More than 71% of Alameda County residents aged 16 or older have received at least one dose of a Pfizer, Moderna, or Johnson & Johnson vaccine. Johnson & Johnson’s one-dose vaccine schedule and its ability to be stored at less extreme temperatures are part of the reason why 45% of Alameda County residents, or 592,000 people over the age of 16, are considered fully vaccinated today.
But the recent 12-day “pause” of the Johnson & Johnson vaccine — after a handful of recipients experienced blood clots — is yet another messaging hurdle that public health professionals are dealing with while reaching out to unvaccinated people and urging them to get their shots.
The unpausing of the Johnson & Johnson vaccine last week comes as reported vaccination rates have begun to slow in the county since peaking more than two weeks ago. The declining number of people getting vaccinated locally is part of a nationwide trend that, according to the New York Times, will slow down the nation’s path to reaching herd immunity, if herd immunity is even still possible.
To overcome any confidence issues, health leaders say it’s necessary to continue reaching out to people who could suffer the worst from the virus, as well as those who are at lower risk but are maintaining a wait-and-see approach. The message is that the J&J vaccine is safe, effective, convenient, and available.
“I think a lot of people who know it’s safe are going to want to get the shot,” said Aaron Ortiz, CEO of La Familia.
The Johnson & Johnson vaccine ‘pause’ explained
Health providers continue to be excited about the Johnson & Johnson vaccine because it’s clinically proven to prevent people from dying of COVID, it only requires one shot, and it’s much more easily stored and transported than the Moderna and Pfizer two-dose vaccines.
But real world data spurred federal regulators to take a second look. On April 13, Alameda County announced it was pausing use of the J&J vaccine following an observation by the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration that a small number of people experienced extremely rare yet severe combinations of blood clots and bleeding disorders after getting the shot. These adverse effects showed up in six women between the ages of 18 and 48, one of whom died. By then, officials reported 6.8 million doses of the Johnson & Johnson shot had been successfully administered in the United States.
Citing “an abundance of caution,” federal health investigators explored the potential link between the vaccine and cerebral venous sinus thrombosis, a type of blood clot that can prevent blood from leaving the brain.
These symptoms reportedly happened in the six women six to eight weeks after their initial doses, which is typically when experts say side effects of vaccines, besides any initial allergic reaction, typically start showing. The problem with these two blood-related conditions is that drugs to treat one symptom can make the other worse, making it a tricky condition to treat.
“We really needed to put everyone on notice,” Dr. Noha Aboelata, founder and CEO of Roots Community Health Center, said during a recent Johnson & Johnson vaccine panel hosted by Alameda County.
The J&J pause meant vaccine sites — including the mass vaccination site at the Coliseum and targeted pop-up mobile clinics backed with federal and state resources — could only use the Pfizer and Moderna shots.
Sites also had to change their appointment schedule to require second doses either three or four weeks, respectively, after the first dose. That slowed the rate at which people could be fully vaccinated by half.
The Coliseum started using the Johnson & Johnson vaccine on April 1, when Alameda and Contra Costa counties took over control of the site from the federal government. The site switched back to the Pfizer vaccine on April 11, two days before the “pause” was announced, according to California’s Office of Emergency Services.
That’s the same week 600 doses of the Johnson & Johnson vaccine arrived at La Familia, which has been providing mental health and community support services in the Bay Area for more than 40 years. Aaron Ortiz, La Familia’s CEO, said they followed public health guidelines, kept their doses cold, and waited to “see what research shows,” regarding the vaccine’s safety.
In less than two weeks, the CDC and the FDA found only 15 confirmed cases of the rare clotting issue, all affecting women, among nearly 8 million doses of the Johnson & Johnson vaccine administered in the United States.
As Bay Area health officers noted in an April 25 statement, the highest risk for blood clotting is among women between the ages of 18 and 49, but the odds of experiencing this are 7 in 1,000,000. At the same time, the risk of dying from COVID-19 in the United States is 1 in 56.
Overall, Bay Area health leaders said they agreed with the findings of the CDC, FDA, and an independent analysis from the Western States Scientific Safety Review Workgroup that the “Johnson & Johnson vaccine is safe and that Bay Area health providers should resume its administration to prevent community spread and severe illness and death from COVID-19.”
This time, however, a shot comes with a warning about rare but serious blood clots in some women under the age of 50.
“All this stuff about the J&J pause, that wasn’t about whether or not it works. It works,” said Dr. Nicholas Moss, Alameda County’s health officer. “So far, it’s been working really well and it’s a great addition.”
Moss said everyone should talk with their doctor or healthcare provider to discuss individual risks. But for people with existing blood clotting or platelet issues, Moss said, “It is recommended you get a different kind of vaccine,” referring to the Pfizer and Moderna options.
What the J&J pause means for vaccine confidence
After the Johnson & Johnson vaccine pause was lifted April 25, county and community sites began slowly reintroducing the shot back into the mix. This includes educating people about the risks of vaccination, and letting them know that women are at greater risk of the rare condition that requires special treatment.
Despite the overall medical confidence in the Johnson & Johnson shot, Ortiz said the impact was felt immediately. “It does create a sense of hesitancy,” he said.
While at the height of its use, more than 6,000 Johnson & Johnson shots were being administered daily at the Coliseum, along with hundreds of others being used at smaller community sites. But in the few days after the pause was lifted, La Familia and Alameda County reported only using a total of about 60 J&J shots, which they said they plan to increase in the near future.
The county received a total of 41,100 doses of the Johnson & Johnson vaccine after it was first authorized for use by the FDA on Feb. 27. Neetu Balram, public information manager for Alameda County Public Health Department, said the county had 8,820 doses of the Johnson & Johnson vaccine on hand when the CDC and FDA recommended the pause and the county hasn’t received any more doses since then.
Balram said the county started administering Johnson & Johnson “to a very limited number of residents who are receiving in-home vaccinations” beginning last week. This week, they’re beginning to use them again at county-run sites.
Those getting a J&J shot are also given a factsheet about the vaccine’s safety from the California Department of Public Health, currently available in seven languages, as well as having a clinician available at community sites to answer any questions. The warning is also featured on the state’s MyTurn vaccine appointment site.
“We recognize that rebuilding confidence in the vaccine may require additional time and education,” Balram said.
Many national and local health experts say pausing the Johnson & Johnson made clinical sense and should give people more confidence in vaccine development and monitoring, but it obviously didn’t have that effect on the public.
An ABC News/Washington Post poll conducted before the pause was lifted found that just 46% of those surveyed believed the Johnson & Johnson vaccine to be “very” or “somewhat” safe, while 70% thought the Moderna and Pfizer vaccines were. Still, the poll found 73% of those not yet vaccinated said they didn’t want the Johnson & Johnson shot.
Overall, public health officials concur that Johnson & Johnson’s one-dose vaccination schedule carries low risks and high benefits for the majority of adults. That’s useful for those targeting priority populations before, during and after a pandemic, as everything there is built on trust and communication.
La Familia and other trusted names in community health are working to see which among them would see a greater benefit in a “one and done” treatment when new data hasn’t increased any of their risks.
“We’re targeting anyone who feels comfortable taking the J&J shot,” said Ortiz. “We’re walking slowly on it and making sure there’s trust in the community.”