5 ways to use Johnson & Johnson vaccines before they expire

It is an ominous sign of the times that millions of doses of the Johnson & Johnson/Janssen COVID-19 vaccine were set to expire in a matter of weeks (until the FDA permitted an extension). One would imagine that in the midst of a pandemic — in which the path to normalcy is heavily dependent on vaccines — that expiring doses would be a never event. But this pandemic has been unique from the very start and the dilemma of expiring doses is another concretization of that fact.

The J&J vaccine is a vaccine that has many advantages including the fact that it does not require extreme cold storage and requires just a single dose for full protection. This is why, since it became the third COVID-19 vaccine available, I often recommend it to my friends. Its attributes allow it to be preferentially used in hard-to-reach populations as well. However, this vaccine has suffered from a slew of negative press that, without context, has diminished the demand for it by the public. Currently, close to 30-fold more doses have been given of non-J&J vaccines than J&J doses.

First, there was widespread misinterpretation of its efficacy that omitted the context that vaccines were not studied head-to-head, and the J&J vaccine was studied at a time when there was more COVID-19 circulating, including troublesome variants. Such confusion was even voiced by the Detroit mayor who initially declined the vaccine for his city saying he wanted the “best” and the J&J vaccine was just “good.” This was followed by the U.S. Conference of Catholic Bishops recommending Catholics choose another vaccine because of the use of the fetal cells in the J&J vaccine’s manufacture rendered it “morally compromised.”  There has also been concern about the manufacturing capabilities of the Baltimore plant that was contracted to produce it, most of which now have to be discarded (the expiring doses on the U.S. market where not manufactured there but in the Netherlands). Finally, there was the unfortunate 11-day pause triggered by a linkage with an extremely rare blood clotting disorder that doesn’t fundamentally change the risk-benefit ratio of the vaccine. 

What all of these events have done is relegate the J&J vaccine to second-tier in the mind of many in the public, especially coupled to the plentiful supply of Moderna and Pfizer/BioNTech vaccines. Indeed, and as predicted, J&J vaccinations have not really picked up post-pause.

There are five things I think should be done, simultaneously, with J&J doses:

1. Study shelf-life extension: as has been recommended, states (in concert with J&J and regulators) should assess the potency of vaccine doses to determine if expiry dates could be modified. This is a process that has costs, can be difficult but is worthwhile and has precedent with other infectious disease products. A 1.5-month extension has already been granted but longer durations should be studies to avoid a repeat in the future.

2. Allow states to transfer their stocks to other states. There are varying demands for vaccinations in different states and there may be places where J&J demand is sufficient to rotate in more rapidly expiring doses for immediate use. 

3. Door-to-door vaccination: States with expiring doses should literally have vaccinators go door-to-door (like politicians often do) and ask residents if they want a vaccine on the spot until all doses are exhausted or all neighborhoods covered.

4. Vaccinate at the southern and northern borders: There are many people who live close to the borders of the U.S. and could be candidates for vaccination. Stations for vaccination could be set up at multiple locations where, in a first-come, first-serve basis Mexicans and Canadians could be vaccinated.

5. Permit states to transfer stocks to other countries: As global demand for the vaccine, even in North America, is high the expiring doses could be transferred to other countries. However, it is not currently possible for states to donate their vaccine stocks to another country. This policy should be immediately reversed (of note Canada’s hold on J&J has to do with Baltimore-manufactured doses, not Netherlands-manufactured expiring doses.)

The J&J vaccine is a safe and efficacious vaccine that is a key tool in ending this pandemic globally. It has already been a victim of vaccine hesitancy and misunderstanding. The extended month and a half expiry date has given it a temporary reprieve but it is far too valuable to now become a victim of bureaucracy and find its final destination be a landfill instead of a person’s arm.

Amesh Adalja, M.D., is an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA.