Extending the J&J vaccine pause for a week was a deadly mistake

When the pause began, millions of Americans were still ineligible for vaccines. And universal eligibility on April 19 will not mean immediate access; obstacles to vaccination will remain, especially for people who can’t travel long distances. This undermines the blithe assertion that unbounded supply of other vaccines makes pausing one irrelevant. Plus, the J&J vaccine requires only one appointment instead of two and can be delivered in settings where others can’t. The pause has stymied essential efforts, such as outreach to homebound D.C. seniors at far higher risk from covid-19 than from vaccination. Looking at ACIP’s roster helps diagnose its mistake. Its voting members are almost all doctors far more familiar with rare vaccine side effects than with marshaling scarce public health capacity to respond to a surge of infections. The committee lacks comparative effectiveness experts or health economists familiar with weighing inevitable tradeoffs at a population-wide scale. Nirav Shah, a nonvoting member representing the Association of State and Territorial Health Officials, argued that “not making a decision is tantamount to making a decision. Any extension of the pause will invariably result in the fact that the most vulnerable individuals in United States who were prime candidates of J&J vaccine will remain vulnerable.” His pleas went unanswered. What ACIP must provide, but likely never will, is an estimate of how many of the hundreds of thousands of Americans infected with covid-19 in the coming days could have been protected if J&J vaccines were available.