It’s Okay To Be Confused About J&J’s Vaccine

12:12 minutes

a needle in the foreground and the johnson and johnson logo in the background
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This story is a part of Science Friday’s coverage on the novel coronavirus, the agent of the disease COVID-19. Listen to experts discuss the spread, outbreak response, and treatment.

This week, the FDA and CDC both recommended a temporary pause in distribution of Johnson & Johnson’s one-shot COVID-19 vaccine, after the emergence of a very rare, very unusual blood clotting side effect. The clots, which block blood leaving the brain, have been found in only six of the nearly seven million people who have already received the vaccine in the U.S. One has died, and another is in critical condition.

Vox staff writer Umair Irfan has been reporting on the Johnson & Johnson pause, and joins Ira to explain the challenging balance between side effect risks—the rarest of which cannot be detected in clinical trials and therefore naturally emerge when vaccination moves to the general population—and the benefits of protecting people from COVID-19. Plus, what recommendations the FDA may end up making.

He also talks about why a small number of people are still getting COVID-19 after being fully vaccinated, the grim outlook for wildfire in the West this summer, and more science stories from the week.

Further Reading

Segment Guests

Umair Irfan

Umair Irfan is a senior correspondent at Vox, based in Washington, D.C.

Segment Transcript

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Later in the hour, on this Earth Day edition of Science Friday, the story of the endangered right whale and a new book looks at the history of the conservation movement. But first, earlier this week, the FDA and CDC both recommended a temporary halt on the use of the Johnson & Johnson COVID-19 vaccine, after the data showed rare instances of an unusual blood clotting condition.

How rare are we talking? Well, 6 people out of 7 million, who have received the vaccine, all of the women between the ages of 18 and 48. Dr. Anthony Fauci has said he expects the pause to last from days to weeks while the FDA decides on recommendations for how to move forward. For a similar clotting issue linked to the AstraZeneca vaccine, meanwhile, the UK has advised that people under 30 opt for a different vaccine.

Here to help untangle the risk calculations and the challenges of a rare vaccine side effect, plus other important stories this week, Vox staff writer Umair Irfan. Welcome back.

UMAIR IRFAN: Thanks, Ira.

IRA FLATOW: Let’s get right into this. You’ve been reporting on this J&J pause. Do we know why the vaccine might have caused these clots?

UMAIR IRFAN: Well, it’s just speculation at this point. But it may be that the spike protein that is generated by these vaccines, the vaccine administers the instructions to your human body for making the protein, and then the body uses that protein as a target for its immune response. And so the idea may be that this is actually triggering an autoimmune reaction that is triggering blood clots.

But critically with this condition, it’s not just that they’re causing clots, but also that they’re causing another related condition called thrombocytopenia, which is a low level of blood platelets. And that’s why regulators are really worried because these two conditions together mean that you can’t use the same conventional treatments for blood clots. The low levels of blood platelets means you can’t use blood thinners because that will lead to actual more complications. And so they really want to come up with a way to warn doctors if they see these symptoms and come up with a protocol to make sure that if they do find this in some patients that they are ready to treat it in a way that doesn’t make the situation worse.

IRA FLATOW: So I would imagine that people who are supposed to get vaccinated or think they’re getting vaccinated with the J&J vaccine, they’re probably really confused right now.

UMAIR IRFAN: Right. And this is a difficult needle for regulators to thread. Right now we’re talking about a complication that’s extremely rare, as you noted. We’re talking about almost literally a one-in-a-million type complication. And some people have criticized the regulators for overreacting to this. But because this complication occurs in very specific circumstances, they want to come up with a way to make sure that they can get these complication rates to zero.

And we saw something pretty similar with the other mRNA vaccines, with the Moderna and the Pfizer, BioNTech vaccines because we saw some severe allergic reactions in people who received them. And what regulators did was they developed a screening criteria for people who are about to receive the vaccine to filter out people who have a history of severe allergic reactions and also added a waiting period post vaccination for 15 minutes to make sure that if there was any complication that people could get treatment right away. So we could potentially see sort a similar set of instructions being deployed for the Johnson & Johnson vaccine, basically a way to screen out people at high risk or adding an additional precaution.

