Dr. Megan Ranney is a practicing emergency physician, researcher, and advocate for innovative approaches to health. She is also the Associate Dean of Strategy and Innovation for the Brown University School of Public Health. She spoke to Michael Graham of Delaware Valley Journal about the Biden administration’s decision to call a halt to the use of the Johnson & Johnson vaccine, the level of risk from the shots, and how America’s public health leaders have handled their mission.
What was your reaction when you heard the federal government was recommending a halt to distributing the J & J vaccine based on the fact that six cases of blood clots had resulted from 7 million doses of the vaccine?
I’ll be honest: My first reaction was a deep sigh. ‘Oh my God, we are already struggling with confidence in vaccines in this country. Do we really need to pause on J & J?’ But then my second reaction, as I started to read about it, is I really think this was the right thing to do. Because based on the data we have, it looks like there really is an association between the vaccine and these blood clots, and it’s the job of the FDA and CDC to be careful.
But we’ve also got to be really careful about the messaging, about the fact that the risk really is one in a million. It’s far smaller than the risk of blood clots from birth control pills, blood clots from COVID, or the risk of catching COVID itself.
So, while my first reaction was a sinking feeling in my stomach about what this is going to do to vaccine confidence, I think it also demonstrates the CDC and FDA are not covering anything up. They’re going to follow the data.
When it comes to the COVID-19 pandemic and all the statistics and data, is the biggest challenge facing public health policy the fact that Americans really don’t understand math?
Well, no one is as good at math as they think they are — including physicians. But I think that the real problem is that we constantly misjudge risk. We all overestimate the risks of certain things and underestimate the risk of others. And this is just part of human nature. I think that’s one of the really big issues with COVID.
And our interpretation of the data is always biased by who we hang out with and our cultural environment. Two people may look at the same data and even when the numbers are clear, remember that old trope: ‘There are lies, damn lies, and statistics.’ I think folks can look at the data and interpret it in two different ways, depending on how they want to interpret it — especially on a subject where the data keeps changing, which is so true for COVID. The job of good science is to get high-quality data, and then make the conclusion and the story that the data tells very clear, to reduce the chance of unintentionally creating those “damn lies.”
If a person of typical health, somewhere between 25 and 45 years old, had the choice to wait a month until some other vaccine comes available or to get the J&J vaccine today, what would your advice be?
For a woman of childbearing age — which is the women we’ve seen with the highest risk of this unusual form of clots — I would say that in the short term, they need to make an individual decision based on whether they have a family history of blood clots or anything else that would make you think you’re at higher risk. Do you smoke? Are you overweight? Do you have a family history of clotting disorders? If any of those are true, I might suggest you be very careful with your masking and in your social distancing and consider waiting until we have a little more information,
But for someone like me, who doesn’t smoke, is not overweight and has no family history of clotting disorders or autoimmune problems — if my choice was the J&J vaccine today or nothing for another month, I would probably choose theJ&J vaccine today, because I work in the ER and I’m exposed to COVID patients on every single shift. And so the risk to me of catching COVID is pretty darn high. That’s a much higher risk than the risk of the J&J vaccine.
For other folks who are at high risk of catching COVID, or of having bad outcomes with COVID, I would also advise getting the J&J vaccine rather than getting nothing. The risk of these bad outcomes for the average person – based on the data we have today – is almost vanishingly small. This side effect is unusual, and can be dangerous, but seems to be very very rare for most of us.
Finally, I’d remind people that this data is ONLY about the J&J vaccine. The Moderna and Pfizer vaccines are manufactured with very different technologies.
Do you agree that the public health messaging hasn’t been handled well and that pulling the J&J vaccine is going to send yet another message that will promote vaccine hesitancy?
There’ve been a lot of folks who’ve made mistakes over the last year. And yes, some people in the scientific establishment, the public health messengers, have made mistakes. But so have some politicians, and the media; pretty much everybody’s made mistakes because we’ve all been operating with limited knowledge and with the need to make decisions really quickly.
I think what influenced the decision to make this announcement is that something very similar was reported with the AstraZeneca vaccine in Europe. And it’s the same kind of unusual, rare side effect, and in many ways the J&J vaccine is similar to AstraZeneca’s. And I think that’s probably what shifted them.
And God forbid that anyone cover this up and wait for a few days before making an announcement. Can you imagine the negative media?!
So they’ve made the announcement and temporarily halted the shots, which might have undermined confidence in the vaccine. On the other hand, they could have waited and let people get the shot without knowing about the risk as we see it today, and then be accused of trying to hide things from the public or from doctors. So which option is worse? For the public health community, something like this makes them ‘damned if you do and damned if you don’t.’
I’m not part of the FDA or the CDC, but I can understand why they made this call. Their job is to err on the side of caution. I believe they take their obligations to protect the safety of Americans seriously. I’m hopeful that we’ll have more guidance, and more trustworthy data, soon.