coronavirus transmission among the elderly. The Ministry of VWS and RIVM were aware of this, but a team of behavioral scientists and communication experts advised that the Health Council—officially an independent scientific advisory body with the legal duty to advise the government and parliament on health issues—should not “write anything about this yet. It is not finalized.” Instead, they recommended that the Health Council should “sing the praises of B/P,” meaning BioNTech/Pfizer.
On January 29, 2021, a report from the RIVM revealed inconsistencies in the composition of AZ batches. The RIVM reported this to the European Medicines Agency (EMA). Although the pharmaceutical company is not liable for most vaccine-related damages, it is liable for negligence in the production process. A few days later, on February 2, an internal RIVM email circulated, indicating that the EMA wanted people to be observed for fifteen minutes after receiving the AZ vaccine. At this point, the side effect anaphylaxis—an acute allergic reaction causing severe difficulty breathing—was already well-known.
Five days later, South Africa halted the administration of AZ. The injections provided little to no protection against the dominant coronavirus variant in the country, despite a recent delivery of one million doses. The RIVM was concerned about this news, especially since the South African variant was also present in the Netherlands. However, they concluded that “even with slightly reduced protection, continuing vaccination is of the utmost importance.”
On February 19, an internal email with the subject “alarming report on AstraZeneca side effects” was circulated within the RIVM. Numerous sick reports had been received from general practices following AZ vaccinations of staff members. Instead of stopping AZ immediately, a strategy was devised: “Do not vaccinate staff on the same day. The advice should be to spread the vaccination of staff over at least two days due to sick reports the day after vaccination,” according to an internal email. This way, patient treatment could continue.
The RIVM struggled with whether to issue a warning. An employee sought clarification from the so-called internal “side effects guru.” “Have more signals been received, or is this in line with expectations?” the person asked. The “guru” replied: “It is so difficult to interpret, but it is important that no panic arises and that any peculiarities are assessed by Lareb.”
By mid-February, AZ’s image had already taken a nosedive. Vaccination willingness for AZ had significantly declined, as was also noted in Bilthoven, where the RIVM is headquartered. Therefore, a “brainstorm” was scheduled with the behavior unit and the vaccination program on February 20, 2021. “The refusal of the AZ vaccine and/or the impact of receiving this vaccine on vaccination willingness could become an issue.”
On February 22, the “concrete next steps” from the meeting were discussed. “We are looking for ways to improve AZ’s reputation and minimize its impact on vaccination willingness.” In its communication, the RIVM wanted to polish the tarnished image of the vaccine, partly through “media attention (via ambassadors/stakeholders)? RTL Nieuws/AD article?” It was also noted that many people find their own general practitioner and doctors on TV very important, so they too needed to be addressed “as soon as possible. Vaccinating with AZ will become increasingly important in the coming months. The sooner we can turn around the perception of AZ, the better,” wrote an RIVM employee. A day later, a letter with a flyer was already prepared. A mention of side effects was removed from the letter.
On March 11, several countries decided to stop AZ vaccinations. Olaf Dekkers of the Medicines Evaluation Board (CBG) stated on Nieuwsuur that evening that “a vaccine is only withdrawn from the market in the most extreme case.” The Netherlands would continue with AZ, he said. Remarkably, just five hours earlier, the Ministry of VWS had decided to pause AZ. It was not an immediate stop, as revealed in a memo from the Ministry of VWS. “The PGB group is still being vaccinated with AstraZeneca. But when it’s gone, it’s gone.” After a pause of just four days, the CBG advised on March 18 to resume AZ vaccinations. “Complaints after vaccination have arisen, but so far, no causal link has been established between the vaccine and these reports.” The Ministry of VWS responded enthusiastically. “It’s great that vaccinating with AstraZeneca can resume.”
However, the image problem persisted. Behavioral scientists came up with a one-pager, a brief memo aimed at addressing this issue, called Voor en door vaccinatie (“For and by Vaccination”). “It seems like a communication trick to anticipate reports of possible side effects,” said data analyst Van den Bos.
On April 1, 2021, VWS reported being informed by Lareb about “two reports of thrombosis combined with low platelets after vaccination, one of which was fatal.” A day later, VWS knew from Lareb about “five reports of thrombosis complaints combined with low platelets, causality not proven. (…) This will have implications for the communication about AZ.”
After an emergency meeting, the Health Council (GR) decided to advise that AZ should only be administered to people over 60 years old. This was remarkable, as scientific research had shown that this vaccine was hardly effective for that age category.
Another dilemma for the Health Council was the group that had already received a first shot with AstraZeneca but still needed a second. Could the vaccines be mixed with mRNA injections, such as those from Pfizer? It was unknown whether the side effects of the second shot would be less severe than the first. Meeting records revealed that the necessary knowledge was lacking in the Health Council. Minutes from a meeting of behavior experts on April 9, 2021, showed that even the EMA was unclear about the age-dependent risks of AstraZeneca. This made the Health Council’s advice to administer AstraZeneca to people over 60 even more remarkable.
How did it all come to this? The documents show that four Dutch ministers signed a contract with AZ on July 7, 2020, even though the manufacturer had never been the most desirable supplier internationally. However, AZ offered its vaccines up to seven times cheaper than Pfizer and even ten times cheaper than Moderna. On October 20, 2021, the GGD definitively announced the cessation of AZ vaccinations. “The AstraZeneca vials still in circulation will no longer be usable after October 31, 2021,” they reported. Therefore, a definitive switch to BioNTech/Pfizer was made.
