J&J pause stirs new worries about vaccine equity
Public health experts worry that the pause on administering the Johnson & Johnson COVID-19 vaccine will hinder efforts to reach marginalized, vulnerable populations including communities of color.
The one-and-done nature of the J&J COVID-19 shot, and less stringent storage requirements, made it ideal for homebound people, those in underserved neighborhoods and rural, remote areas with limited health care access. The other two authorized COVID-19 vaccines, from Pfizer-BioNTech and Moderna, require a second dose and more complicated cold storage.
The Centers for Disease Control and Prevention and the Food and Drug Administration recommended the pause after a handful of reports of a rare combination of blood clots and low platelet counts within two weeks of getting vaccinated. The cases involved six women out of the more than 7 million Americans who recently got the J&J shot, and one man from an earlier clinical trial. One of the women died, and another is hospitalized in critical condition.
The CDC’s Advisory Committee on Immunization Practices met Wednesday to discuss the cases and will meet again in about a week or 10 days when it hopes to have more data from the more than 3.7 million J&J shots administered in the 21⁄2 weeks before the April 13 halt.
“I would urge that any pause be counterbalanced by consideration of the equity considerations that would befall from any lengthening of the pause,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention and director of the Association of State and Territorial Health Officials.
Committee member Dr. Camille Nelson Kotton, clinical director of Transplant and Immunocompromised Host Infectious Diseases at Massachusetts General Hospital, said that although it was necessary, she worries that the pause will fuel increased hesitancy and cause lack of availability in communities of color relying on the shot’s logistical advantage.
“It’s really very disappointing,” she said. “For communities that for a variety of reasons can’t actually get to a (Pfizer or Moderna) vaccine site, having the ca
pacity to do a one-and-done really saves lives.”
The pause alone may contribute to vaccine hesitancy, she said, particularly in communities of color that have been hit hardest by COVID-19.
“Although I definitely support putting it on pause while we evaluate things, even that single motion of putting it on pause likely enhances vaccine hesitancy,” she said.
Officials also need to “use simple terminology and make it very clear that the risk from COVID-19 infection is far greater than any of the risks from any of the vaccines,” Kotton said. “I’m hearing from patients that many of them are thinking that the risk from vaccine is higher than the risk of either getting the COVID-19 infection or severe disease from COVID-19.”
Dr. Marina Del Rios, director of social emergency medicine and associate professor of emergency medicine at the University of Illinois at Chicago, agreed that accurate information about the vaccines now is even more important.
Public health officials must explain that the pause proves monitoring of vaccine safety is happening, she said.
“I worry that there is too much messaging ... pointing to the potential risks and not enough messaging really pointing to the fact that COVID is still here, it’s still claiming lives,” Del Rios said. “Really, no medical management is without risk.”
Though the Biden administration says the J&J halt won’t cause an overall vaccine shortage because it represents a small percentage of shots, some public health officials worry about availability for underserved people.
“Obviously there’s a lot of this vaccine out there, and it’s not being used (now),” said Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine.
The pause is going to make distribution to underserved communities more difficult, said Murphy, a professor of medicine in infectious diseases.
“The J&J vaccine’s really got a much easier logistical component,” he said. The pause, he said, “is having an acute, but hopefully temporary, impact as we speak.”
“Putting it on pause likely enhances vaccine hesitancy.” Dr. Camille Nelson Kotton Clinical director of Transplant and Immunocompromised Host Infectious Diseases at Massachusetts General Hospital