To federal health officials, asking states on Tuesday to suspend use of the Johnson & Johnson coronavirus vaccine until they could investigate six extremely rare but troubling cases of blood clots was an obvious and perhaps unavoidable move.
But where scientists saw prudence, public health officials saw a delicate trade-off: The blood clotting so far appears to affect just one out of every million people injected with the vaccine, and it is not yet clear if the vaccine is the cause. If highlighting the clotting heightens vaccine hesitancy and helps conspiracy theorists, the “pause” could ultimately sicken — and even kill — more people than it saves.
“It’s a messaging nightmare,” said Rachael Piltch-Loeb, an expert in health risk communications at the N.Y.U. School of Global Public Health. But officials had no other ethical option, she added. “To ignore it would be to seed the growing sentiment that public health officials are lying to the public.”
The one-dose Johnson & Johnson vaccine was just beginning to gain traction among doctors and patients after its reputation took a hit from early clinical trials suggesting its protection against the coronavirus was not as strong as that from the vaccines made by Pfizer-BioNTech and Moderna. Before Tuesday’s pause, some patients were asking for it by name.
But amid the blizzard of news and social media attention around the pause, those gains may well be lost, especially if the rare blood clotting feeds politically driven conspiracy theorists and naysayers, who seemed to be losing ground as the rate of vaccinations rose.
The problem is explaining relative risk, said Rupali J. Limaye, who studies public health messaging at the Johns Hopkins Bloomberg School of Public Health. She noted that the potential rate of blood clotting in reaction to the vaccine is much smaller than the blood clotting rate for cigarette smokers or for women who use hormonal contraception, although the types of clots differ.
And officials are not “pulling” the vaccine. They are simply asking for a timeout, in effect, to figure out how best to use it.
Vaccinators were already fielding questions from worried patients on Tuesday.
Maulik Joshi, the president and chief executive of Meritus Health in Hagerstown, Md., which has given 50,000 doses of all three vaccines without any reported major reactions, said he had a simple message to calm patients’ fears: “It’s a great thing that they have paused it, and this is science at work.”
Jennifer Steinhauer, Madeleine Ngoand Hailey Fuchs contributed reporting.
The European Union will receive an extra 50 million doses this month of the coronavirus vaccine developed by Pfizer and BioNTech, the leader of the bloc’s executive arm said on Wednesday, a lift in its effort to meet inoculation targets in the face of difficulties with vaccines developed by AstraZeneca and Johnson & Johnson.
The 27-nation bloc has also entered negotiations with Pfizer over the supply of 1.8 billion new vaccine doses — including booster shots to prolong immunity and new vaccines to tackle emerging variants — in 2022 and 2023, said Ursula von der Leyen, the president of the European Commission, its executive arm.
With these two announcements, the European Union embarked on a hard pivot to mRNA vaccines such as Pfizer’s, staking its coronavirus response on them, a day after Johnson & Johnson suspended the rollout of its vaccine in the European Union and as the bloc continued to suffer the fallout from restrictions on the AstraZeneca vaccine, after reports of extremely rare but serious potential side effects from both.
In another setback for AstraZeneca, Denmark on Wednesday became the first country to permanently stop the administration of the vaccine developed by the British-Swedish drugmaker. Denmark has heavily relied on Pfizer’s vaccine and has approved two others — Moderna’s, and Johnson & Johnson’s.
The European Union has not canceled its existing orders of AstraZeneca and Johnson & Johnson vaccines, but signaled it was not going to be placing more for the future.
“As we can see with the announcement by Johnson & Johnson yesterday, there are still many factors that can disrupt the planned delivery schedules of vaccines,” Ms. von der Leyen told the news media on Wednesday.
The European Union has set itself a target to to fully vaccinate 70 percent of its adult population by the end of the summer, some 255 million people, but its campaign has fallen behind those in United States and Britain, suffering blow after blow, first with major supply disruptions from AstraZeneca, and then as it has sought to respond to the reports of potential rare side effects.
Ms. von der Leyen’s announcements on Wednesday were significant in two ways.
Pfizer’s commitment to bring forward the delivery of the 50 million doses, which were originally slated for the end of the year, means the company will deliver a total of 250 million doses to the bloc by the end of June. Ms. von der Leyen said 100 million people in the European Union had already been inoculated.
But it also signaled that the bloc would seek to peg its strategy to tackle variants and the need for boosters in the medium term on mRNA vaccines, a newer technology being used by Pfizer and Moderna, moving away from vaccines based on other approaches like those from AstraZeneca and Johnson & Johnson.
