If you thought AstraZeneca was done with the debacle around its COVID vaccine and rare cases of blood clots, think again.

On Tuesday, the German cities of Berlin and Munich both suspended the deployment of AstraZeneca’s vaccine in people under the age of 60, due to further cases of blood clots in the brain. Such cases are very rare, but almost all affect women who are middle-aged or younger.

The day before, the Euskirchen district in the state of North Rhine-Westphalia also stopped giving the vaccine to women under the age of 55, following the death of a 47-year-old woman who developed thrombosis after receiving the jab.

Shares in AstraZeneca in London were down 1.7% in mid-afternoon trading.

Also on Monday, Canada’s national vaccine authority responded to European jitters over AstraZeneca’s jab by recommending its suspension for all adults under the age of 55. It said the move was “a precautionary measure, while Health Canada carries out an updated benefit/risk analysis based on emerging data.”

To be clear, there is as yet no proven link between AstraZeneca’s vaccine and the condition that is being called vaccine-induced prothrombotic immune thrombocytopenia, or VIPIT. Even if there is such a link—and the possibility is still being investigated by the European Medicines Agency (EMA) and others—the case numbers are minuscule in comparison with the number of people who have received the vaccine.

In mid-March, when the issue sparked a days-long suspension of the AstraZeneca vaccine across most of the European Union, the company said it had received just 37 reports of blood clots out of 17 million vaccinations.

However, although the EMA fairly swiftly ended that suspension with an assurance that the benefits of the vaccine outweigh its risks, cases continue to appear, and some health authorities are plainly not convinced of that calculus.

‘Precautionary measure’

The “precautionary measure” announced Tuesday by Berlin health chief Dilek Kalayci came soon after the state-owned clinical groups Charité and Vivantes announced they would—for the time being—no longer offer the AstraZeneca vaccine to female employees under the age of 55. Berlin’s police force reportedly stopped using it on all officers last week.

Munich announced its own suspension shortly after the Berlin announcement, saying it was “a precaution until the question of possible vaccination complications for this group of people has been clarified.” At this stage, there have been 31 cases (nine fatal) of vaccine recipients developing blood clots in Germany, according to vaccine safety experts at the Paul Ehrlich Institute—with the exception of two, all have been women between the ages of 20 and 63.

Germany’s standing committee on vaccinations—STIKO, which is housed at the Robert Koch Institute and advises the government—is preparing a new recommendation about the AstraZeneca vaccine. The institute told Fortune Tuesday that the recommendation will likely come this week, though not today.

State health ministers from across the country are meeting Tuesday evening to discuss the issue. According to Bloomberg, Germany’s vaccine commission will change its recommendation on the AstraZeneca jab, saying, for the time being, it should only be used on women and men older than 60.

AstraZeneca had not responded to a request for comment on the German and Canadian suspensions at the time of writing.

Confusion abounds

There is a certain irony to the decision to stop giving the AstraZeneca vaccine to younger people, given that Germany’s health authorities earlier this year advised for a while that it was not suitable for those aged 65 or over.

The latest suspension could further damage people’s willingness to take the AstraZeneca vaccine in Berlin—where hundreds of thousands of residents have already not been responding to inoculation invitations—and beyond.

As Bill Moss, the director of the International Vaccine Access Center at Johns Hopkins University in the U.S., said last week, the widespread European decisions to pause the AstraZeneca rollout earlier this month will make it “hard to restore confidence” in the vaccine.

“They may have undermined confidence in the vaccine, fueled anti-vaccine sentiment in Europe, and provided fodder for misinformation and disinformation about the safety and effectiveness of vaccines,” he warned.

That said, doctors in Canada seem to think the opposite will prove true on their turf. Joss Reimer, the medical lead for the vaccine taskforce in the province of Manitoba, indicated Monday that people will be reassured by the precaution taken by health authorities.

“The pause, I hope, will send a message of confidence to Manitobans,” Reimer told CBC News.

Third wave

The Canadian vaccine drive is not expected to be heavily dented by the AstraZeneca pause, the National Advisory Committee on Immunization said Monday, because the “AstraZeneca COVID-19 vaccine was expected to make up a small proportion of the COVID-19 vaccines available for use in Canada.” Canada is still vaccinating older people, and by the time it comes to under-55s the hope is that plenty BioNTech/Pfizer and Moderna doses will be available.

Berlin and Munich had better hope that the same will be applicable there, because infection rates are shooting up as Germany and the rest of Europe plow into a third wave that is likely to be even more severe than the second.

AstraZeneca has famously under-delivered on its European commitments. Johnson & Johnson’s vaccine is coming, but only in late April. Novavax will hopefully come through soon after, but the company has reportedly been holding off on signing a bulk contract with the European Commission due to production problems.

In the meantime, that leaves BioNTech/Pfizer and Moderna’s vaccines. The producers of both vaccines have in the last couple weeks received the EMA’s go-ahead to ship vaccines from new European plants. BioNTech said Friday that its newly-approved factory in Marburg, Germany will be able to pump out a whopping billion doses annually.