The Johnson & Johnson vaccine was just about to break through.
While it had only recently started to roll out, states, cities and clinics had big plans for it as an important weapon in the fight against Covid-19. The one-shot vaccine could do what the two-shot Pfizer and Moderna vaccines couldn't. It could reach the homeless and even be distributed door to door. It could fill the gaps at a crucial point in vaccination efforts that were already losing momentum.
But on Tuesday morning, the Johnson & Johnson vaccine became the focus of international scrutiny after federal health authorities recommended pausing its use after six women ages 18 to 48 developed a very rare type of blood clot in the brain after they got the shots. A review from the Centers for Disease Control and Prevention and the Food and Drug Administration is expected in the coming days.
And while White House officials have stressed that the Pfizer and Moderna vaccines will help pick up the slack, it's the kind of jarring news that some public health experts worry could deepen suspicions among people who are already skeptical of vaccines and introduce new uncertainties for those who might be on the fence at a precarious time when new cases are surging in many states.
People wait in line for hours at a pop-up COVID-19 vaccination site in the parking lot of Bravo Supermarket in Orlando, Fl., on April 9, 2021. The one-day mobile site offered 400 doses of the one-shot Johnson and Johnson vaccine.
People wait in line for hours at a pop-up Covid-19 vaccination site in the parking lot of Bravo Supermarket in Orlando, Fla., on Friday. The one-day mobile site offered 400 doses of the one-shot Johnson and Johnson vaccine.Paul Hennessy / SOPA Images/Sipa USA via AP
"As it plays out, this is the sort of thing that increases the possibility of vaccine hesitancy across the board," said Dr. Steve Schrantz, an assistant professor of medicine at the University of Chicago, who specializes in infectious diseases. "It's a very hard thing to message, and it can put further doubt in people's minds."
The U.S. had been averaging more than 3 million shots a day since early April, but vaccination numbers in some states that had been on the upswing were leveling off. On Feb. 13, West Virginia was among the country's leaders in vaccinations, having administered 95 percent of doses delivered to it. But the state's efficiency has fallen in recent weeks, and as of Monday it had administered just 74 percent of its doses.
West Virginia is one of several Southern states where vaccine efficiency rates have fallen since the end of February; Alabama, Arkansas, Georgia, Louisiana, Mississippi, Missouri, North Carolina, South Carolina and Tennessee are all administering their vaccine doses more slowly than had been earlier in the year.
And the consequences of halting use of the Johnson & Johnson vaccine were already being felt in many communities.
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Local health officials in Worcester, Massachusetts, had expected to receive at least 20,000 doses of the Johnson & Johnson vaccine each week over the next month for use by two community health centers, part of a program to vaccinate Black and Latino residents, who together are about a quarter of the city's population but half of its Covid-19 patients.
"We try to reach the folks who don't usually access health care in the conventional way," said Dr. Michael Hirsh, medical director for Worcester's Public Health Division.
Hirsh said the city hasn't had to cancel any clinics yet — it relied on a supply of Pfizer doses as a replacement at a pop-up clinic Tuesday — but he said he's not sure what comes next.
"I think we have enough to get us through this week," he said. "We have to make sure that Moderna and Pfizer can help us to compensate for this loss."
Bristol Health, a Connecticut health system, had been using the Johnson & Johnson vaccine at a mobile clinic at the nearby headquarters of ESPN, where it administered 500 Johnson & Johnson doses Monday. For now, it plans to switch to Moderna and Pfizer doses for the clinic and for hospital patients being discharged to nursing homes, even though coordinating second shots for such patients can be complicated.
"Now, we have to figure out how we go to the nursing home and plan to give them their second dose," said Albert Peguero, manager of emergency preparedness at Bristol Health.
And in Anchorage, Alaska, the Alaska Native Medical Center had been counting on Johnson & Johnson's one-dose regimen to vaccinate a different hard-to-reach population: Native people who travel for hours, often by air, from rural areas for specialized medical care, such as a surgery.
"What we were looking at doing was helping people get vaccinated while they're in the hospital," said Shirley Young, a spokesperson for the hospital.
Patients will be offered Pfizer or Moderna shots, she said, but scheduling second shots may be difficult. "Time will tell what people choose to do," she said.
Biden administration officials maintained that the Johnson & Johnson pause won't derail the administration's vaccination goals. Jeff Zients, the White House Covid-19 response coordinator, said in a statement that 25 million doses of vaccines made by Pfizer and Moderna have been distributed every week and that 28 million doses will be made available this week. Pfizer announced Tuesday afternoon that it would boost vaccine production to deliver 10 percent more doses than it had previously promised.
The city of Vernon demonstrates the use of special refrigeration to store Pfizer COVID-19 vaccine as they city is using a van to operate a mobile clinic and provide vaccination