Health and Science

Johnson & Johnson vaccine pause makes it tougher to immunize hard-to-reach populations against Covid

Key Points
  • For some populations, such as prisoners changing facilities or homeless people who don't have a permanent residence, administering a two-dose regimen is a challenge.
  • Many states have been using the J&J vaccine with these groups because it's hard to find people to administer a second dose.
  • The one-shot option may also be more appealing to those who are more hesitant to get a vaccine.
  • The J&J pause could have "an important negative impact on the U.S. vaccination rate," said Josh Michaud, an expert at the Kaiser Family Foundation. 
A homeless person wearing gloves and a protective mask sits with a sign that reads, "Seeking Human Kindness" amid the coronavirus pandemic on April 19, 2020 in New York City, United States.
Alexi Rosenfeld | Getty Images Entertainment | Getty Images

The Johnson & Johnson Covid vaccine pause may not significantly slow the overall pace of the U.S. vaccine rollout, but is making it tougher for hard-to-reach populations to get a shot.

Following the Food and Drug Administration's request on Tuesday that states temporarily halt using the J&J vaccine "out of an abundance of caution" after six women developed a blood-clotting disorder, White House Covid czar Jeff Zients said that the announcement would not have a significant impact on the U.S. vaccination program.

"We have more than enough supply of Pfizer and Moderna vaccines to continue the current pace of about 3 million shots per day," Zients told reporters at a press briefing.

So far, this has held true. The country is averaging 3.3 million daily vaccine doses reported administered over the past week, and 3 million when counting only Pfizer and Moderna. Only about 7.8 million of the 202 million total shots given in the U.S. have been from J&J, according to Centers for Disease Control and Prevention data.

But the single-shot Johnson & Johnson vaccine does represent about 10% of all fully vaccinated people in the U.S., a proportion that was on the rise for weeks, and it has proven valuable for certain situations and communities.

"Because of the characteristics of the J&J vaccine, it is being used in many cases for particular circumstances and populations for which it has been harder to get vaccines for," said Josh Michaud, associate director for global health policy at the Kaiser Family Foundation. 

Mass vaccination sites and mobile vans that drive doses to be administered on the go likely have an easier time with the Johnson & Johnson storage requirements, Michaud said. That vaccine only needs to be kept in a standard refrigerator while the needs for Pfizer and Moderna are more strict.

And for certain populations, such as prisoners who are changing facilities or homeless people who do not have a permanent residence, administering a two-dose regimen can be a challenge. Many states have been using the J&J vaccine with these groups because it's hard to find people to administer a second dose, according to Michaud. 

The one-shot option may also be more appealing to those who are more hesitant to get a vaccine. A March Kaiser Family Foundation survey showed that among those who say they want to wait and see how the vaccines are working before getting vaccinated themselves, a larger share would get the J&J one-dose vaccine compared to either of the two-dose options.

One in six people in the "wait and see" group said they would "definitely get" the J&J vaccine, while roughly one in ten said the same about the Pfizer or Moderna vaccines.

"We know there is a significant portion of people on the fence about vaccines in general," Michaud said, "And I think the J&J vaccine is actually a plus for that group. It's a big selling point for people on the fence."

Add all of these factors up and the J&J pause could have "an important negative impact on the U.S. vaccination rate," he said.

It is not yet clear how long the halt on using the Johnson & Johnson vaccine will last. White House chief medical advisor Dr. Anthony Fauci has said that the pause could last from a matter of days to a few weeks

Vaccinating the homeless

Shelly Nortz, deputy executive director for policy with the New York City-based advocacy group Coalition for the Homeless, said the Johnson & Johnson vaccine pause will make it harder to get shots for the population she works with.

The coronavirus has hit New York City's homeless hard, particularly those in communal living facilities. A Coalition for the Homeless and New York University analysis showed that as of February, the age-adjusted mortality rate for sheltered homeless New Yorkers was 49% higher than the citywide rate.

