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

Craig Spencer MD MPH
Elemental
Published in
4 min readApr 19, 2021

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Photo: Roger Starnes Sr/Unsplash

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…

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Craig Spencer MD MPH
Elemental

ER doctor | Ebola Survivor | Public Health Professor at Brown University | A Few Other Things