Johnson & Johnson Break could hurt homeless people

Weeks ago, Van Yu, a doctor in New York, felt he had a breakthrough in his efforts to immunize homeless people against COVID-19. He said people on the street and in shelters would say to him, “I want the one-shot thing.”

Unlike Pfizer and Moderna’s two doses, the Johnson & Johnson vaccine is a one-time agreement. It is also much easier to store and transport. These traits have made it ideal to immunize people who are hesitant or difficult to detect a month after the first dose.

Then, last week, the use of J&J land came to a halt. Reports of half a dozen vaccinated people developing highly unusual blood clots, one of which was fatal, led to federal regulators recommending an interruption of the shot, and that all 50 states followed suit. A federal vaccine advisory panel discussed the matter in an emergency meeting, only to conclude that it needed more time to decide what to do.

For most Americans, the interruption of the J&J vaccine over the past week has had little to no effect on their ability to be vaccinated. Because the vaccine is the latest to be approved and has a shortage due to the manufacture of snafus, J&J accounted for less than 5% of US vaccine stocks at the time it was discontinued.

But for healthcare providers struggling to find people on the sidelines – even those who live on the streets, move through shelters or otherwise do not have a permanent address – J & J’s vaccine was a short-lived blessing. In its absence, they say, some of the most at-risk people in the U.S. do not get a different kind of shot. And even if the pope lifts, they also cannot be vaccinated. Some clinicians fear because they will worry that it is unsafe.

“The break is a big problem for us,” Yu, chief medical officer of the National Center for Urban Community Services, told BuzzFeed News. ‘I’m sitting on 185 doses. These are 185 people who are not vaccinated before there is a break-even point. ”

Vaccine administrators like Yu are engaged in a race against the coronavirus and its highly transmissible variants, which threaten to gain a foothold in the U.S. before the country achieves herd immunity through mass vaccination. All adults were eligible Monday, and federal officials say there will be enough supplies by the end of May for everyone to be immunized. But only half of the eligible population has been vaccinated so far, and cities and states have struggled to distribute doses fairly among low-income and colored people.

This Friday, the Advisory Committee on Immunization Practices – the group of independent vaccine experts who advise the Centers for Disease Control and Prevention – will meet again to discuss what to do with J&J. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said he expected it to resume with a warning or restrictions. Regulators in Europe, where the vaccine has also been suspended, said on Tuesday that it would be restarted, albeit with a warning label.

Much depends on the forthcoming decision of ACIP, and not just in the US. In addition to one shot, J & J’s vaccine does not have to be in the fridge at the ultra-cold temperatures required by Pfizer’s vaccine. The vaccines of J&J and AstraZeneca are supposed to play an important role in COVAX, a global collaboration to distribute vaccines fairly across countries, especially lower incomes. But both vaccines are currently being investigated under safety investigations in connection with blood clotting issues.

Because the Pfizer and Moderna vaccines until the second dose do not provide full protection, William Schaffner, a professor of infectious diseases at Vanderbilt University, called J&J an “outcome in more ways than one.” “Any kind of minority group, hard-to-reach group … if you can get it once and get the job done, it obviously reduces half the work you have to do,” he said.

These include rural residents, patients with emergencies and coloreds, especially black people, who at the beginning of the onset expressed the greatest reluctance among racial groups to be vaccinated. Malcolm John, a doctor of infectious diseases at the University of California, San Francisco and head of the Black Health Initiative, said J&J was extremely popular among the local black community. While it was interrupted, he said, people still seem to be enthusiastic enough about it not having written it off completely.

“There’s this historical reservation around vaccines, so I think it’s necessary more than once to do that, and to overcome the anxiety more than once, it’s a challenge for some people,” he said. There are also practical concerns: ‘If you are talking about populations with the greatest risk, it is the one that is likely to have the leading positions, and it is less likely to take time off.’

Perhaps the most difficult-to-reach demographics are people experiencing homelessness. There are more than 567,000 such individuals nationwide, according to an estimate taken on a night in early 2020, though that is likely to be an understatement. Aside from being short-lived – often lacking reliable internet and internet access, and spending large amounts of every day seeking food and shelter – they tend to distrust the medical system and underuse health services, despite the fact that they have more mental illnesses, chronic substance abuse, HIV / AIDS, and other conditions.

