In Michigan, my mother-in-law was discharged from a hospital after a harrowing (non-COVID) illness. The plan was for her to receive a COVID vaccine on the way out the door.
But this hospital only had the Johnson & Johnson shot and because of the FDA’s pause of this vaccine, my mother-in-law was discharged still unvaccinated. This was a far greater omission than any risk from a one in a million side effect had the vaccine been given.
Anti-fear messaging is important to clinicians like me who attempt to help patients put risks in perspective. As a doctor who has both studied outbreaks and also the impact they have had on the human psyche, I feel it is important to provide context at all times.
Instead, perspective is too often lost and replaced by emotional theater, as it was this past week with the discovery that an extremely rare complication might be associated with the Johnson & Johnson adenovirus vector coronavirus vaccine.
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While scientists struggled to describe the entity known as vaccine-induced Immune Thrombotic Thrombocytopenia in three-minute TV interviews, and viewers attempted to understand antibodies directed at platelet factors leading to clots, public health officials who never examine patients struggle to tell the public what to be on the lookout for.
But neither the information of what an affected person’s antibodies or platelets are doing nor an elaborate description of the possible symptoms of cerebral venous sinus thrombosis is particularly useful. In fact this kind of detail can be misleading and even harmful.
The American public, not trained in medicine and already struggling to master concepts as complex as viral variants and Messenger RNA vaccinology, is now expected to become hematologists, immunologists and neurologists – all in the name of being informed, of taking the pandemic seriously.
Perspective is too often lost and replaced by emotional theater.
But telling a person that their headache is likely NOT due to severe blood clotting from the J&J shot immediately messages that it could be. One in a million is one in a million.
I spent almost all last week reassuring people that their headaches or dizziness were anything but. In fact, almost all the time the headache and dizziness I encountered were from fear and anxiety over the erroneous possibility that this could actually be from the shot. The news media was the culprit, not the vaccine.
Public health officials have always been poor at this kind of messaging, and now, amid pandemic fatigue, is the worst time for it, when the last thing any of us needs is misdirected shock and awe.
Former President Trump is right. Tremendous damage was done by pausing the use of the J&J vaccine, even if Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, now says it is likely to be back in play with some kind of restriction or precaution to pre-menopausal aged women, which is what should have happened in the first place.
It seems likely that this problem may be the same as what was found with the Oxford/Astra Zeneca vaccine, but there too the numbers were extremely small, just over 200 blood clots out of over 35 million who received the vaccine. And how many had associated risk factors like birth control pill use or heparin has to be carefully examined. Pausing the vaccine so that clinicians might be better informed first, as is claimed now, is foolish at best.
I prescribe treatments (and administer vaccines) with known rare side effects all the time. I am always open about this but I rarely would never invoke a remote possibility to dissuade use. Yet this is the danger of the J&J and Astra Zeneca fiascos. That extremely important, effective, easy-to-administer vaccines will encounter growing distrust and hesitancy, which could easily spill over irrationally to all the COVID vaccines.
I spoke with Dr. Arnold Montos, acting head of the FDA’s advisory committee on vaccines this past week, and he told me his group had played no role, that it was all being handled by the CDC’s Advisory Committee on Immunization Practices, which delayed acting or ruling.
This was a big mistake because it helped extend the focus on the extremely rare problem rather than getting millions of doses of a lifesaving vaccine back on track.