IRA FLATOW: Should we be surprised that a complication is coming out now that millions of people are getting vaccinated?

UMAIR IRFAN: This is actually what we expected. Because when we test vaccines in clinical trials, we’re only testing them in tens of thousands of people. But now we’re administering them in hundreds of millions of people. And that’s where the very, very rare complications start to arise. And so regulators say that they’re acting out of an abundance of caution. Even though these are rare complications and the benefits of these vaccines still outweigh the risk, they want to make sure that they can get the risk to as low as possible because we want as many people as possible to get these vaccines.

IRA FLATOW: Another thing you’ve been following is this phenomenon, also rare, in people who are fully vaccinated are still getting sick with COVID-19. What’s going on there?

UMAIR IRFAN: Right. The CDC calls these breakthrough infections. And they reported some additional data this week. They found that out of the 75 million or so people in the US that have had full vaccinations, about 5,800 of them were reported to have contracted COVID-19. And of those cases, about 396 resulted in hospitalization and 74 in death.

Now, that was expected, as well, because we know that these vaccines, even though they’re highly effective, they’re not perfect. They’re not airtight. And we still have a rampant pandemic, which means that even vaccinated people are still being exposed to the virus. And if they get exposed enough, some of them may be vulnerable to an infection. Not everybody’s immune system is the same, and not everybody receives the same level of protections. But on balance, it shows that the rate of breakthrough is extremely low and that these vaccines work exceptionally well.

IRA FLATOW: Pfizer said this week that we’re likely to need booster shots as soon as a year after the first vaccine. And we’ve been hearing that these drug companies are preparing possibly for that for later this year.

UMAIR IRFAN: Right. So some of them are investigating booster shots, basically an identical version of the shot but one more of it. Or some of them are reformulating their vaccines to target these new variants that are in circulation. Right now the B117 variant is very likely to become the dominant version of the virus here in the US. It seems to be able to slightly more effectively escape protection from the vaccine, even though the vaccines still remain highly effective against that one as well.

And so the pharmaceutical companies are investigating both options, basically a booster or a reformulated version of the vaccine. But it’s not clear yet whether we will need them at this point. It’s also a function of how much we can control the spread of the virus.

IRA FLATOW: Yeah. And speaking of the spreading of the virus, things are pretty bad in Michigan right now, are they not? Is it related to what we’re talking about, or is it a whole different issue there?

UMAIR IRFAN: Well, it’s a mix of factors. Michigan is now closing in on its record of COVID-19 cases and is reaching a new peak here. And there’s a number of reasons behind this. Well, one is that, of course, there is this new variant in circulation, the B117 variant, which is a little bit more transmissible and also more dangerous.

But Michigan also began restricting or relaxing some of its lockdown restrictions in February. And many of these outbreaks seem to be associated with gatherings of people. And people in Michigan are also having a hard time signing up for getting vaccines. And so these factors all combined mean that there seems to be a more transmissible strain, people having a hard time getting protection, and also getting together seems to be fueling these additional spikes.

IRA FLATOW: And a lot of states are opening up totally, aren’t they?

UMAIR IRFAN: Right. And so this is sort of a warning sign for states that if you relax too soon, you could potentially undo some of the fragile progress that they’ve made.

IRA FLATOW: Let’s move on. Just in time for Earth Day, the state of Montana has been pushing a number of bills to allow people to hunt wolves in this state because the Trump administration took them off the Endangered Species list.

UMAIR IRFAN: Right. The gray wolves are the classical story of conservation. They were added to the Endangered Species list back in the 1970s. And since then, because of conservation efforts and some reintroduction efforts, they’ve recovered in much of the Western United States in places like Montana. And the latest estimate shows that there’s about 1,200 wolves in the state.

But a consequence of that is that now people are getting worried about these wolves. There’s a question about how many wolves are appropriate, what’s the correct level to have. So there are hunting groups that are concerned about wolves attacking deer and elk populations. And there are farming groups that are concerned about wolves attacking livestock.

And so in Montana, they’ve recently started pushing these bills through the legislature. Two of them have already been signed by the governor that would extend the hunting season, that would allow them to use more methods of killing wolves, and even reimburse hunters, essentially giving them bounties for killing wolves. And this has been criticized, of course, by conservation groups saying, that even though we’ve made progress, we’re not out of the woods just yet.

IRA FLATOW: And it’s not just Montana. Wisconsin had a wolf hunt last month. Minnesota has debated similar bills. Why are the states so keen on killing the wolves?

UMAIR IRFAN: Well, for exactly the reasons I mentioned, that this is a lot of farmers and a lot of people in the region have misperceptions of how wolves fit within the broader ecosystem and see them as a threat. In Montana, in particular, conservation has pointed out that actually deer and elk populations are fairly stable, around some of the highest levels that they’ve seen. And they’ve grown alongside the wolf populations. And so all these animal populations are relatively healthy at the moment. The wolves don’t seem to be threatening them.

But there’s also sort of a culture war issue, as well, that once these gray wolves have been delisted, a lot of people are saying, why is the government still involved in regulating them? Or why is the government still protecting these animals and restricting our rights to protect our land or our desire to hunt? And so this is one of the tensions that we’re seeing across many of these habitats.

IRA FLATOW: So it seems to be a back and forth, back and forth. If you allow the hunters to go back, we might see the wolves endangered again.

UMAIR IRFAN: Potentially. But hunters say that they can also hunt in ways that are sustainable. And that remains to be seen, if there are practices that will help maintain these populations.

IRA FLATOW: Mm-hmm. We know that spring is just getting started. But out West, researchers are already sizing up the wildfire risk for this summer. And it’s not looking good, is it?

UMAIR IRFAN: No, it’s not. This winter the West had very little precipitation. And of that precipitation, it’s been dissipating very quickly. The snowpack is actually disappearing pretty early this season and very fast. And if you look at the drought conditions, about 76% of the West, about 3/4 of it, is in drought conditions right now compared to about a quarter, 27%, around the same time last year. So this combination of dry weather and then likely with summer heat is going to create much more dry vegetation that’s going to be primed to burn.

IRA FLATOW: And I guess there’s a benefit for predicting that we’re in for another bad wildfire season because maybe people can be more careful.

UMAIR IRFAN: Right. The vast majority of wildfires are ignited by humans. And that can be things like power lines, unattended fires, and things like that. So people could be taking additional precautions around these highly dry vegetation areas. But people can also be preparing for the inevitable smoke that’s associated with these fires, by better insulating their windows and purchasing air purifiers to help mitigate some of the health impacts that are associated with them.

IRA FLATOW: And finally, before you go, a quick look ahead. NASA’s getting ready to test the first-ever helicopter on Mars. It’s been postponed and on again off again.

UMAIR IRFAN: Right. This is the Ingenuity helicopter. It’s this small box with two counter-rotating rotors. NASA ran into some hardware problems that they’ve managed to fix but are now fixing some software problems. And they’re trying to reinstall some of the control hardware.

The issue with this is that they don’t have a live control system because of the latency of communicating with Mars. So all this flying has to be done autonomously. And of course, there’s really no way to pick it up if it tips over. So NASA wants to be extra careful when they protect– when they do the first flight of this aircraft.

IRA FLATOW: And we’re talking, what, just about 30 seconds at 10-foot elevation.

UMAIR IRFAN: Right. This is going to be a very brief first flight. But NASA is acknowledging that also that the Wright brothers first flight was only 12 seconds. And so Ingenuity is actually going to be carrying a piece of the Wright brothers’ first aircraft on it as it takes its first flight on another planet.

IRA FLATOW: Very cool. Thank you, Umair.

UMAIR IRFAN: Thanks, Ira.

IRA FLATOW: Umair Irfan, staff writer for Vox, based in Washington, DC. After the break, untangling our role in the potential demise of the endangered North Atlantic right whale, one high tech solution, and how a springtime lobster fishing ban in Massachusetts may help.

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