The Memo: Specter of vaccine hesitancy rises after J&J blow

The pause in the use of the Johnson & Johnson COVID-19 vaccine announced Tuesday is virtually certain to exacerbate vaccine hesitancy, dealing a fresh blow to the nation’s efforts to recover from the pandemic.

Vaccine hesitancy is on its way to becoming the main hurdle in the fight against the virus, experts say. 

Vaccinations are becoming more plentiful. The nation has recently been averaging more than 3 million vaccination shots per day, bringing relief to people desperate for protection against a virus that has claimed more than 560,000 lives in the United States.

But what happens when all those people are vaccinated? Millions of Americans seem likely to decline the vaccine — and their reluctance is only heightened by any bad news, such as the suspension of the J&J vaccine.

Vaccine hesitancy “is a significant worry,” said Larry Gostin, a Georgetown Law School professor and expert in public health. 

Gostin noted that reluctance to be vaccinated had risen precipitously in parts of Europe after concerns were raised there about an AstraZeneca vaccine. The AstraZeneca shot has not yet been approved for use in the U.S.

Now, on this side of the Atlantic, “it is absolutely predictable that, at least in the short term, we are going to see a lack of trust in the Johnson & Johnson vaccine, which could either turn into a distrust of vaccines generally or to ‘vaccine shopping’ — that is, avoiding the J&J and seeking out Moderna or Pfizer. Either of those things are significant problems,” Gostin said.

Steven Wilson, an assistant professor of politics at Brandeis University, has written about the phenomenon of vaccine hesitancy, and especially the way it can be exacerbated by the dynamics of social media.

He noted that this was already such a broad problem that the World Health Organization had listed it as one of the top 10 threats to world health in 2019, before COVID-19 had even been heard of. 

The real danger of the Johnson & Johnson news, Wilson suggested, lay not in its capacity to reinforce the views of hardline skeptics and conspiracy theorists, but in its potential to weigh on those who are ambivalent.

“The biggest element in terms of the J&J fallout is likely to be an increase in hesitancy levels among those who think, ‘Maybe they are telling me it’s only a small chance but blood clots are very bad,’ ” he said, adding that humans are notoriously bad “at evaluating low-probability events.”

Serious side effects from the J&J vaccine appear to be extremely rare. The current pause pertains to six cases of blood clots. More than 7 million shots of the vaccine have been administered in the United States.

Anthony Fauci, the nation’s leading expert on infectious diseases, and Jeff Zients, the White House coordinator for the COVID-19 response, sought to reassure the public when they appeared in the press briefing room Tuesday.

Zients said that the pause should not have a serious effect on the availability of vaccines, since the J&J vaccination had accounted for fewer than 5 percent of all shots in the United States so far.

President Biden underlined that point later in the day, insisting that “there is enough vaccine — that is basically 100 percent unquestionable — for every single, solitary American.”

But the upsurge in availability is a separate issue from vaccine hesitancy. Zients told reporters that the latter “is a challenge and we need to be addressing it, and we are.”

The effort to overcome hesitancy is increasingly leveraging the power of popular culture rather than relying on briefings from scientists. 

Stars including Jennifer Lopez, Demi Lovato, Matthew McConaughey and Lin-Manuel Miranda will join Biden, Fauci and former President Obama for an NBC TV special titled “Roll Up Your Sleeves,” set to air Sunday. 

The special is intended to promote the vaccination effort and to dispel concerns around it.

The political fault lines around the pandemic are starkly drawn, however. 

In an Economist/YouGov poll released last week, 40 percent of Republican voters and 38 percent of former President Trump supporters said they would not get a vaccine even when offered one. Those figures were far lower among Democrats and Biden supporters, at 8 percent and 5 percent respectively.

There is some evidence in public polling that vaccine hesitancy among communities of color has declined, whereas it remains high among white conservatives.

Trump issued a statement Tuesday morning, blasting the Biden administration, as well as the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) for pausing the J&J vaccine. 

Trump said that the vaccine had enjoyed “extraordinary” results and “now its reputation will be permanently challenged.”

Trump’s purported concern for protecting the reputation of vaccines comes rather late. He cast doubt on scientific advice throughout the pandemic, and it only emerged in March that he and then-first lady Melania Trump had been vaccinated in January. 

Also in March, Trump said in an interview with Fox News that he “would recommend” people get vaccinated. He then noted approvingly that many of those refusing to do so had voted for him. “We have our freedoms and we have to live by that, and I agree with that also,” he said.

“Distrust in science is absolutely America’s Achilles’ heel,” said Gostin. “It has caused countless deaths throughout this pandemic and it could really prove an obstacle to our path toward normality.”

Gostin defended the joint FDA and CDC decision to recommend a pause in the use of the J&J vaccine, arguing that the agencies were simply doing their job. But he worried that the nuance of their position may be lost on the public.

Kavita Patel, a public health expert and nonresident fellow at the Brookings Institution, said the FDA was coming under unfair criticism, especially on social media platforms, for the pause.

“Vaccine safety is what we expect the agency to monitor,” she said. “It is hard to understand where the line is — what is the number of cases where [the pause] should have been triggered?”

But even as she defended the FDA’s actions, Patel acknowledged, “it’s a huge blow, there’s no doubt about it.”

Patel is also a practicing physician. She worries about the impact of uncertainty on medical professionals and patients alike.

“I have doses right now in the fridge,” she said. “Do I throw those away? Doing that feels awful.”

The Memo is a reported column by Niall Stanage.