And while the vaccination campaign among New York homeless is off to a solid start — Nortz said the city's most recent announcement showed about 4,500 fully vaccinated single homeless adults out of some 21,000 in total, a pace not far behind the nationwide rate — the J&J halt is going to be a hurdle.

"Everybody was really eager to have the one-and-done situation with J&J," she said, "especially for people who are unsheltered and therefore not in the same place predictably."

The Coalition for the Homeless recently launched a partnership with the Center for Urban Community Services, which offers mobile medical care across New York, to provide the Johnson & Johnson vaccine at one of its emergency food sites. That program is now on hold, as are discussions about offering the J&J vaccine at the group's headquarters where many clients come to pick up their mail.

Dr. Van Yu, chief medical officer at CUCS, agrees that a two-dose Pfizer or Moderna vaccine regimen makes things much more complicated.

"If you're living outside, how am I going to find you in four weeks?" he said.

Yu said the shelter system can make it easier to keep track of people, but there is still a lot of churn as people come and go or are reassigned to one of New York City's hundreds of shelter sites.

The ease of storing the J&J shots is another advantage when vaccinating the homeless, according to Nortz. 

"The fact that the other two approved vaccines require, in one case, deep refrigeration storage makes it very challenging to do anything mobile or pop-up or with an unknown number of people showing up," she said.

Zients said Tuesday that all vaccine delivery channels, including mobile delivery units, are equipped to deliver all three vaccines. Yu said the Moderna vaccine is easy enough to handle at his group's mobile sites, but that the Pfizer vaccine's ultra-cold refrigeration requirement means it's not an option.

He is currently sitting on 185 unused J&J doses, and does not have access to any Moderna vaccines.

Some homeless people in the South Bronx, where Noel Concepcion works as the department director of adult homeless services for the nonprofit group BronxWorks, have preferred the J&J vaccine because it only requires one dose. But the pause and surrounding misinformation is making it harder to communicate the importance of vaccinations to a group that is already skeptical of the government, Concepcion said, and it may fuel some hesitancy toward all three vaccine options.

BronxWorks had to cancel a vaccination event to use existing supply of J&J shots due to the pause, according to Concepcion.

J&J more convenient for many working people

Other barriers to getting a Covid vaccine, such as an inflexible work schedule or childcare responsibilities, have made the single-shot Johnson & Johnson vaccine an essential option for some.

Liz Schwandt, who runs a volunteer group called Get Out the Shot aimed at helping people book vaccine appointments in Los Angeles, said that many of the callers into her team's helpline don't have traditional job benefits or protections such as time off from work. Many of them are domestic workers such as house cleaners, private nannies, or gardeners who get paid in cash off the books. Some are employees who do not work a 9-to-5 job, like the group of night shift custodians that Get Out the Shot recently booked appointments for.

Elizabeth Raygoza gets her Pfizer vaccine shot, March 17, 2021, from Physician Assistant-Certified Alyssa Hernandez as the city of Vernon Health Department staff used the city's new mobile health unit clinic to administer COVID-19 vaccinations to nearly 250 essential food processing workers at Rose & Shore, a major, locally-based prepared foods products producer that serves supermarkets, schools, restaurants, airlines and others.
Al Seib | Los Angeles Times | Getty Images

"We hear stories all the time like hey, my employer is making me get the vaccine, but won't give me time off," she said, adding that "for a working family, missing four hours of a shift [for a vaccination appointment] can be a big wage loss." 

Childcare responsibilities and reliance on public transportation also make going to multiple appointments more tedious, according to Schwandt.

While Get Out the Shot books appointments for all three vaccines, Schwandt said the FDA's initial approval of the J&J vaccine back in February was welcome news.

"We were so thrilled with it," she said. "We loved having the one and done option for people."

A CDC panel on Wednesday postponed a decision on Johnson & Johnson's Covid vaccine while the investigation into the blood-clotting disorder continues. The panel is expected to reconvene next week, when it will decide what it will recommend to the CDC.