I am generally a deeply cynical person when it comes to politics, but there is a part of me that is always trying to have a little bit of faith that they will get it right. That faith is rarely rewarded. In most cases giving the benefit of doubt upfront is just a recipe for future disappointment. I remind myself often to try – at least try – to give it anyway.
Waking up to the news that the Johnson & Johnson COVID vaccine has been put on hold due to what is being called a "rare disorder" involving blood clots in six recipients was pretty deflating. I think the vaccination drive can be successful with or without any specific company's product (it might take longer, but losing one brand wouldn't bring the whole process tumbling down) so even if it ends up withdrawn entirely I think we'll get past that. What is upsetting is the certainty that this will reinforce anti-vax sentiments in those already inclined toward skepticism, and no amount of data and reason will convince people that six reactions out of seven million (!!) recipients is lightning-strike level odds.
I am trying very hard to have faith that there was a good reason for this decision, and the CDC/FDA did not withdraw one of the vaccines over such a small number of reported adverse reactions. Because if that's truly all there is to the story, the harm they will do in giving fuel to anti-vax skepticism will outweigh any good they might do by studying these reactions. In my best impression of an optimistic person, here is the benefit-of-doubt version of why they might have good reason to do this: we are focusing on the wrong denominator. The total number of JNJ shots in the data pool is nearly 7 million, and 6 cases out of that is very few. However, if all six of the cases are from a specific sub-group in the population, it *may* be reasonable to sound some alarms.
Information is conflicting but it appears that these blood clots occurred in women age 18-50. That's a big demographic, but it's only a part of the overall population of data. This is especially true given that the elderly have been prioritized so far and are almost certainly overrepresented (maybe by a lot!) in the data. To take this to the point of being ridiculous, imagine that there were 6 blood clots out of 6,800,000 shots, but that all six occurred in left-handed 21 year old male Jews. There are obviously only a handful of people meeting that description in the pool, so six adverse reactions out of that small group could be legitimately worrying.
Now. The natural reaction is, OK why not keep giving the vaccine to everybody other than women 18-50. It seems unlikely that an announcement that a certain vaccine is dangerous for certain people would be ignored by the rest of the population. "There may be a problem with this vaccine" is a statement that most people will hear and draw conclusions without waiting for qualifiers. Even if reactions so far are limited to a sub-group, they may be playing it safe and taking it as a potential sign of larger problems.
That's the goodwill interpretation. I assume – I have to assume – that the people in charge of these decisions have a very good reason for having done this. The problem is, I think their risk modelling is entirely based on clinical data and might not account for the very real possibility of consequences beyond that – namely that the withdrawal could fuel a wave of negative sentiment among people on the fence about getting vaccinated. It doesn't require much in the way of an excuse to allow people to talk themselves out of something they don't really want to do anyway.
Ideally "Is this going to look bad?" isn't THE guiding principle for medical decision-making, but public health has the word public in it for a reason. Perceptions matter. If it does turn out that six adverse reactions was enough to prompt this kind of decision in the middle of a public health crisis, that will be…extremely unfortunate. That will seem, at least from our armchairs, like a bad or at least questionable decision. Introducing an element of doubt and distrust about the safety of vaccines into this equation is very costly, and I'd be willing to bet there's a raft of prescription drugs with a higher incidence of side effects. Yet those drugs are approved because it has been determined that the benefits outweigh the risks and costs. In this situation the risks and costs include perception, like it or not. And while I doubt the CDC models for skepticism and doubt – How could they? – it has to be considered here. The damage that is done in this case will be permanent, and no statements of reassurance later will wash away the now-durable perception that one of the vaccines is unsafe.