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Why the Johnson & Johnson pause may not matter for America’s Covid-19 vaccine rollout

America’s Covid-19 vaccine rollout is going so well it could fulfill demand by midsummer without Johnson & Johnson’s shot.

Vials of Johnson & Johnson’s Covid-19 vaccine in front of the pharmaceutical company’s logo. Justin Tallis/AFP via Getty Images

This week, America’s Covid-19 vaccine rollout has been rocked by the federal government’s recommendation to pause distribution of the Johnson & Johnson shot after it was linked to rare blood clots among six people (out of 7 million who got the vaccine), one of whom died.

But even without the Johnson & Johnson vaccine, the US can still vaccinate every adult by midsummer.

It’s very unlikely that the vaccine is never put back into use — federal officials have said the pause could lift in a matter of days or weeks. But the fact the Johnson & Johnson vaccine may not be needed to inoculate every adult is a testament to how much America’s vaccine rollout has improved, and how quickly it’s still going, as the US continues pumping out the other Covid-19 vaccines from Pfizer and Moderna.

It wasn’t always like this. A few months ago, America’s vaccine rollout was deeply troubled. The supply chain frequently broke down, at times leaving doses unused; the rate of vaccination wasn’t fast enough to reach herd immunity quickly. Two vaccines, both needing two doses to take full effect, seemed like they might not be enough. When the Johnson & Johnson one-shot vaccine was approved, I wrote that it could be a game changer, because it would increase supply and wouldn’t require a second appointment.

But things have changed since then. Moderna and Pfizer have managed to significantly increase the supply of vaccines they manufacture. Local, state, and federal governments have kept up, distributing the vaccines soon after getting them — putting us on track to inoculate all US adults soon. Data shows that people really are making and keeping their appointments for a second shot, at least so far. And Johnson & Johnson had already run into serious manufacturing problems that were likely to slow the distribution of its vaccine in the short term anyway.

Given all this, it makes sense to pause the vaccine that may have notable safety risks when the other two vaccines don’t.

“The bigger picture is the supply is there,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “We’re still in a good position.”

Kates said there are still some real concerns: Will the pause hurt overall willingness to get vaccinated? Would some people who could be reached by a one-shot vaccine in the next couple of weeks be missed? We still don’t have good answers to those questions.

But at least in terms of the vaccine rollout, the Johnson & Johnson pause may not have much, if any, effect. More vaccines are, obviously, always better — anything that gets the US back to normal quicker will save lives. Especially in the context of Covid-19 cases plateauing and spiking in some parts of the country, it would of course be nice to have more vaccines.

Still, the US is currently doing a good enough job that it doesn’t need a third vaccine to get across the finish line very soon — by midsummer, a goal that was widely considered overly ambitious just months ago. And to the extent the vaccine rollout needs to speed up, Moderna and Pfizer seem poised to continue delivering more and more supply in the future.

1) America now has plenty of vaccine supply

The US is currently administering more than 3.3 million vaccines a day, based on a weekly average. That’s well more than triple what the country was doing before President Joe Biden came into office.

And even before the pause, Johnson & Johnson’s shot so far only made up about 4 percent of Covid-19 vaccines administered (although that includes a few months in which Johnson & Johnson’s vaccine wasn’t approved). So it has never been a big part of the US’s distribution efforts.

Even if the Johnson & Johnson vaccine never comes back, the US is on track to vaccinate the vast majority of adults by July and all adults by mid-July. And that’s likely to speed up, as vaccine manufacturers promise to continue scaling up supply in the coming weeks — with the White House now working with Moderna and Pfizer to get its remaining orders of doses faster, and Pfizer recently announcing 10 percent more doses than previously expected by the end of May. (The White House, for its part, has said the pause won’t affect the vaccine rollout.)

As Biden said in his speech on the anniversary of the Covid-19 shutdown, “A July 4 with your loved ones is the goal.” That still seems likely — with or without the Johnson & Johnson shot. That would leave America with the rest of the summer to celebrate, hopefully in person, as life swings back to normal, as has happened in Israel after its successful vaccination rollout.

There’s another, albeit temporary, factor with Johnson & Johnson: Due to a huge manufacturing blunder at a Baltimore plant, the bulk of production for Johnson & Johnson’s vaccine has been temporarily shut down. Even before the pause was announced this week, supply of Johnson & Johnson’s vaccine was expected to drop by more than 80 percent. So the timing of this pause may have a silver lining: If the pause lasts another week or two (which is how long federal officials have suggested the review could take), it might not affect vaccinations much because Johnson & Johnson’s vaccine was already slowed down.

Boosting and speeding up the supply further would be unquestionably good. With hundreds of Americans still dying each day from Covid-19, and cases increasing in some parts of the country, a pause is no small thing.

One complication, though, is the rollout’s main problem soon may not be vaccine supply but demand — particularly, hesitancy on getting the shot. It’s still hard to say how a pause might affect willingness to be vaccinated, but hesitancy at least mitigates the impact of slightly less supply.

