Siddaramaiah isn’t the first politician to wrongly link COVID vaccines to heart attacks, and each such occasion is a nightmare for science.
New Delhi: After Karnataka chief minister Siddaramaiah’s doubts over the safety of COVID-19 vaccines and their potential to cause heart attacks sparked controversy earlier this week, the Union health ministry issued a press release aimed at countering such claims.
Siddaramaiah had said his government had formed an expert committee to see, among other things, “whether COVID vaccines could have any adverse effects”, i.e. heart attacks.
The health ministry’s press release noted that the All India Institute of Medical Sciences in New Delhi recently launched a study to understand if there has indeed been a spurt in heart attacks and if yes, why. The preliminary results show, it said, that there is no change in the pattern of heart attacks now as compared to during previous years.
One would have thought the issue would fade off with that. But the chief minister decided to double down on Thursday (July 3) with another post on X.
Before going into the science of vaccines, health and illness, let us deal with some basic facts.
Let us take at face value Siddaramaiah’s concern that COVID-19 vaccines may have caused deaths. As per news reports, 22 people died in Karnataka’s Hassan district of heart attacks in about 40 days. Therefore, the chief minister felt one must go deeper into the causes of these deaths. Fair enough.
At least when presented in the manner that Siddaramaiah did, the case may appear to be one of a ‘cluster’ of deaths with one cause – heart attack. There are no reported incidents of a cluster of deaths due to heart attacks from elsewhere in India, making the Hassan case appear even more salient.
‘Cluster deaths’ usually occur due to the ingestion of a contaminated item at a large scale or due to a rapidly spreading infection. Vaccines, in general, cannot cause an infection per se that can lead to so many deaths in such a short span of time.
So were the vaccines contaminated with something?
Even if we were to assume that the vaccines were contaminated, any deaths from their administration would have occurred almost immediately. Any death due to the consumption of a spurious drug, vaccine or food item would happen within hours of intake. We are in 2025. The mass rollout of COVID-19 vaccines happened in 2020 and 2021.
Even if the chief minister suspects that there was something inherently wrong with the vaccines – its properties – and that they caused heart attacks, it begs the following question: for how long can that ‘defect’ lead to heart attacks?
Yes, the COVID-19 vaccines did carry a small risk of heart attack, which could occur in the range of 1 to 7.5 cases per million, according to several estimates. There are reports of a few cases of thrombocytopenia – a low platelet count – following COVID-19 vaccination, but this cannot be a regular occurrence.
The risk of heart attack due to COVID-19 vaccines was limited to nearly 40 days after uptake, as Dr Shahid Jameel, a veteran vaccine expert, wrote in the Indian Express. At maximum, it can go up to a few months, as one professor at the Christian Medical College in Vellore told The Wire last year.
This risk does not last forever.
The chief minister has not directly declared that vaccines did cause these attacks – but the tenor of his two X posts were enough to create doubt. And that they did – the response on social media is enough to indicate that.
If the Karnataka government-appointed committee would actually conclude that vaccines were not culprits, the news would be brushed under the rug and nobody would care to go into the details.
This could be harmful in the long term, because people in India seem to blame anything and everything on vaccines. Such arguments also divert attention from issues of larger importance of public health.
As far as public health measures are concerned, the chief minister could have also asked the expert committee his government set up to specifically look at the health infrastructure and human resources needed to save patients in what is known as ‘golden hour’ after a heart attack – if care reaches a patient within the first hour of their suffering a heart attack, especially due to sudden cardiac arrest, they can be saved.
One of the proxy indicators that is used to calculate the burden of a disease is the disability-adjusted life year (DALY). In simple words, DALYs are the sum of the number of years lost due to premature deaths caused by a disease and the number of years lived with a disability due to that disease. One DALY is one year of healthy life lost due to disability or premature death.
According to a study by The Lancet Global Burden of Health Diseases published in 2017, Karnataka figures in a list of ten states in India where DALYs due to heart disease are the highest in the country. In 2016, the DALYs for Karnataka were 4,805. This is nearly four times higher than the lowest figure of 1,063 years, which was registered in Mizoram.
Or, perhaps the chief minister could have given the committee a mandate to see if the incidence of non-communicable diseases (loosely known as lifestyle diseases) among people in his state was going up.
Half-baked allegations redux
One cannot uncritically advocate for vaccines by not taking all the facts into account. But as a journalist who has covered COVID-19 since its outbreak, the vaccines’ rollout – and the legitimate and illegitimate doubts surrounding it – I find it painful to have to react to the same thing time and again. The arguments to tackle the misinformation around vaccines remain the same, but the skeptics continue to change their arguments and grow more imaginative.
This time, the assault on vaccines has come from none other than a sitting chief minister.
On the other hand, there is now sufficient evidence that COVID-19 infection made patients’ hearts weak. There is a deluge of studies available now which say that the risk of long-term effects of COVID-19 remain elevated even three or four years after an infection. Listing even a majority of them, if not all, here is not possible because of their sheer number. For reference, this is one of the latest such papers.
But we have, so far, not seen the Union or any state government acknowledge this risk. We have not seen any government announce that it is going to up its game in screening non-communicable diseases (like cardiac ailments) in the post-COVID scenario. We have not seen any government try to figure out how to deal with long COVID patients.
