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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on April 14th, 2021

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COVID-19 Update 4/14: The Johnson & Johnson Pause

COVID-19 | Facebook Live Recap

On this week's COVID-19 update, Dr. Steven Bishop explains and discusses the recent pause of the Johnson & Johnson vaccine. How alarming is it? What happens next? How should we think about in context against natural infection? Watch the video below and read on for a full transcript.

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COVID is like "trying to hold on to an octopus."

I hope you guys had a good time with Dr. Pong last week. I'm going to steal a phrase from him about COVID. He said dealing with COVID, it's like trying to hold on to an octopus. And he is 100% percent correct because things are changing on a constant basis. So we're going to talk about vaccines today because that's what's going on.

The main thing is, I'm sure everyone has seen in the news, that the Johnson & Johnson vaccines have been paused, effectively pulled from the market, for now, because of concerns about blood clots.

Blood Clots in Adenovirus Vector Vaccines

Let's dive into this a little bit. We've got four major vaccines going on in the world right now, or in the Western world. We've got the Pfizer vaccine, the Moderna vaccine, and then we've got Johnson & Johnson, which was being used here in the U.S., and then AstraZeneca, which was being used in Europe.

These four vaccines are basically two different families of vaccines. So Pfizer and Moderna are kind of one family of vaccines. That's the mRNA vaccines that most of us have gotten at this point, Pfizer and Moderna.

And there's the other family of vaccines, which are adenovirus vector vaccines. It's a slightly different technology. That's Johnson & Johnson and AstraZeneca. They both use this different technology to produce the vaccine. What we have seen for whatever reason or another is that there have been some cases of blood clots and, in particular, cerebral blood clots associated with the use of the AstraZeneca vaccine and the Johnson & Johnson vaccine.

Central venous thrombosis. That was the word I was trying to come up with. It was right on the tip of my tongue. Central venous thrombosis is what we've seen with these two vaccines.

And unfortunately, there was a woman in Virginia this week who did die from a central venous thrombosis after getting the Johnson & Johnson vaccine.

Concerning but not as alarming as it seems (right now)

Now, what does this mean? So what they have seen with the J & J vaccine, in particular, is that about six or seven people out of the six or seven million people who have gotten the vaccine have gone on to either have some sort of blood clot or a central venous thrombosis, and that's concerning. But it's not as alarming as it seems at first, because there's a background rate of all these things.

Everyday people just going about their lives, they have blood clots sometimes. Central venous thrombosis is something that happens to people sort of more or less at random. Younger women are at higher risk, especially if they are of childbearing age or if they are pregnant or recently pregnant, or if they're on medications that increase their risk for blood clots, like birth control pills.

And that's who we've mostly seen get these blood clots after the Johnson & Johnson vaccine. It's younger women ages 18 to 48 is what we have seen.

But again, the background rate of these blood clots and other issues is actually kind of similar to what we're seeing in the Johnson & Johnson vaccine. So I think it's a little it's premature to say that the vaccine is causing or is not causing these clots, the same thing with AstraZeneca.

But what we've seen is a pause, right? We're going to stop giving them until we can analyze the data a little bit more closely. Same thing with AstraZeneca in Europe. Most of the European countries are pulling back on AstraZeneca because of the same problems. And they're going to look at the data a little more carefully and try to really figure out, are these clots just random happenstances that were going to happen to these people anyway? Or is it really because of the vaccine?

And it's going to take them some months to figure that out. So I expect we won't see these vaccines back for some time until they really sort these things out. So we'll just be really left with kind of where we were before, which is with Moderna and Pfizer. I know it's a little bit of a disappointment for a lot of people who were looking forward to doing that single-dose Johnson & Johnson vaccine.

But unfortunately, we do see a concerning data signal, so it's good for them to pull back on that and really analyze what's going on before we continue using it. And production is ramping up for Pfizer and Moderna, so hopefully, that will fill the gap.

Good News: Pfizer & Moderna Protection Lasts Up to 6 Months (At Least)

Some good news about vaccines that came out this week as well, both Pfizer and Moderna released data saying that their vaccines maintain good immune protection up to six months after the doses are completed, which is great.

The protection from symptomatic COVID and severe COVID remains in the 90 plus percent range for both at six months out, which is fantastic. So lots of good news on that front as well. And again, no new harmful data signals that I'm aware of related to either the Moderna or the Pfizer vaccine at this point, so that's also good.

Over the next few months, we'll probably start to see data come out from the trials looking at the teenage population for Pfizer and Moderna and figuring out if those are going to get EUAs as well.

The other thing that's important to note about the release of the six-month follow-up data is that that's sort of the next step toward getting full FDA approval for those vaccines. It's not the only step or it's certainly not the last step, but it's the next step. So they're continuing to accumulate good data and publish that in an effort to eventually get full FDA approval for those vaccines, which is what we want to see and get us out of this emergency use authorization at some point down the road. Hopefully over the next year or so.

So that's kind of where we are. A lot of big news. Some of the bad, some of the good, but I think overall, you know, you're going to expect to have some of these vaccines are not going to work out the way we hoped.

And that's unfortunately just par for the course. But it seems that we at least have two very good ones at this point that we can continue to use. And, you know, hopefully, we'll find that there isn't a bad data signal there with the Johnson & Johnson vaccine and it'll come back on on the market.

Risks from Vaccines vs. Risk from Natural Infection

The other thing to keep in mind, whenever we see some of these unusual side effects or concerning side effects that seem scary, and they are scary, is to think about the risks of the natural infection, right? Everyone is talking this week, oh, if I get the Johnson & Johnson vaccine, I might get a blood clot.

Well, if the vaccine is linked to blood clots, yes, that's true. You might get a blood clot if the vaccine truly is causing those. That being said, you might also get COVID.

And we know that the risk of getting a blood clot with a natural COVID infection is very high.

So, even if there is some small percentage of people who are developing blood clots after the Johnson & Johnson vaccine, it's still going to be way less than the number of people who would get a blood clot from getting infected with COVID naturally.

So it's good to keep these things in mind, as we evaluate vaccines and vaccine side effects. It's the same thing as when we talked about ITP. I don't know if you guys remember that a couple of months ago, we were talking about immune thrombocytopenia as a side effect of probably the Pfizer and maybe the Moderna vaccine as well.

And that's where the immune system attacks the platelets in the body and you can have bleeding and hemorrhaging. And that happens with all vaccines. There's a certain rate of ITP that does develop.

But you have to think of that in the context of how many people develop ITP after a viral infection and COVID? And the answer is a lot. A lot of people do. So the number of ITP cases caused by the vaccines, as long as it's less than what would be caused by the virus, it's still a net benefit.

So that's another perspective to take. Another way to think about these things.