The Johnson & Johnson Covid-19 Vaccine Pause Isn’t Just About Blood Clots

The J&J pause seems scary, but it helps rebuild the transparency and trust we need

I’m writing weekly for Medium about my experiences as an emergency medicine doctor during the Covid-19 pandemic. You can read my previous posts on vaccine passports, why this summer will be really weird, and more, here.

The joint recommendation by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) on April 13 to “pause” the use of Johnson & Johnson’s (J&J) Janssen vaccine was a very unwelcome surprise.

Prior to the announcement, the pace of vaccination had been expanding every week, partly due to the increased supply of the J&J vaccine. Soon every adult American would be eligible for a shot. We were en route to vaccinating our way to a blissful summer. And then came news that the J&J vaccine may be related to an increased risk of blood clots.

In the immediate aftermath of the announcement, pundits took to cable news and social media to pontificate as to why the FDA and CDC decision was unarguably wrong.

The most compelling arguments centered around the low risk of complications. There had only been six U.S. cases of a rare blood clot found in the over 6.8 million people who received the vaccine. Basic math shows this is a remarkably small risk, less than one in a million. That’s less than your chance of dying in an avalanche or getting struck by lighting. And way less than getting a blood clot from birth control pills, which millions of women take every day.

With Covid still circulating and so many Americans still unvaccinated, this decision seemed unwise at face value. But that argument overlooked something critically important.

A time-sensitive signal to health care workers

When the pause was put in place, I was working in the emergency room. In between patients, I logged into a CDC briefing on what to look out for and how to manage complications from the vaccine.

The first patient I saw when I got off the call was a young woman in her thirties who received the J&J vaccine a week earlier. She came in complaining of a headache and numbness to one side of her face. She had been so preoccupied with her symptoms that she hadn’t read the news, and was unaware of the announcement. She had come to the ER because she knew something wasn’t right.

I’ve seen patients with similar complaints countless times in my career. But this time, based on what I’d just heard in the briefing, I altered my differential diagnosis and changed my clinical workup.

This pause intended to put medical providers on alert and provide clinical guidance. And by highlighting what to look for and how to report complications, it also helped ensure that we will get the data needed to better understand the actual risk.

In the days since the pause was put in place, polls to understand how this announcement impacts vaccine hesitancy have launched. Many pundits have warned this decision will undermine the vaccine rollout and prevent people from lining up for their shot.

This may be true. Even so, the decision to hold J&J shots was the right one.

Yes, it will be harder to convince many, especially younger women, to get the J&J vaccine if and when we start using it widely again. And yes, that will still be true even if the risk is shown to be much lower than any risk of getting Covid, getting struck by lightning, or even dying from a vending machine crushing you.

But I think we’re being unfair to what people understand about the vaccines when we assume that a pause on one will dramatically impact vaccine hesitancy. We should stop pretending people don’t know the difference between the available options by now. Or assuming that potential issues with one vaccine means people won’t be willing to get the others.

A long-term investment in trust and transparency

Given how quickly the mRNA vaccines are getting distributed, the decision to pause J&J will perhaps set back the timeline for getting everyone vaccinated by only a few weeks, if at all. And yes, some people who might otherwise have gotten vaccinated will get Covid in that time.

But the trust in our public health leaders who make tough and transparent decisions will only be bolstered in the long term. We mustn’t underestimate how remarkably important that is.

We spent the first year of the pandemic with a president and administration that routinely undermined science and repeatedly overruled the long-trusted public health institutions tasked with keeping us safe. We now know how the Trump administration meddled in the daily affairs of the CDC, rewriting reports to elevate politics over public health. And we saw in plain sight how the administration’s push for unproven treatments like hydroxychloroquine and convalescent plasma made many question who was really calling the shots at the FDA.

The decision to pause the J&J vaccine while we learn more about its risks was a hard one to make. And even if the basic math doesn’t add up, the complicated calculus does. This pause helped providers like myself better understand what to look out for, ensuring better care for our patients and better articulating the actual risk from the vaccine. More importantly, it will help rebuild trust in the public health institutions whose reputations have recently taken a beating.

The decision to pause the J&J vaccine appears shortsighted in the short term. But for the health of our patients and for the long-term credibility of our public health institutions in the future, it was absolutely the right one.

NYC ER doctor | Ebola Survivor | Director of Global Health in Emergency Medicine at Columbia University | Public Health Professor | Doctors Without Borders BoD

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