“We need to focus now on technologies that have proven their worth: mRNA vaccines are a clear case in point,” Ms. von der Leyen said.
Organizers marked 100 days until the start of the Tokyo Olympics on Wednesday with a subdued ceremony amid tougher restrictions and growing questions over the event as Japan endures another surge of coronavirus infections.
The governor of Tokyo, Yuriko Koike, pledged that officials would do everything to deliver a “memorable tournament.” Wearing a mask and gloves, she unveiled statues of the Olympic mascots inside Tokyo government headquarters while a video link showed another group of officials unveiling a monument of the Olympic rings atop fog-shrouded Mount Takao, 30 miles west of the capital.
But parts of Tokyo and other municipalities remain under a quasi-state of emergency ordered last week to stem what officials describe as Japan’s fourth wave of infections. Japan has recorded nearly 3,200 infections a day over the last week, according to a New York Times database — few by the standards of the United States and Europe, but a worryingly high number for Asia.
The host nation is also lagging in vaccinations: Shots for those 65 and just began on Monday. So far, Japan has inoculated only frontline medical workers, who make up less than 1 percent of the population, and it will be far from fully vaccinated by July 23, when the Games are scheduled to begin.
Japan is calling these the “Recovery Olympics” — highlighting the nation’s recovery from the devastating earthquake, tsunami and nuclear disaster in 2011, as well as the world’s recovery from the pandemic. But the Games, originally scheduled for last year, are marching on despite more than 70 percent of the Japanese public saying they should be delayed again or called off entirely.
Organizers announced last month that international spectators would be barred, although thousands of athletes from over 200 nations are expected to compete. The ceremonial torch relay has been making its way across Japan with little fanfare; its two-day leg in Osaka this week was diverted off public roads and took place in an empty park.
Researchers in Britain investigating the effects of using one coronavirus vaccine for a first dose and another for a second have expanded their trial, they said on Wednesday, a day after the pause in the rollout of the Johnson & Johnson vaccine in the United States, the European Union and South Africa fueled uncertainties about vaccination campaigns.
Mixing doses could help countries weather vaccine supply shortages. Some governments have also recommended that some people who have received a first dose of the AstraZeneca vaccine receive a second injection of a different vaccine after a small number of recipients developed a rare blood-clotting disorder.
On Wednesday, German health authorities recommended that anyone under 60 who had received an initial inoculation with the AstraZeneca vaccine be given either the Pfizer/BioNTech or the Moderna vaccine for their second shot.
Some 2.2 million AstraZeneca doses were given to Germans younger than 60 when the authorities first began administering the vaccine, only to reverse that strategy after detecting several dozen cases of clotting.
Public health officials have emphasized that the benefits of the vaccines that have come under scrutiny still far outweigh the potential risks for most people, and some have warned that pausing their rollout could do more harm than good.
The Com-Cov study led by the University of Oxford began in February using AstraZeneca and Pfizer shots, but on Wednesday the researchers announced that they would recruit more volunteers and expand the trial to include doses of the vaccines developed by Novavax and Moderna.
“If we can show that these mixed schedules generate an immune response that is as good as the standard schedules, and without a significant increase in the vaccine reactions, this will potentially allow more people to complete their Covid-19 immunization course more rapidly,” said Dr. Matthew Snape, the lead investigator of the trial.
Researchers are expecting to publish their first findings by July, although the study will run for a year.
In other news around the world:
Reduced air pollution during the first lockdown in France may have led to “non-negligible health benefits,” the national public health agency said on Wednesday. A study by the agency estimated that the two-month lockdown last spring had avoided roughly 2,300 deaths from exposure to particulate matter pollution and another 1,200 from exposure to nitrogen dioxide, mainly related to traffic.
India has recorded a record 184,372 new coronavirus cases in 24 hours, officials said on Wednesday, as Maharashtra State, the country’s second most populous, prepared to impose a 15-day lockdown. The authorities in Maharashtra ordered its 120 million residents to remain indoors except for essential reasons beginning Wednesday evening. Hospitals there are running out of beds and essential supplies, and the state’s top official, Uddhav Thackeray, has asked the central government to mobilize the Indian Air Force to deliver oxygen cylinders. The leader of the state of Uttar Pradesh, Yogi Adityanath, said on Wednesday that he had tested positive for the coronavirus and was self-isolating.
