Johnson & Johnson vaccine break makes it harder to vaccinate hard-to-reach populations against Covid

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A homeless man wearing gloves and a protective mask sits with a sign that read “In Search of Human Kindness” amid the coronavirus pandemic on April 19, 2020 in New York City, United States.

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Johnson & Johnson Covid Vaccine Break may not significantly slow the overall pace of vaccine deployment in the United States, but could make it more difficult for hard-to-reach populations to get vaccinated.

Following the Food and Drug Administration’s request on Tuesday that states temporarily stop using the J&J vaccine “out of caution” after six women developed a blood clotting disorder, White House czar Covid Jeff Zients , said the announcement would have no impact on the U.S. vaccination program.

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

So far this has proven to be true. The country has recorded an average of 3.3 million daily doses of vaccines administered in the past week, and 3 million counting only Pfizer and Moderna. According to data from the Centers for Disease Control and Prevention, only about 7.8 million of the 202 million vaccines administered in the United States come from J&J.

But Johnson & Johnson’s single-shot vaccine accounts for about 10% of all fully vaccinated people in the United States, a proportion that has been on the rise for weeks, and it has proven useful for some situations and communities.

“Due to the characteristics of the J&J vaccine, it is used in many cases for special circumstances and populations where it has been more difficult to get the vaccine,” said Josh Michaud, associate director of global health policy at the Kaiser Family Foundation.

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

And for some populations, such as inmates who change institutions or the homeless who do not have a permanent residence, administering a two-dose regimen can be a challenge. Many states have used the J&J vaccine with these groups because it is difficult to find people to administer a second dose, Michaud said.

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The one-shot option may also be more appealing to those who are most reluctant to get vaccinated. A March Kaiser Family Foundation survey showed that among those who say they want to wait and see how the vaccines work before getting vaccinated themselves, a larger share would receive the J&J vaccine at one dose compared to one. 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 about one in ten said the same about the Pfizer or Moderna vaccines.

“We know there is a significant portion of people on the vaccine barrier in general,” Michaud said, “and I think the J&J vaccine is actually a plus for this group. sale for people on the fence. “

Add all of these factors on the rise and the J&J hiatus could have “a significant negative impact on the vaccination rate in the United States,” he said.

It is not yet known how long stopping use of the Johnson & Johnson vaccine will last. White House chief medical adviser Dr Anthony Fauci said the hiatus could last anywhere from a few days to a few weeks.

Vaccinate the homeless

Shelly Nortz, deputy executive director of policy for the Coalition for the Homeless, a New York-based advocacy group, said Johnson & Johnson’s vaccination hiatus will make it harder to get vaccines for the population she works with .

The coronavirus has hit homeless people in New York City hard, especially those in communal living facilities. An analysis by the Coalition for the Homeless and New York University showed that in February, the age-adjusted death rate of protected homeless New Yorkers was 49% higher than the city ​​wide rate.

And while New York’s homeless vaccination campaign is off to a good start – Nortz said the city’s most recent ad showed around 4,500 single homeless adults fully vaccinated out of some 21,000 in total, a rate close to national rate – J&J stop is going to be an obstacle

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“Everyone was really looking forward to having a unique situation with J&J,” she said, “especially for people who are not sheltered and therefore not in the same place predictably.”

The Coalition for the Homeless recently partnered with the Center for Urban Community Services, which offers mobile medical care throughout New York City, to deliver the Johnson & Johnson vaccine at one of its emergency feeding sites. This program is now suspended, as are discussions on the offer of the J&J vaccine at the group’s headquarters where many customers come to collect their mail.

CUCS Chief Medical Officer Dr Van Yu agrees that a two-dose Pfizer or Moderna vaccination regimen makes things much more complicated.

“If you live 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 the hundreds of shelter sites in the city of. New York.

Another benefit when vaccinating the homeless is the ease of storing J&J vaccines, according to Nortz.

“The fact that the other two approved vaccines require, in one case, deep refrigeration storage, it is very difficult to do anything mobile or pop-up or with an unknown number of people,” he said. she declared.

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

He is currently taking 185 doses of unused J&J and has no access to any Moderna vaccine.

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

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

J&J more convenient for many workers

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

Liz Schwandt, who leads a volunteer group called Get Out the Shot aimed at helping people make vaccine appointments in Los Angeles, said many callers to her team’s helpline are not benefiting. traditional benefits or protections such as leave. Many of them are domestic workers such as housekeepers, private nannies or gardeners who are paid in cash from the books. Some are employees who don’t work from 9 a.m. to 5 p.m., like the group of night guards that Get Out the Shot recently made appointments with.

Elizabeth Raygoza was vaccinated against Pfizer on March 17, 2021, by Alyssa Hernandez, a certified medical assistant, as staff at the City of Vernon Health Department used the city’s new mobile clinic to administering COVID-19 vaccines to nearly 250 essential workers at Rose & Shore, a leading producer of locally prepared food products that serves supermarkets, schools, restaurants, airlines and more.

Al Seib | Los Angeles Times | Getty Images

“We hear stories all the time like hey, my employer is giving me the vaccine, but won’t give me any free time,” she said, adding that “for a working family, four hours are missing. shift [for a vaccination appointment] can be a big waste of wages. ”

Childcare responsibilities and reliance on public transport also make multiple dates more tiresome, according to Schwandt.

As Get Out the Shot makes an appointment for all three vaccines, Schwandt said the initial FDA approval of the J&J vaccine in February was good news.

“We were delighted 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 as the investigation into the blood clotting disorder continues. The group is expected to meet again next week, when it decides what to recommend to the CDC.

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