As it stands now, though, America is on track to vaccinate all or most adults by midsummer. If you had told me in January that would be the case, I would have been very happy. That the US remains on track even after putting a vaccine on pause is great.

2) If the other vaccines don’t carry significant risks, a pause is prudent

There has been a lot of debate among experts and the media about the effects of the Johnson & Johnson pause on public trust. Will the pause signal to the public that the vaccine is dangerous, even if federal officials ultimately conclude the vaccine is safe? Or will the pause signal to Americans that the system is working as intended — catching problems before they become crises — so you can trust the verified vaccines?

A recent survey from YouGov and the Economist suggests that the pause only affected public views about the Johnson & Johnson vaccine but not the Moderna and Pfizer shots, and vaccine hesitancy overall appears to have continued to drop this week, even after the pause. But we’ll need more data and research to verify those findings.

In the meantime, there’s a practical way to look at this situation: Based on the facts we have, does it make sense to be more cautious about the Johnson & Johnson vaccine?

On that score, there’s a good argument for a pause. We have two other vaccines that are highly effective. We have enough of these vaccines to inoculate every eligible American by midsummer. These other vaccines don’t appear to have any major side effects — certainly not a potentially deadly side effect.

In that context, it makes sense to just let the other two vaccines carry the rollout while federal officials investigate if something is truly going wrong with the Johnson & Johnson shot.

This possible side effect risk of the Johnson & Johnson vaccine seems extremely rare — less than one in 1 million, as far as we can tell. But compare it to a major side effect risk of zero, based on the information we have right now, with the Moderna and Pfizer vaccines. As someone who got the Johnson & Johnson vaccine a couple of weeks ago, I don’t have regrets, but I can say that, if I knew the risk calculus and were given a choice, I probably would have switched to the Pfizer or Moderna vaccine. Because why not?

A key benefit to the pause, as federal officials have made clear, is it also gives doctors and other health care workers a chance to get acquainted with this potential side effect. That’s especially important because a traditional treatment for blood clots could actually make a patient worse with the specific condition that the Johnson & Johnson jab seems to cause. The pause also gives doctors and officials time to collect data to make sure that this really is a rare side effect — it could end up being more common if it turns out doctors just weren’t watching for the right symptoms and causes.

And the pause lets officials figure out if any particular demographic is more affected. So far, it looks like women under 50 are largely the ones impacted — which makes the situation especially bad because this group doesn’t typically suffer from these kinds of blood clots. Figuring out who’s affected could help federal officials make recommendations about who could get the shot if the pause is lifted. It might end up, as much of Europe did with the AstraZeneca shot, that the Johnson & Johnson vaccine is targeted at older groups or men.

If all of this can be done without significantly slowing the vaccine rollout, and keep the US on track for that midsummer normal, the decision starts to seem sensible. The pause isn’t ideal — it would obviously be great if blood clots never appeared — but there’s a good case for it in the current context of the US’s vaccine rollout.

3) People are apparently making their appointments for two-shot vaccines

One of Johnson & Johnson’s key benefits is that it only requires one shot, while the other vaccines from Moderna and Pfizer require two shots spaced weeks apart. This was at the center of the case, one which I made, for the Johnson & Johnson vaccine being a game changer when it was approved in late February. That helps with logistics, allowing health care providers to avoid making a second appointment. And it helps with patients, who are as a whole notoriously difficult to get into follow-up appointments.

But then something funny happened: It turns out that people are generally pretty good at getting their Covid-19 vaccines. While studies of previous multi-dose treatments found that half or more of patients didn’t follow up, the data so far suggests nearly 9 in 10 people make both their appointments for their Covid-19 vaccines.

There’s a big asterisk to the data: The early priority groups — health care workers and those at nursing homes — may have driven up the numbers, because it’s easier to get vaccinated if it’s available at your workplace or home. It’s possible adherence rates are dropping as the vaccine rolls out to a broader population.

But maybe not. We’re in the middle of a pandemic. Everyone wants to go back to normal. Given the severity of this situation, it’s possible Americans will continue to get their second shots at high rates.

Still, there’s no denying getting one shot is easier. Especially for people with limited or no paid time off, or other responsibilities that can make schedules tight and hectic, a one-and-done approach is better. Some people may slip through the cracks as a result — and it will be on public health officials to find ways to connect with those people.

At the very least, though, the data so far indicates there’s no big crisis of people failing to follow up, and the country is still on track for mass vaccination.

If that’s true, Johnson & Johnson’s advantage shrinks considerably. It would be great to have a one-shot vaccine that works — I certainly liked being done with it all after one shot — and to have another tool against Covid-19. And we’ll likely have that tool back at some capacity within a few weeks, once federal regulators complete their investigation.

But America’s vaccine rollout is going so well that the country is on track to vaccinate most adults, with or without Johnson & Johnson.