Vaccination Path Forward Temporarily Unclear for Thousands of King County Residents

by Carolyn Bick

Because of Washington State's decision to follow Centers for Disease Control and Prevention recommendations to indefinitely pause the use of the Johnson & Johnson vaccine against the novel coronavirus, following incidents of serious blood clots in a handful people in the United States who have gotten the Johnson & Johnson vaccine, thousands of King County residents now do not know when they will be able to get vaccinated.

The Centers for Disease Control and Prevention (CDC) recommended on March 13 that use of the vaccine be paused, after six women who were given the Johnson & Johnson vaccine developed a serious condition called cerebral vein sinus thrombosis (CVST), blood clots that develop in the brain. These six cases represent 0.000086% of the 6.8 million Johnson & Johnson vaccines administered nationwide up to April 12. The kind of CVST that these six women developed — specifically, one associated with a low platelet count — occurs in about five in every one million people each year.

Though it was expected that the CDC's Advisory Committee on Immunization Practices (ACIP) would vote on whether to recommend the Johnson & Johnson vaccine's use at an emergency meeting about the vaccine on April 14, it did not do so, citing a lack of information. This means that the future of the vaccine's use is currently unknown.

For several thousand King County residents, this may mean that their vaccination future — or, at least, their vaccination date — is also unknown.

Public Health — Seattle & King County (PHSKC) was poised to administer 2,000 doses of the Johnson & Johnson vaccine this week both through its mobile teams and at its Auburn mass vaccination site, said PHSKC Public Information Officer Gabe Spitzer in an April 14 email to the Emerald. Though PHSKC managed to reschedule 400 of those doses, switching them to the two-dose Moderna vaccine, it is unclear what will happen to the other 1,600 people who had planned to get the Johnson & Johnson vaccine this week. There are also 440 doses of the Johnson & Johnson vaccine slated for next week, Spitzer said, and noted that PHSKC will take things week by week with regard to planning for Johnson & Johnson vaccine administration.

In a follow-up email to the Emerald on the evening of April 15, several hours after this original story was published, Spitzer said that all 2,000 people were able to be rescheduled for the Moderna vaccine. However, Spitzer noted, these 2,000 doses were only the ones PHSKC received from the State. There are 100 other providers in King County who get vaccine doses from the federal government. These doses include the Johnson & Johnson vaccine. However, because PHSKC only retroactively receives data about that, Spitzer said, he did not know whether those providers had been able to reschedule those Johnson & Johnson doses as either Pfizer or Moderna vaccines.

Though the number of Johnson & Johnson doses represented only 5% of the vaccinations County health officials expected — and a similarly small percentage statewide — the continued pause came just one day before everyone in the state age 16 and older became eligible to get vaccinated, which could mean that Washington State falls further down the rungs in state vaccination rankings. As of this writing, the state stands at number 19, having distributed a little more than 80% of its allocated vaccines.

PHSKC Health Officer Dr. Jeff Duchin told journalists in a virtual April 14 meeting meant for outlets led by and serving People of Color that though significantly more people will become eligible for vaccination on April 15, PHSKC will not cease to focus its vaccination efforts on Black, Indigenous, and People of Color (BIPOC) communities. As noted in this story, PHSKC has been working with community partners to hold vaccination events at sites where communities of color — particularly elders in those communities — may feel safer or more at ease, such as at churches or senior centers.

However, Duchin also acknowledged that the lack of these one-dose vaccines for the foreseeable future could have serious impacts on those who wanted to get them.

"These vaccines have been particularly attractive in populations who only want one dose or who can't return for a second dose — that's one of the things that is great about this vaccine," Duchin said. "I do want to reemphasize that this is a really effective and useful vaccine that we are looking forward to using again. … I anticipate that we will be using this vaccine again."

Those who may face challenges in getting two separate doses of the vaccine, with a span of several weeks between doses, include those in the unhoused community or those who work multiple jobs and cannot easily get time off work to both get the vaccine and then recuperate from any associated, temporary side effects.

Editor's Note: The Emerald originally reported that PHSKC was poised to administer 9,000 doses of the Johnson & Johnson vaccine this week. However, this was incorrect. PHSKC accidentally conflated the doses of Johnson & Johnson it had available (9,000) and the number of doses it was going to give out (2,000) in its correspondence with the Emerald. On April 15, PHSKC notified the Emerald of its mistake, and the Emerald immediately made a correction to this story.

Featured image by Alex Garland.