Biden on blood clot debacle: Look, y'all, there's enough vaccine for every American even without J&J

The transcript of what he said in the tweet below reads like word salad but I think that’s mostly a transcription problem. It scans better this way: “There is enough vaccine — that is basically 100 percent unquestionable — for every single solitary American.”

Which is sort of true and sort of false. It’s not true that there “is” enough vaccine right now. Pfizer and Moderna are committed to delivering 200 million doses each by the end of May and another 100 million by the end of July, although it sounds like Pfizer will beat that pace by two weeks. There will be enough vaccine for everyone three and a half months from now.

So yeah, we can get all adults immunized even if Johnson & Johnson goes completely bust, which I’m sure it won’t. But it’s not that simple. Watch, then read on.

To listen to Biden there, you’d think the vaccines were fungible. If a viral vector vax like J&J goes on temporary hiatus, no problem. We’ll just swap Pfizer and Moderna in. But the mRNA vaccines need deep-freeze storage units, which not every pharmacy or even every town has. They require two shots, not one, which may make needle-phobics anxious and will require people who need to travel further to get vaccinated to block off even more time to do so. How many will keep the second appointment? J&J also tends to have fewer side effects than Pfizer or Moderna (ironically in light of today’s news), which may make it attractive to people who worry about that sort of thing. They’re now out of luck for awhile.

Beyond that, having to rely exclusively on Pfizer and Moderna for a spell necessarily means fewer vaccines overall being delivered to the states in the near term. The mRNA products can get everyone immunized over a time horizon of four months but nothing’s going to replace the missing J&J doses over the next week or two, which means some people who otherwise would have been protected this month will have to do without and risk infection and death. In fact, Gretchen Whitmer had requested extra Johnson & Johnson doses specifically from the federal government, believing that vaccine-hesitant people would be more willing to submit to the jab if they knew they only needed to do it once. How eager will those people be to get J&J once it returns to the market after the scare that’s been thrown into them today?

The other problem with Biden’s comments is that it amounts to shrugging off the FDA’s questionable decision to pause J&J. Who cares if that vaccine isn’t around anymore, Biden seems to say? We have plenty. But there are reasons to care. Dr. Manny Alvarez lit into the agency on Guy Benson’s radio show today, accusing it of breeding vaccine skepticism without a good reason: “Imagine how are you going to convince the public to take a Johnson and Johnson vaccine? So from that aspect, that’s criminal to me… You know, the first thing when I woke up this morning, I had a meeting. I had to have a discussion with with a very intelligent young woman and she said, Dr. Manny, no way you’re going to convince me to take a Johnson and Johnson…”

It’d be one thing if the incidence of blood clots was alarmingly high, warranting a step as sensational as pausing the vaccine, but Kevin Drum did the math:

The US population of women aged 18-48 is 65 million. About 2,000 have died of COVID-19 over the course of 12 months, or roughly 300 every two months. That’s right around 5 per million.

The population of women who have received the J&J vaccine is presumably about 3.5 million. One has died of a blood clot over the two months the vaccine has been available. That’s 0.3 per million. If the woman in Nebraska also dies, that goes up to 0.6 per million.

Even if you reason that the number of women dying of COVID is destined to shrink in the coming months as the population moves towards herd immunity, it would need to shrink a lot to make the vaccine riskier than the disease — unless the CDC discovers many more incidents of fatal clotting than we currently know of. Given how few are known so far, you’re left to wonder why they didn’t quietly start investigating without pausing the vaccine and then proceed to ordering a pause if the investigation revealed an alarming prevalence.

Although you know what doctors would say to that. What would happen to public trust if it leaked that the CDC or FDA was secretly looking into rare blood clots caused by J&J’s vaccine and hadn’t immediately told Americans about it? Anti-vaxxers would have a field day.

What they could have done and I think should have done was reveal the blood clot data publicly ASAP but not pause distribution of the vaccine. Leave it up to each individual to decide whether to proceed with their J&J dose or to switch to Pfizer or Moderna. “We believe the incidence of these clots is very rare but we’re investigating and will update the public as soon as we know more,” the FDA might have said. They might even have recommended that women under 50 avoid J&J for now, until science has a better handle on the situation. I saw numerous people on social media today who were scheduled to get the Johnson & Johnson vaccine in the next few days furious at having had their appointments canceled. Plenty of Americans would have gone through with it despite today’s news. They should have been given the opportunity.

Exit question: Will J&J ever come back on the market? I think it will because of the logistical disadvantages of the mRNA vaccines that I described above, but not everyone is so sure. Dr. Paul Offitt, a vaccine expert, told Stat, “In this country, you have two other vaccines, which are likely going to be produced in a quantity that enables everyone to be vaccinated. So I think as we get more and more of the Moderna and Pfizer vaccine out there … I think it would not be surprising if … this vaccine would not come back onto the market.”