Notes on the pause of Johnson & Johnson COVID-19 vaccines

A quick message to speak to the new public concern regarding Johnson & Johnson COVID-19 Vaccine:

For those who are not already aware, federal health agencies have called for an immediate pause in use of Johnson & Johnson’s single-dose coronavirus vaccine after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

Nearly seven million people in the United States have received Johnson & Johnson shots so far. As such, this complication has occurred in approximately 0.00008% of all J&J vaccine recipients. This calculates to literally less than one in a million. Nonetheless, out of an abundance of caution, the single-dose Johnson & Johnson vaccine will be unavailable until more information on these 6 cases can be obtained and analyzed.

Pfizer and Moderna formulations of vaccination against COVID-19 will remain available, and outpatient administration of these two-dose regimens continue to be scheduled and administered.

*****However, please note the following with respect to homebound patients:*****

The issue with Pfizer and Moderna for homebound individuals has mostly to do with storage and handling requirements. Both vaccines must be stored at sub-zero temperatures, then once a vial is accessed it must be fully distributed within a short timeframe (I believe in the range of 10-14 hours) before it is considered unusable. Each vial typically contains 10 doses. So if there aren’t 10 recipients within easy access for a vial to be fully distributed within the time frame, all unused doses will be lost. This is a significant challenge for administering to homebound patients because not only must 10 doses be fully distributed within the opening of a vial, but temperature control between doses (with an administering provider e.g. nurse traveling between locations), is that much harder to control unless carrying a working freezer in their vehicle, so a vial might actually expire in shorter than the expected time.

In short, due to the risk of losing viable doses in the process, the Pfizer and Moderna vaccines are not appropriate for home administration at this time.

I know it is challenging, but I will continue to ask everyone to be as patient as possible as this massive process of immunizing the world’s population is pursued as efficiently and safely as possible. Public health officials are being called upon to get people safe from the virus while keeping people safe from potential risks of a quick mass-produced vaccine roll-out, and the demands are for all of this to be accomplished “right away.” The urgency is well understood at the level of those making things happen, but the fact that there is a process involved must also be understood by those who are waiting for things to happen. Let’s all remain supportive of one another, uphold safe social-distancing behaviors, and endeavor to exercise kindness and compassion. Rest assured, this whole thing will continue to happen one day at a time, and progress is indeed being made slowly but surely.

Thanks for understanding,

Dr M

Mary A. Medeiros, MD, MPH
Thrive Adult Primary Care
835 W Central St, Ste 4 | Franklin, MA 02038
Phone: 774-318-4205

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