A potential disaster, probably a minor one for us but potentially a major one for the rest of the world. Hopefully when the FDA un-pauses the vaccine next week or whenever, public opinion will bounce back. But I’ll be surprised if it bounces back all the way.

And who knows how far it’ll bounce back abroad, where they’ll hear the news about Johnson & Johnson being paused but might not hear the news later that upon further review it’s been deemed overwhelmingly safe after all.

There’s a silver lining in this data but the cloud is dark.

J&J is down 15 points practically overnight on safety, to the point where a plurality now believes it’s unsafe. Like I say, maybe that’ll changed after Fauci declares all is well a week or two from now but I doubt it’ll ever be 52/26 again. The silver lining is that the sudden skepticism about Johnson & Johnson isn’t bleeding over to perceptions of Pfizer and Moderna:

Hi Nate, we’ve updated the article now with comparison data. No statistically significant differences between pre- and post-announcement sentiment toward other vaccines, and the Moderna and Pfizer vaccines are seen about the same as they were in our last poll in late Feb

— YouGov America (@YouGovAmerica) April 15, 2021

Maybe we can message our way back to some degree of public confidence in J&J but other countries probably won’t be as lucky. The NYT ran a depressing story last night about how news of the pause is reverberating overseas, particularly in third-world countries where convincing people to get vaccinated is a heavier lift. Johnson & Johnson was an attractive vaccine for poorer regions because it’s one dose and easier to store, just like AstraZeneca is. And now, just as with AstraZeneca, public faith in J&J has been shaken by a bureaucratic overreaction to reports of rare cases of blood clots. Everyone who’s been worried this week about vaccine hesitancy spiking in the aftermath of the pause has good reason, especially abroad:

“People, especially those who were vaccinated, felt like they had been tricked in a way — they were asking, ‘How do we get rid of the vaccine in our body?’” said Precious Makiyi, a doctor and behavioral scientist in Malawi, where health workers have been racing to empty their shelves of nearly expired AstraZeneca doses. “We fought so hard with vaccine messaging, but what has happened this past week has brought us back to square zero.”…

“It’s sending vaccine confidence into a crater,” Ayoade Alakija, a co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”…

“I became even more skeptical when I heard that the United States suspended Johnson & Johnson,” said Lawmond Lawse Nwehla, 32, an engineer in Dakar. “They said it was effective and then they stopped it. So I wonder why.”

“Many more people will die without the AstraZeneca and Johnson & Johnson vaccines than with them,” the Times noted, summarizing the views of medical experts in Africa. But that’s true here as well, as some doctors have been pointing out today on Twitter. Jeremy Faust did some back-of-the-envelope math on how many deaths we might reasonably expect from vaccine-related clotting versus how many deaths we might expect from COVID in demographics that go unvaccinated. You can read his entire thread here but this is the takeaway:

Let’s look at the scorecard.

If COVID infects all US women ages 20-50: kills 5,400 (and actually it’s far higher; recall I used the ridiculously low infection fatality rate of 1 out of 10,000, just to make the numbers super conservative)

J&J-induced CVS: kills 48.

⚖️🤔

— Jeremy Faust MD MS (ER physician) (@jeremyfaust) April 15, 2021

Faust allows that the number of vaccine-related clotting cases could turn out to be much higher than we think as the CDC investigates, but he doubts it. Enough time has already passed since the pause, he argues, that doctors nationally will have been looking through their records for recent clotting patients and already reporting to the agency. He wants the pause to end immediately for all men and for women over 50 and to end soon even for women under 50 since J&J might be the only vaccine available to them where they live.

Another expert, Ashish Jha, agrees with Faust that the pause should end now, not a week from now:

Nearly all the adverse events are in women 18-49 years old

Cerebral Venous Sinus Thrombosis (CVST), the clot seen with J&J, is known to be more common in young women

Suggests that young women probably the group at high risk

This actually gave ACIP a smart way forward

2/7

— Ashish K. Jha, MD, MPH (@ashishkjha) April 15, 2021

But what about the fact that we have Moderna/Pfizer?

They are great. But not easy for everyone.

For many, J&J is a life-saver

Imagine 54 yo male migrant farm worker with diabetes who can't return for a 2nd shot?

Based on what we know today,

Would you give him J&J?

4/7

— Ashish K. Jha, MD, MPH (@ashishkjha) April 15, 2021

ACIP's decision to wait would be fine if there was no pandemic going on

But there is

And waiting 7-10 days won't do much. Not sure what data they will get in that time

But we'll have done real harm to a terrific vaccine particularly well-suited for vulnerable populations

6/7

— Ashish K. Jha, MD, MPH (@ashishkjha) April 15, 2021

We’re in a pandemic

Short pause to alert folks is reasonable

Waiting when its unlikely to change what we know is not

J&J highly-effective, safe vaccine with rare side-effects

I'd make it available soon, particularly for those for whom alternatives are not good choices

Fin

— Ashish K. Jha, MD, MPH (@ashishkjha) April 15, 2021

Jha’s also worried about rural recipients having to do without J&J. Rural areas are redder politically and Republicans are vaccine-skeptical to an alarming degree in polls lately: Roughly 45 percent say that they’re unlikely to get the vaccine. Johnson & Johnson is the best chance at getting them to roll the dice because it’s a single shot and doesn’t use the novel mRNA technology that may put some risk-averse people off. And now, thanks to the pause, those Republicans have special reason to be wary of J&J too. I’m glad Trump rode to J&J’s defense a few days ago, at least. Maybe he can help rebuild confidence in their product.