This week, the FDA announced that it was recommending a pause in the administration of the Johnson & Johnson-manufactured COVID-19 vaccine, on the grounds that six vaccine recipients of the nearly 7 million doses administered had suffered from a rare blood clotting disorder. One person died. Officials said the pause was out of an “abundance of caution.” All 50 states have heeded the federal recommendation, which officials now say may stretch from seven to 10 days.
The Biden administration had its reasons. After four years of Trump obfuscations and lies about the pandemic generated by a brain trust that probably couldn’t collectively pass a high school biology exam, the first step in restoring public trust in public institutions is painstaking transparency. Second, the complications linked to the Johnson & Johnson vaccine are not standard blood clots and are not effectively treated by a standard course of care; the drug normally used to treat clotting, Heparin, actually makes this particular clotting condition worse. Doctors who encounter post-J&J vaccination patients who are experiencing clotting symptoms will be more effectively able to treat those patients with the knowledge that this type of clotting is a possibility— albeit minuscule.
Columbia University’s Dr. Irwin Redlener, an expert on pandemic preparedness and public health, told The Daily Beast that he understands the Biden administration’s goals in being radically transparent, but that the inoculation pause may have done more harm than good. “In this case, caution was too abundant,” he says.
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Redlener noted that it’s not uncommon for companies developing public health remedies to pause a rollout after the discovery of a cluster of adverse side effects, but that the public usually doesn’t hear about those instances because rarely is a public health remedy rolled out at this scale. However, he believes that there was a better way for public health officials to manage an “emotionally volatile situation” than pausing the Johnson & Johnson vaccine entirely.
The better approach, he suggested, would have been for public health officials to announce that they were looking into an extremely rare side effect of the Johnson & Johnson vaccine, and remind the public that the likelihood of experiencing serious complications from getting COVID-19 was many times higher than the likelihood of experiencing any serious adverse effects from the vaccine. Pausing, in other words, could delay vaccinations for many and subject some to the risk of COVID.
But the risk of pausing the vaccine goes beyond people getting sick. Redlener is concerned that pausing the vaccine over minuscule odds of clotting in an age of dis- and misinformation can lead to a messaging mess that will prove difficult to clean up. He specifically points the finger at right-wing and fringe media’s tendency to seize on any information that could be twisted to confirm their audience’s paranoia. “These are uncharted waters,” he says. “On the internet, people find what they’re looking for. If they’re looking for reinforcement of their own preexisting beliefs they’ll find it, and when it’s magnified by conspiracy theorists like Tucker Carlson, it’s not very easy to combat.” Furthermore, while a pause associated with a small number of vaccine-adjacent complications could very well provide fodder for anti-vaxxers’ paranoia, anti-vaxxers aren’t a monolith, and thus outreach to them will require a multi-pronged strategy. If enough people maintain enough doubt in the COVID vaccine, we could be stuck in a semi-pandemic purgatory for years.
In addition to the public health implications of being too cautious, the pause in the Johnson & Johnson vaccine has also brought to light just how much risk we expect others to take on in the name of public health.
Women, in particular, have reason to feel a little overlooked when it comes to assignment of public health urgency.
According to the most recent data available, America ranks last out of every industrialized nation in maternal mortality. Out of every 100,000 live births, 17.4 mothers will die—that’s quite a bit more than one death in 7 million doses! Black mothers fare particularly poorly. Out of every 100,000 live births to Black women, 37.1 women die. Overall, Black women are three to four times more likely to die of pregnancy-related complications than women of other races. Controlling for education and income-levels doesn’t erase this disparity; Black women with college degrees are more likely to die from complications of childbirth than white women who didn’t finish high school. Researchers have tried to understand why this is happening, and the best explanation available is that racism built into the American health-care system systematically disenfranchises and victimizes Black women, and that Black women are not believed when they advocate for themselves. America’s maternal mortality disaster is truly an embarrassment and a disgrace, and, to my knowledge, nothing has been paused out of an abundance of caution to address this public health emergency.
Many have pointed out that hormonal birth control subjects much of the population to widespread risk as well. About one out of every 1,000 hormonal birth control users per year experience blood clotting. Before prescribing birth control associated with clotting risks, doctors don’t typically check patients for a condition known as Factor V Leiden, an inherited genetic clotting disorder. Between 3 and 8 percent of people of European descent have this condition, which, in combination with many hormonal birth control methods, could endanger their health and even their lives. Doctors simply don’t test for it, and many women don’t even know they have it until they experience dangerous complications as a result.
Other options for birth control also carry potential side effects: IUD insertion is quite painful and the device can, on rare occasions, perforate the walls of the uterus; condoms require frequent trips to the store and can lead to terminal levels of heterosexual male whining; total abstinence is kind of a bummer for people who aren’t asexual; and the withdrawal method can lead to pregnancy, which increases a person’s risk of clotting fivefold. (To be fair, the type of clotting typically associated with hormonal birth control like the Nuvaring or the patch is not the same type of clotting suffered by the Johnson & Johnson vaccine; however, the type of clotting it does cause— deep vein thrombosis and pulmonary embolism— frequently lands you in a hospital bed.) I’m sure many birth control users would love to see more abundant caution in the refinement of drugs that are riskier than one in a million, or for the medical establishment to take simple steps to make sure that birth control users don’t carry clotting risk factors.
Speaking of one in a million, the average rate of blood clots in the population in general is about one in 1,000 per year, a frequency that can be attributed to many common factors. As I mentioned, women raise their risk of clotting by both trying not to get pregnant and by getting pregnant; in addition, being overweight, smoking, cancer, and a sedentary lifestyle increase a person’s risk for suffering from clots. One in 1,000 is a lot higher than less than one in a million.
To put a bow on the caution overkill, this week, a study by researchers out of Oxford University found that the risk of blood clots for COVID patients was 95 times higher than the general population. That certainly makes the less than one in one million number that led to the Johnson & Johnson vaccine’s pause feel a bit like overkill, like being a passenger on the sinking Titanic lined up to board a lifeboat but suddenly being told that loading is being paused “out of an abundance of caution,” because somebody fell out of another one of the lifeboats and drowned.
The chance of drowning for people remaining on the Titanic remains elevated, yes, much more elevated than the risk of drowning for people in the lifeboats, sure, but we’re going to stop getting people off this large sinking ship while small boat experts figure out what’s going on. Please enjoy this performance of our lovely in-house string quartet.
