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CDC panel recommends people not get J&J vaccine if Pfizer, Moderna available

The advisory committee voted in favor of language that calls the mRNA vaccines from Pfizer and Moderna the “preferred” options over Johnson & Johnson’s.
A health care worker administers a dose of the Pfizer-BioNTech Covid-19 vaccine at a pop up vaccination site at Hammons Field in Springfield, Mo., on Aug. 3, 2021.
A health care worker administers a dose of the Pfizer-BioNTech COVID-19 vaccine at a pop up vaccination site at Hammons Field in Springfield, Mo., on Aug. 3, 2021.Angus Mordant / Bloomberg via Getty Images file
/ Source: NBC News

People shouldn’t get the Johnson & Johnson COVID-19 vaccine when the Pfizer-BioNTech and Moderna shots are available, an advisory panel to the Centers for Disease Control and Prevention said Thursday.

The panel, called the Advisory Committee on Immunization Practices, convened following an update from the Food and Drug Administration on the risk of rare but potentially life-threatening blood clots linked to the Johnson & Johnson vaccine.

At least 54 people in the United States, mostly women, have been hospitalized from these blood clots, and nine people have died.

The panel voted unanimously in favor of deeming the mRNA vaccines, from Pfizer and Moderna, the “preferred” options for adults over the Johnson & Johnson vaccine, ultimately concluding that the mRNA vaccines provided greater protection and fewer risks than Johnson & Johnson’s. The recommendation would not prohibit use of the Johnson & Johnson shot, but instead make clear that the other options are a better choice if they are available.

“I really cannot recommend a vaccine that has been associated with a condition that may lead to death,” said committee member Dr. Pablo Sanchez, a pediatrician at Nationwide Children’s Hospital in Ohio.

CDC Director Dr. Rochelle Walensky will need to sign off on the recommendation.

Johnson & Johnson’s vaccine is linked to a blood clotting condition known as thrombosis with thrombocytopenia syndrome, or TTS. The AstraZeneca vaccine has also been associated with the blood clot issue.

Both the Johnson & Johnson and AstraZeneca vaccines use an adenovirus technology to train the immune system to fight the coronavirus. The shots developed by Pfizer-BioNTech and Moderna use a different approach, mRNA, to train the immune system, and have not been linked to these clots.

The ACIP meeting came after the FDA announced Tuesday it added a contraindication to the Johnson & Johnson vaccine, saying that people who had previously developed TTS after receiving one dose of that vaccine should not receive a second dose. The FDA also said the highest reporting rate of the blood clot issue — about 1 case per 100,000 doses administered — has been in women aged 30 to 49. About 15 percent of the cases have been fatal.

Dr. Sara Oliver, an epidemic intelligence service officer at the CDC, said in a presentation to the committee that data shows the Johnson & Johnson vaccine prevents more hospitalization and deaths from COVID than the TTS it can cause. Still, she said, the vaccine prevents fewer hospitalizations and deaths than two doses of an mRNA vaccine.

During the meeting, Dr. Penny Heaton, the global head of research and development at Johnson & Johnson’s vaccine division, defended the shot, saying it offers high levels of protection against COVID, only requires one dose and is easier to store and transport than the mRNA vaccines, which must be stored at cold temperatures.

But committee members noted that there’s increasing evidence to suggest that one dose of Johnson & Johnson’s vaccine is not sufficient. In October, federal health officials said that all Johnson & Johnson recipients should get a booster shot if it’s been two months since their initial vaccination. The vast majority of initial Johnson & Johnson recipients have opted for a Pfizer or Moderna booster.

The Biden administration is urging all eligible Americans to get a booster amid the threat of the omicron variant. Initial data suggests three shots of the mRNA vaccines provide adequate protection against the new strain. 

In the U.S., the Pfizer and Moderna vaccines are readily available. More than 570 million doses of Pfizer and Moderna have been delivered to providers, whereas only 28 million doses of Johnson & Johnson have been delivered.

The link between the Johnson & Johnson vaccine and blood clots first emerged in April after six cases were reported in women. Federal health officials paused the use of the vaccine at that time to investigate the cases, and resumed administration 10 days later, adding a warning that the vaccine could be linked to the clots, particularly among women ages 18 to 49.

A total of 54 cases of TTS following Johnson & Johnson vaccination were identified through late August, Dr. Isaac See, a scientist in the CDC’s emerging infectious diseases unit, said Thursday during a presentation to the committee. All the patients were hospitalized, including 36 who were admitted to the intensive care unit.

Most cases occurred in women, and symptoms usually occurred within nine days of vaccination with the first dose, he said. No cases of the rare clot issue have occurred in pregnant women. Risk factors for the clot issue include obesity, hypertension and diabetes.

Johnson & Johnson’s vaccine initially held promise, because it could be given as a single dose, rather than the two doses required for the Pfizer and Moderna vaccines. But clinical trials showed that its effectiveness was much lower than those of Pfizer and Moderna.

That effectiveness fell further with the emergence of the delta variant, leading health officials to recommend boosters.

More than 16 million people in the United States have received a single shot of the Johnson & Johnson vaccine, according to the CDC. More than 470 million doses of the Pfizer and Moderna vaccines have been administered.

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