J&J shot back, but patients can pick
Choice will be offered to those wary of vaccine
Bay Area health officials and providers are gearing up to resume using the Johnson & Johnson coronavirus vaccine this week following a nearly twoweek nationwide pause. But some — anticipating consumer wariness over rare blood clots associated with it — will offer the Pfizer or Moderna shot option as well. Others have yet to decide if they will resume using the Johnson & Johnson product at all.
Federal and state regulators over the weekend recommended that the singledose Johnson & Johnson vaccine could again be used safely, following review of rare but serious blood clots and low platelets in 15 cases out of the 8 million U.S. residents who have received the shot.
The scientists who reviewed the cases found there is a possible link between the vaccine and the clots, but it remains unclear what exactly that is or why most of the 15 cases were in women under age 50. UCSF on Sunday announced that a Bay Area man in his 30s also had developed a clot in his leg after getting the vaccine; he was in good condition and was expected to leave the hospital.
That means the risk of developing blood clots from the vaccine is roughly 2 in 1 million for the overall population, and 7 in 1 million for women ages 18
to 49 — whereas the risk of dying after a confirmed case of COVID19 is 1 in 56, according to a joint statement from Bay Area health officials.
All nine Bay Area counties and the city of Berkeley say they will resume using the Johnson & Johnson vaccine, with most starting this week. The biggest change going forward is that clinics will make clear to people which vaccine is being offered at a given location. If they prefer a different vaccine, they can try another location or provider. This is a shift from earlier public health messaging, which urged the public to get whichever vaccine they could get first.
One major Bay Area vaccinator, Kaiser Permanente, is still reviewing the Johnson & Johnson data and has yet to decide whether it will reinstitute the vaccine.
“Before we resume use of the vaccine, we will be reviewing all available data, including forthcoming interim clinical considerations from the CDC,” Kaiser spokesman Karl Sonkin said in a statement. “This process will ensure that physicians and patients have the necessary information for the safe and effective use of the J&J/Janssen COVID19 vaccine.”
Some Bay Area county officials said they were aware of the new clot case revealed by UCSF and are monitoring that news while still moving ahead to resume administering Johnson & Johnson shots. The male patient began showing symptoms 13 days after getting his shot earlier this month. He has been treated in the hospital and is recovering very well, according to UCSF officials. UCSF said this was believed to be the first case of a male in the U.S. developing a clot after receiving the Johnson & Johnson vaccine.
UCSF hemotologist Dr. Andrew Leavitt helped treat the man for vaccinerelated blood clots. He said Monday the patient “has done beautifully,” adding, “His symptoms have improved with treatment and he’s very happy.”
Leavitt said he agreed with the CDC’s pause and subsequent resumption of Johnson & Johnson’s vaccine, but does not recommend one vaccine over another.
“They all are providing so much benefit relative to their risk,” he said. “People need to make their own personal decision, but I think they all are very good vaccines.”
While the known risks of developing blood clots from the Johnson & Johnson vaccine are extremely low, many Americans were already reluctant to get vaccinated, and the clot development means health officials must work to rebuild confidence. Fewer than 1 in 4 Americans who have yet to be vaccinated say they would be willing to get the Johnson & Johnson shot, according to an April 1821 Washington Post-ABC News poll.
Vaccine experts say the rare blood clot condition should not deter people from vaccination, especially since the U.S. now has two other vaccines in relatively ample supply. Those two, made by Pfizer and Moderna, have not had any reported cases of blood clots.
“No vaccine is 100% free of sideeffects, but the risk is extremely low and the risk of COVID is much higher,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford who said she “absolutely” agrees with the federal and state agencies’ decision to allow the shots to be given.
“These are things people must balance on their own and if they feel this risk is uncomfortable for them,we’re fortunate in this country to have access to two other vaccines at this point,” she said. “It shouldn’t stop people from getting vaccinated, but it gives us the opportunity to have them think about what choice of vaccine they may want to take.”
California health officials are updating the MyTurn website, the state vaccine appointments system, to include a field to show which vaccine is being offered. The update will be completed by Thursday, said Sami Gallegos, a spokeswoman for the California Department of Public Health.
In California, the Johnson & Johnson vaccine made up a smallenough portion of the state’s vaccine supply — 4% in the state, and roughly the same or less in Bay Area counties — that the pause did not drastically curtail vaccinations. Most counties and providers pivoted to the Pfizer or Moderna vaccine.
Still, because the onedose Johnson & Johnson vaccine is more convenient to use in hardtoreach populations, the pause did complicate efforts to reach homeless and homebound residents. Switching to Pfizer or Moderna meant vaccinators had to return a second time, using staff that could have reached other patients with a single shot. As providers return to the Johnson & Johnson product, they will be monitoring how patients feel about it and respond accordingly.
“In the last week when it’s been on pause, people have expressed concerns, so we’re going to see how people feel about it this week,” said Dr. Michael Stacey, chief medical officer of LifeLong Medical Care, which runs community health clinics in the East Bay.
LifeLong had been using the Johnson & Johnson shot to vaccinate a small number of homeless residents and homebound seniors prior to the pause, and plans to reinstitute the vaccine as soon as Tuesday. But it will have to see how comfortable patients are with it before deciding whether to expand its use beyond that, Stacey said.
“We’re going to roll it back out this week but will also be listening and seeing how people are feeling about it,” Stacey said. “Because Johnson & Johnson isn’t our only vaccine that we have available, we want to keep the option open, particularly for those that might benefit from a oneshot vaccine, which is the real advantage of the Johnson & Johnson. But we also are going to be mindful of people that maybe don’t want to get the Johnson & Johnson just because of the very small risk associated with it.”