Infections are surging in Thailand, which reported 1,335 new cases on Wednesday, its highest one-day total of the pandemic. Although the country has kept the virus largely under control for more than a year, officials are worried that the latest outbreak, centered in Bangkok, could spread nationwide as people visit relatives during the ongoing Songkran holiday, which marks the Thai New Year. With less than 1 percent of the population vaccinated, most of Thailand’s provinces have imposed entry restrictions.
Aurelien Breeden contributed reporting.
In March, a year into the pandemic, Jane Fraser, the chief executive of Citigroup, made a new workplace rule: no video calls on Fridays.
“After listening to colleagues around the world,” she wrote in a companywide blog post, “it became apparent we need to combat the ‘Zoom fatigue’ that many of us feel.”
Video calls have emerged as such a widespread pain point in this era of remote work that the term “Zoom fatigue” has entered our lexicon — a catchall phrase referring to the tiredness related to video calls on any number of platforms.
Now, research from Stanford University published on Tuesday found that women experience significantly more Zoom fatigue than men.
The research, which hasn’t been peer-reviewed, suggests that video calls amplify longstanding gender dynamics in group settings and exacerbate an already wide gender stress gap, with women consistently reporting more stress and stress-related health conditions than men, according to the American Psychological Association.
During in-person meetings, people aren’t staring into your face from nearby — some might be typing notes, some might be reading. Video calls disrupt that natural rhythm, forcing everyone logged in to stare at each other, a phenomenon known as “hyper gaze.”
“From an evolutionary standpoint, if somebody was very close to you and staring right at you, this meant you were going to mate or get in a fight,” said Jeremy Bailenson, founding director of Stanford University’s Virtual Human Interaction Lab and a co-author of the study. Constantly being on high alert, he said, creates stress.
He and other researchers created a scale to measure five types of fatigue associated with video calls: general (overall tiredness), social (wanting to be alone), emotional (being overwhelmed and “used up”), visual (symptoms of stress on one’s eyes) and motivational (lacking the drive to start new activities). In their most recent survey of over 10,000 participants, the researchers found that women of all ages scored higher on all five.
In a second survey, the researchers discovered that women reported more mirror anxiety — a psychological phenomenon where seeing oneself in a mirror can trigger heightened self-focus, which in turn creates more anxiety and depression. The self-view in video calls seems to be replicating the mirror anxiety effect, said Géraldine Fauville, a researcher who worked on the study.
As companies consider post-pandemic work culture, the solutions to Zoom fatigue aren’t going to be as simple as switching off self-view (which the researchers recommend you do anyway) or abandoning video calls, said Mollie West Duffy, co-author of “No Hard Feelings: The Secret Power of Embracing Emotions at Work.”
“I don’t think anyone has a playbook for how to do this perfectly,” Ms. Duffy said, “so we’re going to all try to do our best and then we’re going to have to be willing to have conversations two months in about how to adapt.”
With all American adults soon to be eligible for Covid-19 vaccines and businesses and international borders reopening, a fierce debate has kicked off across the United States over whether a digital health certificate (often and somewhat misleadingly called a “vaccine passport”) should be required to prove immunization status.
Currently, Americans are issued a white paper card as evidence of their Covid-19 shots. But these can easily be forged, and online scammers are already selling false and stolen vaccine cards.
While the federal government has said it will not introduce digital vaccine passports by federal mandate, a growing number of businesses say they will require proof of vaccinations for entry or services.
The drive has raised privacy and equity concerns. States such as Florida and Texas have banned businesses from requiring vaccination certificates.
Governments, technology companies, airlines and other businesses are testing different versions of the digital health passes and are trying to come up with common standards so that there is compatibility between each system and health records can be retrieved securely.
Here’s what we know.
Can I get a vaccine passport?
For the moment, only if you live in New York. Last month, it became the first state in the United States to launch a digital health certificate called the Excelsior Pass, which verifies a person’s negative coronavirus test result and if they are fully vaccinated.
Some airlines including Lufthansa, Virgin Atlantic and Jet Blue have started to use the digital health app, Common Pass, to verify passenger Covid-19 test results before they board flights.
Are they legal?
It depends on state regulations. The Biden administration has said there will be no federal vaccination system or mandate. Individual states hold primary public health powers in the United States and have the authority to require vaccines.
Where will the information come from?
All states except New Hampshire have their own immunization registries and some cities, like New York, have their own.
