In Overcoming Paralysis, Brussels Must Choose Harm Reduction

In Overcoming Paralysis, Brussels Must Choose Harm Reduction

Revelations that linked the AstraZeneca vaccine to blood clots in a very small number of those who had received the jab have led the European Commission to call for the development of a “coherent approach” with the European Medical Agency (EMA) on the matter. The demand for clearer and better coordination comes at a time when EU governments’ have implemented their measures to using the vaccine, choosing to restrict it to people of different ages which has caused not only disparate measures across the EU but also increased mistrust and already considerable scepticism towards the AstraZeneca vaccine in the population.

The ongoing debate over the vaccine even in the face of a fierce third wave highlights a key weakness of the EU at large: a broadly black and white view on risks and what is needed to achieve crucial mile-stone objectives, such as herd immunity. As a result, policymakers often enact ineffective policies to force a specific outcome, thereby ignoring that the path to sustainable solutions are more often than not shades of grey rather than black and white. Indeed, an approach focusing on “harm reduction” – a set of policies created to reduce the negative social and physical consequences of human behaviours – rather than complete “risk eradication” present a viable way forward towards realising policy objectives.

A crisis of trust

The EMA concluded that unusual blood clots are an extremely rare side-effect of the vaccine and advised that the benefits of taking the jab are still far greater than the risks. The fact remains that these complications are exceedingly rare yet the flurry of troubling headlines are likely to exacerbate the growing “crisis of trust” with the public over AstraZeneca vaccine, particularly in the wake of European citizens have perceived as a headless and confusing reaction by their governments that was anything but reassuring.

In the face of an unprecedented health crisis, it’s obvious that risks need to be taken after being adequately calculated. However, the EU’s timidity to take a concerted stand for the vaccine amid rising Covid hospitalisations comes at a huge opportunity cost in lives: A direct comparison of the potential harms from the vaccine with the benefits revealed that for people aged 60-69, 0.2 people out of every 100 000 vaccinated with AstraZeneca might develop a blood clot – but 14 people per 100 000 would avoid being admitted to the ICU with Covid.

With that in mind, the heavy restrictions and partial suspensions of vaccination programmes across the EU set a dangerous precedent, where, given the coronavirus’ rapid mutation rate, the bloc’s move hinders herd immunization strategies at a known cost of more infections and death. Clearly, the decision-making has consistently been divorced from medical reasoning.

All or nothing?

But the EU’s flakiness extends to other, longer-standing public health debates as well, particularly smoking and the treatment of its alternatives by EU lawmakers. With more than one in four Europeans smoking tobacco, Brussels has been waging a ceaseless war against it by implementing policies to stop people from smoking. However, if the goal is to reduce societal impact of smoking tobacco, it’s more effective to encourage changes in behaviour through pragmatic responses rather than oppressive proscriptions.

Thus, although the EU’s plan to reduce harm from tobacco is commendable, its current method is handicapped from the start because it fails to take into account the whole range of viable tobacco alternatives that can help smokers kick the habit or at least cause less physical harm, given that many smokers are unwilling or unable to quit completely. For example, EU policy makes no mention of e-cigarettes despite clear evidence that they are an effective solution for smokers trying to quit. As a comprehensive report by Public Health England recently showed, “an increase in vaping product use in England had been positively associated with the success rates of quit attempts”.

Vaping is nevertheless fighting an uphill battle in the EU against deep-rooted biases and lack of knowledge among lawmakers. A recent survey among MEPs revealed that a vast majority had no knowledge about new and alternative nicotine products. The results also positively correlated knowledge of such products with the belief that using them is less risky than tobacco, whereas “those with no knowledge are more likely to consider the products the same or more harmful compared to smoking.”

The EU’s general population, meanwhile, is very aware of the benefits of switching from conventional to e-cigarettes, thereby betraying a growing rift between politics and society. In 2017, 61% of Eurobarometer respondents cited taking up vaping to stop or reduce tobacco consumption while 31% considered them to be less harmful. By 2021, the number of people believing them to be less harmful than tobacco had increased to 37% though the political position on this had not moved. Here again, the reticence comes at the cost of lives: with the risks of smoking well-documented, and banning it outright impractical, there’s little reason why vaping as a steppingstone towards a healthier society should be ignored.

The journey is the destination


That the path towards long-term solutions is not a straight line but requires intermediate steps is perhaps most obvious in the energy transition, and Brussels’ dealing with the challenge makes its static, all-or-nothing view obvious. An energy system based on 100 percent renewables is desirable but impossible to attain with current technology. At the same time, opposition to expanding nuclear energy has been growing for years based on the idea that it’s too risky to do so. However, if the EU is serious in reducing its CO2 emissions by at least 55 percent by 2030 compared to 1990, it will have to accept the use of bridge technologies that won’t be ideal but acceptable until renewable technology has progressed further.

The obvious solution in this case is natural gas, which produces half the CO2 of coal and which Germany wants to use to wean itself off highly polluting lignite coal and unwanted nuclear. Given such restraints, accepting gas as the lesser of two evils is without alternative, given that pollution from oil and coal combustion is estimated to have killed nine million people globally in 2018 alone.Accepting that there are neither easy nor perfect solutions to the most pressing policy issues of our times is the most important step policymakers can take. An analysis of what is at stake shows that harm reduction strategies are therefore more likely to achieve measurable results, from stemming the Covid tide to reducing tobacco use to climate change. Rather than reaching for the stars, Brussels should seek to get half-way there first.

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