What we have instead seen is a clamour against vaccines from various quarters.
Siddaramaiah’s second X post as well as the one before had raised some of the same issues that which many opposition politicians did so earlier.
The chief minister referred to a report by the London Telegraph that came in May last year, and said that AstraZeneca, the maker of the COVID-19 vaccine that was sold as Covishield in India, has ‘admitted’ to rare side effects of the vaccine.
This is the same report that many other opposition politicians, including Congress MP Priyanka Gandhi Vadra, had referred to in a public rally in the run up to Lok Sabha polls to take on the vaccine.
But what Siddaramaiah and Vadra missed is the keyword ‘rare’. Many studies have thrown light on the ‘rare’ part of the story. Different assessments have come out with different numbers, but it broadly ranges from 1 to 7.5 deaths per million population inoculated.
Also, the ‘admission’ regarding the ‘rare’ side effects that the company apparently made in court was nothing new, and those rare side effects have been known since 2021.
Moreover, no vaccine made in human history has been deemed to be 100% safe. The rarest of rare side effects have occurred. But one must also consider the scale of these risks as well as the timelines within which they exist.
Major associations of cardiologists around the world have repeatedly said that the benefits of COVID-19 vaccines far outweigh their risks, and that they were safe for a mass rollout.
“Many peer-reviewed studies (such as [in] Nature, Circulation, Journal of the American College of Cardiology) have discussed myocarditis and cardiac arrest risk, particularly among young adults post-vaccination,” Siddaramaiah said in his second post.
He did not point to any specific study in the journals he mentioned, and it is difficult to go hunting for them on his behalf. But some of these journals have published studies that have ruled out an association between the jabs and cardiac ailments.
The chief minister said even the WHO and “global regulatory agencies” had acknowledged the risk of rollouts granted ‘hastily’ and termed it a ‘calculated risk’.
It is hard to locate any such WHO statement, but the organisation itself is on record as saying that COVID-19 vaccines saved an estimated 14 million lives. There are umpteen other assessments saying the same. Many of these are modelling studies, but neither Siddaramaiah nor any other sceptic has been able to find specific fault in their methodology of modelling while pointing to the “potential unintended consequences” of vaccines as per Siddaramaiah.
All COVID-19 vaccines across the world were given emergency approval. Yes, the final and complete results of the vaccines’ trials were not available at that time, but only interim results were. As far as India is concerned, the preliminary (or interim) data of the third phase of the clinical trial of Covishied (known as Vaxzevria otherwise) had come from other parts of the world, before the rollout in India.
The government approved Covaxin in what is termed as ‘clinical trial mode’. For Covaxin, the interim data came after the emergency approval and it termed the vaccine as being safe. The publication of final, long-term safety data for this vaccine was to come by following clinical trial participants for one year after they had been given the jab. That long-term data is still awaiting publication, although the clinical trials have concluded.
Till now, what is available in the public domain is data that was generated by following the participants for 56 days.
The three phases of clinical trials start before the vaccines are rolled out for the public.
A post-rollout study – also known as a real-world study – conducted by the Indian Council of Medical Research (ICMR) declared Covishield and Covaxin to be safe.
A vast majority of the Indian population was inoculated with Covishield.
Silence from the Union health ministry
The Union health ministry, in some ways, is also responsible for the sustenance of misinformation. This is the first time that it has gone all guns blazing.
In the run up to the Lok Sabha polls, senior leaders of all opposition parties made serious and misinformed allegations, blaming COVID-19 vaccines for heart attacks in public rallies without offering a shred of scientific evidence.
Never did the ministry deem it necessary to counter these claims, perhaps because managing electoral discourse on other issues was more important for it.
The ministry also hardly did anything to instill confidence in the public that vaccines were safe. When social media posts were riddled with misinformation, the ministry did not think of launching a sustainable campaign to engage with the people at large.
The ICMR, nonetheless, went hammer and tongs against a paper authored by a group of researchers at the Banaras Hindu University, which claimed that one-third of those who took COVID-19 vaccines experienced adverse effects. The paper was indeed riddled with inaccuracies, and on the ministry’s diktat, the journal concerned retracted the paper. The authors, however, have contested the retraction.
Invisible impact
Every now and then, we see social media posts blaming vaccines for heart attacks. One wonders if vaccine hesitancy would also spill over to children’s routine immunisation, with senior political leaders leading tirades against vaccines from the front – without making any effort to distinguish them from childhood vaccination. A large part of the public may also not be able to make that distinction.
No study has been conducted to ascertain this proposition in India, but some evidence from the West already suggests that this may be happening. If it happens in India even to the minutest extent, decades of progress in childhood vaccination may stand reversed.
Are any politicians listening?
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Postscript: A recent analysis in The Lancet said that India has performed well in ensuring a high coverage among children as far as their routine immunisation is concerned, especially considering the fact that it has the largest population of children in the world.
Despite that, more than 14 lakh children did not receive a single dose of the DPT vaccine in 2019 (these children are known as ‘zero dose children’). The study does not qualify the reasons for this. There could be many, including gaps in tracking children whose parents are on the move as well as some problems in supply chains.
But in some sense, the stigma against vaccines for children has also historically contributed to this problem. Does this ring ominously for the future?
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