Today was the day that hundreds of college students at Texas Tech University and up to 1,500 others in Lubbock, one of last year’s coronavirus hot spots, were going to be fully vaccinated against COVID-19.
Today was also the day that some members of the Petersburg Mission Baptist Church, a Black church in the rural Texas community of Athens, were going to be fully vaccinated.
And in Corpus Christi, a city-sponsored effort was about to get underway in the coming days to vaccinate the city’s homeless population.
All of that was upended when providers across Texas paused usage of the one-dose Johnson & Johnson vaccine this week after federal and state health officials urged the action because a small number of recipients developed blood clots.
“It messes up our plans,” said Katherine Wells, director of public health for Lubbock, which is now sitting on about 7,000 unusable — at least for now — doses of the vaccine that were supposed to be administered to residents at the county’s vaccination hub before it shuts down in two weeks.
The pause on the Johnson & Johnson vaccine came after a “rare and severe type of blood clot” was reported in six women across the nation after they received the shot, out of 6.8 million doses administered, according to the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration.
The CDC’s Advisory Committee on Immunization Practices on Wednesday delayed making any recommendations to the CDC on whether to continue the pause, promising instead to meet again by the end of next week and give the CDC time to gather better data. They also noted that more than half of the Johnson & Johnson doses in the U.S. have been administered within the last two weeks, within the time frame in which the clots appeared in the six recipients, and more data could come as health officials monitor those outcomes.
But members and other attendees from the medical community agreed that a quick resolution is vital to the continued vaccination of underserved communities who benefit from the convenience of the one-dose regimen.
"The extension of the pause will invariably result in the fact that the most vulnerable individuals in the United States, who were prime candidates for the Johnson & Johnson vaccine, will remain vulnerable, the most at risk will remain at risk, and those who would benefit immediately from vaccination will remain unvaccinated for an unknown period of time," said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention and a nonvoting member of the panel.
The Johnson & Johnson vaccine, lauded by many as being particularly well-suited for some of most hard-to-reach and highest-risk people, was key to Texas’ effort to fully and quickly vaccinate most of its population of 29 million people.
In Texas, half a million people already have gotten the Johnson & Johnson vaccine. More than 9 million people in the state have been given at least one dose of vaccine, including the two-dose vaccines manufactured by Moderna and Pfizer. Nearly 6 million have been fully vaccinated.
Going by sheer numbers of doses allocated, the biggest impact in Texas was likely on larger retail pharmacies such as H-E-B and other chains, which were anticipating that about two-thirds of the supply being delivered this week would be Johnson & Johnson, officials have said.
But because states were already experiencing a large, but temporary, dip in the number of Johnson & Johnson allocations, many of the state’s limited doses landing in Texas this week went to smaller providers and regional hubs that could most benefit from the easier-to-manage vaccine. Nearly 60% of this week’s 143,000 Johnson & Johnson doses were slated to go to the hubs in Houston, Dallas and Arlington, with the rest going to local providers and smaller hubs.
Now, with 59,000 Johnson & Johnson doses arriving and unable to be used until further direction from the CDC, the impact is being felt in some of the state’s hardest-hit communities.
“We were planning to give probably close to 1,000 J&J shots here today” and another 1,500 Moderna first and second doses, said Wells, the Lubbock health director. “So instead of about 2,500 appointments, we have about 900. It ends up being a big, empty room with a lot of volunteers sitting around. And a lot of very expensive firemen.”
Unlike vaccines produced by Pfizer and Moderna, both of which require two doses to be fully effective against the virus, the Johnson & Johnson’s “one-and-done” regimen, combined with its ability to be stored for months at regular refrigeration temperatures, made it ideal for homeless people, residents of rural areas and mobile vaccination efforts.
It is also well-suited for young people whose busy social lifestyles not only contribute to community spread but also sometimes prevent them from returning reliably for a second dose, providers say.