Currently states are required to share their registries with the Centers for Disease Control and Prevention, but the data is not public and could be withheld.
Why are people opposed?
“There are a whole lot of valid concerns about how privacy and technology would work with these systems, especially as Silicon Valley does not have a great history delivering technologies that are privacy enhancing,” said Brian Behlendorf, executive director of Linux Foundation Public Health, an open-source, technology-focused organization.
Some argue that such a credential would intrude on personal freedoms and private health choices.
Others worry that an exclusively digital system would leave some communities behind, especially those who do not have access to smartphones or the internet.
The World Health Organization says it does not yet support requiring vaccination passports for travel because of the uncertainty over whether inoculation prevents transmission of the virus, as well as equity concerns.
First it was AstraZeneca. Now Johnson & Johnson.
Last week, British regulators and the European Union’s medical agency said they had established a possible link between AstraZeneca’s Covid-19 vaccine and very rare, though sometimes fatal, blood clots.
The pause in the use of Johnson & Johnson’s vaccine in Europe over similar concerns threatens to hurt a sluggish rollout that was just starting to gain momentum, after months of short supplies and logistical problems.
Regulators have asked vaccine recipients and doctors to look out for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.
According to a YouGov poll published last month, 61 percent of the French, 55 percent of Germans and 52 percent of Spaniards consider the AstraZeneca vaccine “unsafe.”
Almost everywhere across the European Union, many are eager for alternatives. The Moderna and Pfizer vaccines, based on a different technology, have not been associated with similar side effects.
Although all E.U. countries have been offered a chunk of each vaccine approved in the bloc so far — AstraZeneca, Johnson & Johnson, Moderna and Pfizer — many opted to forgo parts of their share of more expensive or cumbersome vaccines like Pfizer and Moderna early on, instead favoring the AstraZeneca jab.
“In Britain or Eastern Europe, a big part of the campaigns are based on AstraZeneca,” said Yves Van Laethem, a top epidemiologist who is Belgium’s Covid task force spokesman.
Wealthier bloc members like Denmark, France, Germany and the Netherlands can better compensate for the loss of confidence in AstraZeneca, because they acquired extra doses of other vaccines — especially Pfizer — through a secondary market after poorer E.U. nations gave theirs up.
But those countries — including Bulgaria, Croatia, Latvia and Slovakia — are likely to be less able to quickly offer alternatives.
Raphael Minder contributed reporting.
An advisory committee for the Centers for Disease Control and Prevention will meet on Wednesday afternoon to discuss whether the Johnson & Johnson Covid-19 vaccine should remain paused while a possible link to rare blood clots is investigated.
The emergency meeting follows the Food and Drug Administration’s announcement on Tuesday that it was studying six cases of rare and severe blood clots in women aged 18 to 48, one of whom died. All of the women had received the Johnson & Johnson vaccine before developing the clots, though it is unclear whether the vaccine is responsible. As of Tuesday, more than seven million people in the United States have received the shot, and another 10 million doses have been shipped out to the states, according to C.D.C. data.
Following the call from federal health agencies, all 50 states, Washington, D.C., and Puerto Rico on Tuesday quickly paused or recommended that providers pause the administration of the vaccine. The U.S. military, federally run vaccination sites, and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix also paused the injections.
The Advisory Committee on Immunization Practices, or ACIP, is a panel of independent experts who advise the C.D.C. on its vaccine policies. At the meeting, the experts will be reviewing and debating the data from the six cases, and listening to comments from the public, before taking a vote on how to proceed. They could vote to recommend that the pause continues, for example, or to specify that it should apply only to a certain age or sex.
Federal officials said on Tuesday that the pause might last only a few days, though it depended on what officials learned in the investigation. The pause was called for in part because patients who have these rare blood clots should not be given the standard treatment that doctors prescribe for typical clots.
The clotting disorder of concern in the vaccine recipients is different — and much rarer — than typical blood clots, which develop in hundreds of thousands of people every year. The six women had not only clotting in the brain, but a notably low level of platelets, parts of the blood that help form normal clots.
The committee’s assessment will be crucial at a time when the nation is racing to vaccinate as many people as possible to curb the steady accumulation of cases, particularly as worrisome variants gain traction. Some public health experts were disappointed in the F.D.A.’s recommendation to suspend the Johnson & Johnson vaccine, arguing that preventing these extremely rare side effects was not worth the trade-off of slowing the vaccination campaign and potentially eroding the public’s trust of vaccines in general.