Data from major cities suggest that efforts to vaccinate this group are a way to go. In Chicago, at least 1,940 sheltered and unprotected people according to the city received at least one dose as of April 5, which would be about 45% of the 4,300 such people living in the city by 2020. About 16,000 doses have already been given to homeless people in Los Angeles County, where there are an estimated 66,000 residents.

And in New York City, so far only about 5,000 out of about 20,000 adults living in shelters have been fully vaccinated, according to data collected by the city and the Coalition for the Homeless, an advocacy and services group. This does not include unprotected people sleeping on the street or in the metro, who according to the group are thousands, or the nearly 12,000 homeless families who are advised to use public vaccination sites.

“It’s hard to think of a population facing more obstacles,” said Margot Kushel, director of the Center for Vulnerable Populations at UCSF.

In Chicago, Stephan Koruba, a senior nurse at the Night Ministry, a local organization, worked hard to gain the trust of homeless people regarding vaccinations. ‘I’ve heard many people talk about the Tuskegee experiments’ – in which federal scientists studied black syphilis patients in the mid-20th century without treating them – and explained that it carries and resonates with their attitude towards modern times. , “he said.

When the J & J vaccine’s overall effectiveness rate of 66% was reported, it gave the perception in some quarters that it was inferior to Pfizer’s and Moderna’s vaccinations, of which the rates were 95% and 94% respectively – although J&J was effective in preventing hospitalizations and deaths and 85% effective against serious diseases.

But according to Koruba’s experience in the Windy City, people were much more receptive to J&J than Moderna. “Even if people use drugs and even IV drugs here, it’s much easier to talk to each other and it’s open to the one – vaccine from Johnson & Johnson,” he said.

Kushel saw this kind of enthusiasm firsthand in San Francisco. Before the break, she and her team miscalculated the J&J doses at the end of the day. They had to bring the bad news to two dozen people in line, but offered to transport them elsewhere to receive a dose of Pfizer or Moderna. To her surprise, everyone turned down and said they would wait for the staff to find more J&J shots.

“People were like, ‘I’m here, it’s now, and I want to get it right. I want to know that I will then get some protection, ” Kushel said.

The break has delayed a vaccination campaign that experts fear could move too slowly.

Koruba spoke on Tuesday, a week in space, about whether there could be a bit of an overabundance of caution at this point. ‘

‘Everyone appreciates the fact that they’re watching things so closely,’ he said, ‘but my personal feeling is that if you look at a chance of less than 1 in every million that something could happen, you’re likely to die if due to a severe case of COVID is still higher than that. It just does not seem to justify the break. ”

Others hope that this break will be seen as a blip – even an endorsement of the national vaccination system’s ability to detect rare side effects. The six blood clots that caused the break-up all occurred in women under 50, from a pool of 6.8 million vaccine recipients. Two additional cases were reported last week – a man taking part in a clinical trial and a seventh woman – and federal health officials said this week they were aware of a “handful” of new, unconfirmed reports.

The cases confirmed so far are of concern because it is an unusual combination of brain clots and low platelet levels, which help to form blood clots. The interruption has enabled regulators to investigate whether and how the vaccine causes blood clots, and to warn doctors not to prescribe heparin, a blood thinner commonly used to treat similar symptoms, but which can cause this condition. aggravate.

“I appreciate the world for public health because they look after people. I think it can only help with confidence in the vaccine if we treat any adverse side effects like this responsibly, ‘said Shelly Nortz, deputy executive director for policy at the Coalition for the Homeless in New York City.

At the same time, she admitted that ‘it’s not great that there’s a break. It is difficult to find unprotected people, especially for a second dose. She estimates that the break has delayed access to vaccinations for dozens of people.

From now on, clinicians are not sure what to tell their patients about the J&J vaccine if and when it is resumed. What ACIP and regulators say will shape their messages largely.

Yu, from the Center for Urban Community Services, is also figuring out what he personally would feel OK to say about it. “I do not like to encourage people to do something I would not do myself,” he said. Based on the cases currently being reported, he would ‘feel completely comfortable’ recommending that a man get the vaccine as a man himself. But ‘if I’m a 30-year-old woman,’ he said, ‘I do not know what I would feel comfortable saying about it.’

Even if J&J stays out of the game for a while, Koruba, the nurse in Chicago, and his colleagues will continue to try to find people where they can, from park benches to train stations.

“It is clear that we will do everything in our power to make everyone as vaccinated as possible,” he said. “We’re going on. We have to. ‘