Johnson & Johnson vaccine pause poses risks of its own

The risk of the Johnson & Johnson vaccine, paused by health officials Tuesday because it is tentatively linked to a rare type of blood clot, is low relative to similar risks posed by COVID-19 and other medications in common use. Yet the pause could be costly in terms of slowing the vaccine rollout to rural areas and making it harder to win over people reluctant to get vaccinated.

On Tuesday, the Food and Drug Administration and the Centers for Disease Control and Prevention recommended pausing the Johnson & Johnson vaccine after six women between the ages 18 to 48 developed a blood clot within six to 13 days of receiving the shot.

Over 7.2 million doses of the vaccine have been administered, meaning the risk is on the order of about 1 in 1 million.

Dr. Angela Rasmussen, a virologist at the Center for Global Health at Georgetown University, said that the risk of getting the vaccine is worth it relative to other risks.

She stated that about 1 in 5 patients hospitalized with COVID-19 experienced blood clots, a finding from a December research article that analyzed 42 studies examining the risk of thrombosis from COVID-19.

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Another point of comparison is that of birth control pills, which cause clots in about 1 out of every 3,000 women.

“As someone who got the J&J vaccine 8 days ago, and who took oral contraceptives for 20 years, I’ll take these odds,” Rasmussen said in a tweet.

An average of about 164,000 Johnson & Johnson vaccines have been administered daily since the FDA gave it an emergency use authorization in late February. That is only about 5% of the vaccines that are supplied in the United States, so the pause is not likely to slow down the pace of vaccination in the near term appreciably.

That will depend on how long the pause lasts. Dr. Janet Woodcock, acting director of the FDA, said she expected the pause to last a matter of days. But Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said it could be days to weeks.

But the pause will not affect everyone equally. The Johnson & Johnson vaccine, unlike the Pfizer or Moderna vaccines, does not have to be stored at ultra-cold temperatures and only requires one dose. That has been a benefit to those in rural areas and other people who have trouble accessing the vaccine.

“The Johnson & Johnson vaccine certainly is going to be a game changer for all the counties across Ohio but for different reasons,” Tom Quade, Geauga County health commissioner, told an ABC News affiliate in Cleveland back in early March. “For a rural county, I think there will be a greater ability to take it on the road and to make sure we’re serving underserved populations that maybe don’t have the transportation to get to a larger clinic.”

The pause may also cause more people to be reluctant to get the vaccine.

“The news of the problem is probably doing all of the damage,” said Dr. Jeffrey Singer, a general surgeon and senior fellow at the libertarian Cato Institute. “There are already people out there who are hesitant to get vaccinated. This will make them even more hesitant.”

Yet the pause may be needed to help inform physicians on how to treat patients who have a vaccine-related blood clot. It is a very rare type of blood clot, called cerebral venous sinus thrombosis, that usually results in a stroke. Typically, blood thinners like heparin are used to treat clots. But administering heparin for cerebral venous sinus thrombosis can be dangerous.

“We need to make physicians aware of this,” said Fauci. “The pause not only allows us to take a look at the cases and learn more, but it is also a signal to help the physicians.”

Singer argued that physicians might want to advise certain women from getting the Johnson & Johnson shot.

“As we’re learning more about this, we might want to advise women in certain age groups against getting it,” Singer said. “We don’t know why yet, but this seems to be concentrated among women, and we see this kind of thrombosis is seen in women in the first trimester of pregnancy. It’s important to learn more to see if there is a connection.”

While Singer supports the pause, he noted that the risk of dying from COVID-19 after being infected is greater than getting a blood clot from the Johnson & Johnson vaccine.

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“Speaking only for myself, if I was a woman of child-bearing age, I’d personally get the vaccine,” he added.