And it’s an attractive vaccine for those who are worried about what they consider to be the newer technology in Pfizer and Moderna — although in reality, the mRNA technology behind those two vaccines has been studied for more than 30 years — said Dr. Carolyn Salter, who co-owns Sycamore Medical Clinic in rural Palestine, about 100 miles southeast of Dallas in Anderson County.
Salter’s clinic is set to receive its second shipment of 100 doses of the Johnson & Johnson vaccine this week, and “we had plans for all of them,” she said. Since March, local providers in Anderson County have been allocated 3,000 Johnson & Johnson doses.
Salter had partnered with the church in neighboring Athens, about half an hour away, to do an on-site vaccination event during Bible study Wednesday evening, she said. That’s now been postponed.
It’s disappointing, Salter said, because communities of color were especially hard hit by the virus, and rural counties have a lot of residents who are low-income and can’t easily travel to out-of-town clinics for even one dose, much less two.
Anderson County, home to five prisons, was considered a national hot spot for the virus at one point during the summer peak, so residents there are anxious to move past the pandemic, Salter said. The county of nearly 60,000 — about one-third of whom are incarcerated, Salter said — reported more than 2,000 confirmed cases, or 37 cases per 1,000 people, during June and July last year. The county has seen 116 deaths from the virus as of Tuesday.
“It was pretty bad here,” she said. “We have a lot of multigenerational households, a lot of crowded households, which made COVID spread through our community worse than in some others, I think.”
In Corpus Christi, another one-time hot spot, where there are an estimated 850 people experiencing homelessness, a city effort to vaccinate that population — who are often difficult to follow up with for second doses because they don’t have permanent addresses — will have to switch to the two-dose regimens until the problem is rectified, Mayor Paulette M. Guajardo said in an emailed statement. Last summer, Nueces County, which is home to the city, saw a surge in cases in part due to tourist activity. Cases ballooned quickly, doubling from 3,000 to 6,000 total cases over 10 days in early July.
Bruce Wilson, a retired Episcopal priest who now spends his time working in a homeless camp in Corpus Christi, said Johnson & Johnson is the best option because getting people to return for a second vaccine dose is so challenging. So far, Nueces County has been allocated 8,400 Johnson & Johnson doses.
“You never know for sure who’s going to be in the camp that day or not,” said Wilson, executive director of Coastal Bend Neighborhood Empowerment. “Some are out looking for a house or a job or on some other errand, so they might not be there.”
In Lubbock, officials have administered about 106,000 shots, about 2,600 of which were Johnson & Johnson, since December, Wells said. The county has been allocated 16,700 Johnson & Johnson doses since early March, including about 10,000 in the past two weeks for use by the city’s hub.
The effort has been particularly urgent in Lubbock, where last fall more than 40% of hospitalizations in the trauma service area servicing Lubbock were COVID-19 patients, putting a strain on the area’s hospitals.
About 1,500 doses per day were going through the city hub at the Lubbock Memorial Civic Center, and more were being administered through the local United pharmacy chain — which had planned to fully inoculate students at Texas Tech on Wednesday but had to switch from Johnson & Johnson to Modernal, which complicates the effort, Wells said.
Through March, the vaccine being used in Lubbock was mainly Moderna, Wells said, but the hub switched to Johnson & Johnson at the beginning of April in anticipation of shutting down on May 1 because the center was needed for other city uses, she said.
The city has long planned to transition its vaccination efforts to smaller locations like mobile clinics and pop-up events, with the idea of halting two-dose vaccine use and just using Johnson & Johnson for the final weeks, she said.
Now things are more complicated without the Johnson & Johnson doses. The city must switch back to Moderna, and with only two weeks left at the hub, Wells will have to line up alternate locations to administer the second dose four weeks later, she said.
She also said many people who showed up for the Johnson & Johnson shot this week were offered the Moderna shot instead, but declined and said they’d wait.
“I just feel like we’re missing opportunities,” Wells said.
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