Eight days ago, I got the Johnson & Johnson vaccine. Today, I woke up, looked at my phone, and read a New York Times alert letting me know that the Food and Drug Administration was recommending a pause in the administration of this particular vaccine. Six women, between the ages of 18 and 48, developed a rare blood clot disorder within two weeks of receiving the vaccine, the article explained. I am a woman! Between the ages of 18 and 48! Within two weeks of getting the vaccine! I woke my boyfriend up to tell him that if I passed out, he better take me to the hospital stat. Then I went for a run, where if I passed out, he would have no idea, because as alarming as that news alert first thing in the morning was, I am not actually that worried.
What is actually happening with the J&J vaccine? We don’t really know yet. If the vaccine does cause something bad, it’s probably a very, very rare something.
Here is what we do know: The vaccine passed all the safety standards it had to pass during the clinical trials. But now we are giving it to a ton more people than could ever participate in the trials, which means the FDA is watching very carefully to see if anything concerning pops up. With any vaccine, it’s possible that after it hits the market, there will be side effects that it causes in a very, very tiny number of people. It’s also possible that there will be a very, very small number of people who have the same weird medical event right after they get the vaccine—a coincidence that freaks everyone out. As of yesterday in the U.S., 6.8 million people had gotten the J&J vaccine. There are six cases of these blood clots reported, among those, one death. A lot of people are saying that means there’s a one-in-a-million chance that you’ll get the J&J and have a clot, which isn’t quite right—there might be other cases that we don’t know about, and if it’s really only affecting women of a certain age, the denominator of this equation should be adjusted from “everyone who has taken J&J” to “women age 18-48 who have taken J&J.” So yes, on a population level, it might be concerning.
But the total number of people getting clots is still probably a very low number—so low a number that it’s very hard to actually understand in relation to oneself, and in fact, on an individual level, it should not be that concerning. But it’s much easier to check your demographics and think “that is like me, so this could very well affect me”—that is what I thought this morning on a visceral level, even though I understand statistics. I ultimately told myself that while this was worrisome, and it was fine for me to feel a little freaked out, it was not something to actively worry about. There’s not much I can do right now about it anyway! The vaccine is in my body. I just have to wait.
What should you do if the vaccine is not in your body yet? Like if you are in this situation:
Reading through the replies to this tweet, and the general “online” conversation about this small finding that needs to be investigated further, feels like a nightmare, a similar brand of nightmare to the pandemic nightmare that we have all been living through for a year now. One part of that nightmare is the continuation of the feeling that every individual choice we make now suddenly has the potential to affect everyone else—this has been the whole deal with distancing and staying home and wearing a mask, only now it’s about how quickly you can get the vaccine and how important that is for getting to herd immunity and stopping the variants. Should you get the J&J vaccine anyway if you are offered it, to do your part? The most practical piece of information in this thread might be that it seems like states are swapping out J&J shots with Pfizer or Moderna shots. So it seems worth it for those in this position to see if they can keep their appointments and go get other vaccines. (Another long-running issue of this pandemic: no clear, central way to handle things like testing, or your vaccine appointment.)
If you were eager to get the J&J shot specifically—you like the side effect profile best, you don’t want to wait in line for a dose twice, you’re just ready to be done (I picked it for this reason)— it’s not time to worry, either. You don’t even have to be worried about there being one less vaccine in the mix, in the general effort to vaccinate everyone. Because here is the thing about this pause: It is a pause, to figure out what is going on. This kind of thing is very common (what is unusual is how closely everyone is paying attention to the development of these vaccines). The pause is an opportunity for the FDA and CDC to figure out what exactly is going on—despite the fact that it sure sounds like women in my age group are the ones at risk, they’re still figuring that out statistically. Who knows what exactly they’ll find, but the whole situation looks pretty similar to what we are learning about the AstraZeneca vaccine, which seems to also cause blood clotting in very rare circumstances. Researchers in Europe, where that vaccine has been approved and has been widely administered, are now trying to figure out if it makes sense to target the people who get this vaccine. It seems likely that the end result of this pause on J&J will be an un-pause, maybe accompanied by more specific instructions. In the press conference the FDA and the Centers for Disease Control and Prevention jointly gave this morning, doctors from each entity emphasized that they need a little time to communicate to health care professionals the details of what they’ve seen. The specific type of blood clot that is maybe linked to the J&J shot requires a unique kind of treatment, so the FDA and the CDC is currently helping doctors figure out what to ask patients to see if they’re at risk. (For anyone worried and wondering, the official FDA guidance currently says that “People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.”)
To me, all this feels a little bit like last week, when 15 million J&J doses had to be tossed, and that was counterintuitively an example of the system working as it should, from a public health standpoint. It is a hiccup, but not a terribly detrimental one: America is lucky in the sense that we have a lot of vaccines, both in terms of types and sheer number. It is true that we are currently in a race against time, in the sense that the more people we get vaccinated, the more likely we are to get to herd immunity sooner, and to limit the number of variants (though even there, we’re doing pretty well right now in terms of the vaccines being effective against variants). It’s also true that the J&J vaccine has unique advantages, because it only requires one shot and doesn’t need to be refrigerated at absurdly low temperature, so it’s much easier to get to rural communities and certain other populations. For those reasons, it would be good to ‘unpause’ it as soon as we can—but it’s also good to do due diligence to make sure that those communities get a vaccine that we can reasonably ask them to trust.
As I kept reading the news this morning, my main concern wasn’t possible blood clots in my body—it was that America’s relationship with vaccines is so tortured that we can no longer look at this situation and see it clearly. There’s a lot of swirling talk about if the pause is reasonable, if it is good or bad from a trust-in-public-health standpoint. I think the current situation is unique enough that where you land on this might have more to do with your own priors than anything else. Here’s how I see it: yes, anti-vaxxers might see this as ammunition for their arguments. But also, our reaction to anti-vaxxers has skewed our ability to talk frankly and directly about vaccines and risks. The truth is vaccines come with risks. They might very, very small, and completely worth taking (in the case of COVID vaccines, definitely worth taking). But they can still be scary, and discounting that isn’t necessary. It would be much better for everyone if we could just talk about this. I have even argued that doing so might, in the end, inspire more trust in public health officials on the subject. But there is so much problematic ‘war’ mentality, and thinking that if we admit anything might be wrong with a vaccine, it gives ‘the other side’—as in anti-vaxxers, as in not a reasonable group of people who is engaging in good faith—things to lob back at us (‘us’). This causes us to paper over reasonable conversations in favor of militancy that ends up not being terribly convincing, and all of this is despite the fact that the number of anti-vaxxers has stayed reasonably stable over the past few decades. In fact, the same number of people don’t get vaccines simply because they don’t have access to health care.
It is not unreasonable to be freaked out about this news if you are a woman in this age range who has been vaccinated with J&J in the last couple weeks. It is also true that in all likelihood, you will be fine. It is also not unreasonable to look at this news and react in frustration because incidences of blood clots due to, say, hormonal birth control are higher than the incidence rate here, but no one worries about that as much. But the answer is not that we should worry about neither, it is that we should—at a societal level—worry about both. This is a situation in which we should level everyone up, rather than discounting harms. Yes, there are going to be some side effects to drugs and jabs that vast majorities of the population end up taking. The right thing for doctors to do is take the time understand them, and figure out what they can do to make the number of them as small as possible. That’s what’s happening with J&J. It’s not ideal. But it’s how science works sometimes.
Update, April 13, 2021, at 4:18 p.m.: This piece has been updated to remove a reference to a writer’s location.