The Washington PostDemocracy Dies in Darkness

Underserved communities bear brunt of paused Johnson & Johnson rollout

Clinics offering the one-shot vaccine were canceled throughout the country, affecting students, shift workers, rural residents and other hard-to-reach groups

Registered nurse Lucy Delgado administers the Johnson & Johnson vaccine to Polonne Colin on Saturday at a clinic in Immokalee, Fla. The clinic is focusing on inoculating migrant farmworkers and their families. (Lynne Sladky/AP)

Mobile clinics serving a rural expanse north of Columbus, Ohio. A program sending paramedics to vaccinate homebound seniors in Chicago. And sites promising immunization at 34 public colleges and universities throughout New York.

Thousands of people can no longer rely on these initiatives, all casualties of Tuesday’s decision by federal health officials to recommend a pause in the use of Johnson & Johnson’s coronavirus vaccine. The pause was initiated so experts could review data involving a severe type of blood clot found among six of the more than 7 million people who have received the vaccine in the United States, and so the federal government could advise clinicians about how to identify and treat the possible adverse reaction.

Because the single-shot option is favored for transient and hard-to-reach populations, the pause’s most immediate cost was exacted on those with the fewest other options. That includes students, rural residents and people involved in shift work, throwing a new hurdle in front of the Biden administration’s efforts to introduce greater equity into the nation’s vaccination campaign. The places best able to address the change were those with abundant vaccine supply, newly underscoring the uneven nature of the rollout.

“We have to scramble a little bit to make sure no one is left behind,” said New Hampshire Gov. Chris Sununu (R), whose state has been vaccinating residents at a faster clip than most others. The single-shot vaccine has been key to that rapid pace, he said, but deploying it to homebound residents and the homeless population is just as critical to aims of equity.

Sununu pressed White House officials during a call with governors Tuesday to present more of the data informing the government’s recommendation, saying the move threatened to undermine confidence in the shots just as the immunization effort was accelerating, according to two people who participated in the call. “Pausing is in many ways easy to do,” Sununu said in an interview afterward. “The challenge we’re going to have is reinstalling that public trust, hopefully in a matter of days when they give the all-clear.”

Federal officials estimated that the pause would last a “matter of days,” although they did not foreclose the possibility that the vaccine would be recommended for a narrower subset of the population. The product is the least plentiful of the three vaccines authorized for emergency use in the United States, making it possible for some providers to substitute shots developed by Pfizer-BioNTech and Moderna. Those companies have promised to deliver enough supply to vaccinate 200 million people by the end of May and 300 million by the end of July.

That fallback came in handy in some places. A clinic serving migrant farmworkers in Immokalee, an unincorporated community of about 25,000 on the edge of Florida’s Everglades, said it would continue its efforts using other vaccines on hand. “We still have doses of the Moderna vaccine for distribution by appointment at our vaccination clinics and remain committed to our vaccination efforts, especially in underserved populations in our community,” clinic leaders wrote on Facebook.

But offering an alternative product was made more difficult in other places by the scheduling and storage requirements of the two-dose protocols. In addition to requiring just one shot, Johnson & Johnson’s product can be kept at normal refrigeration temperatures for three months, making it easier to handle.

Appointments were canceled in some of the states buffeted by mounting daily cases, including Michigan. Among the abandoned clinics were several planned by the University of Michigan at locations in Flint, Dearborn and Ann Arbor. Gov. Gretchen Whitmer (D), in her appeals to the White House for additional shots, has specifically asked for more doses of the Johnson & Johnson vaccine.

Mobile clinics in six northwest Ohio counties were canceled this week and next, threatening the goal set forth by Ohio Northern University to reach six rural counties in 60 days. “We have paused scheduling any further appointments at any clinic,” said Steven Martin, ONU’s pharmacy dean.

In Chicago, a program to reach homebound seniors was also on hold, said Allison Arwady, the city’s public health commissioner. So, too, was a planned event with the Illinois Restaurant Association to bring shots to food service workers. The city was examining the possibility of using a different vaccine at Chicago State University, the largest vaccination site on the city’s far South Side, but that would depend on supply.

“We don’t have vaccines sitting on shelves,” Arwady said. “We push it all out.”

No such pressure affected planning in Tennessee, where the Department of Health issued a statement noting, “Our vaccine supply continues to surpass demand and we do not anticipate this shift will impact our efforts to vaccinate as many Tennesseans as possible.”

Elsewhere, the impact on newly announced initiatives was immediate. Use of the Johnson & Johnson vaccine was halted at 34 State University of New York campuses, including Suffolk County Community College, where Gov. Andrew M. Cuomo (D) had appeared Monday to tout the initial allocation of 21,000 doses for students in the system. Jim Malatras, the chancellor of the SUNY system, said Tuesday that he was working with the state to find alternative vaccines.

The impact also was felt in New York City, which had been administering as many as 4,000 doses of the Johnson & Johnson vaccine each day, said Mark D. Levine, a City Council member. But the consequences exceeded the pace of inoculations, he observed on Twitter.

“J&J has allowed us to reach marginalized NYers — homebound, NY’s experiencing homelessness, folks being discharged from hospitals, incarcerated NYers,” he wrote. “Imperative that we fill this equity gap.”

Urban and rural areas alike were affected. Primary Health Care, a community health center serving several counties in central Iowa, was forced to postpone clinics steering the Johnson & Johnson vaccine toward the homeless population. Reaching undocumented people was also a concern in California’s San Joaquin Valley, where the health director in Madera County, Sara Bosse, said the single-shot option has buoyed efforts to “reach populations that have low access to medical care.”

“I’m on the fence about whether the pause was the best bet given vaccine hesitancy,” Bosse said. “I think we want to demonstrate that we’re taking safety very seriously, and in that way, a pause is positive because it shows the data is being watched very closely. At the same time, it’s a very, very small number. And so I’m hopeful that in the review, they’re able to comfortably resume Johnson & Johnson.”

In some places, questions spurred by the pause went beyond the Johnson & Johnson shots. When Arwady, the Chicago health commissioner, faced questions during a Tuesday briefing, she found herself tamping down unease about immunizations more generally.

Reading aloud queries submitted to her department, she said: “ ‘I got my first Pfizer shot one week ago today. With the recent news about J&J, I do not want to go back for the second shot.’ … ‘I was hesitant to get any covid vaccine in the first place, and this makes me more skeptical about any vaccine that is still being followed and studied.’ ”

Arwady said she understood the concern but wanted to be “really clear,” explaining that the review of rare instances of blood clots was “in no way” related to the other authorized vaccines in the United States.

“There’s a different technology for how that vaccine is made,” she said. “… So I would really encourage you to go back and get your second shot.”