Vaccine halt highlights pitfalls of effective public health policy

This week, the Food and Drug Administration called for a halt in the administration of the single dose vaccine for COVID-19 manufactured by Johnson and Johnson. The halt was ascribed to the rare incidence of blood clots that could potentially be related to the vaccine. The decision comes in part as a result of the way public health experts look at public policy problems.

There have been six cases of blood clots in 6.8 million administrations of the vaccine. Perhaps there have been a few more that have gone undetected. To be sure, anyone who suffers negative health consequences from a vaccine is a cause for concern and deserves a full examination of the potential negative impacts of the vaccination. If the only impacts of a vaccination campaign were these negative impacts, the idea of “do no harm” would clearly indicate a halt in vaccinations.

But as we all know, vaccinations also have benefits. In the case of the COVID-19 vaccinations, the obvious benefit is the reduced incidence of the dangerous illness that has paralyzed the world for the past year. Halting the administration of the vaccine means that it will take longer for people to become protected against the illness. This is true even if — as the Biden administration maintains — there are enough vaccines from Pfizer and Moderna to vaccinate everyone in the United States. 

People who were scheduled to get the J+J vaccine will have their appointments canceled and will have to reschedule and navigate the still-complicated logistics of doing so. Anyone who has tried to schedule a vaccine appointment knows how difficult it is even with the expansion of vaccine availability. Those who have their appointments canceled and have less savvy in navigating online appointment portals or need rides to vaccine sites will bear much of the burden of the pause in vaccination.

The benefit-cost calculus of halting the vaccination campaign is more complicated than just how many blood clots will be avoided vs. how many vaccinations appointments are delayed or canceled. Hesitancy about being vaccinated is a very real problem in the United States. People who were on the fence about getting a vaccine may now find themselves on the side of avoiding it. 

The results of the halt is thus not only the delay but also almost certainly fewer people eventually vaccinated. This hampers the possibility of herd immunity, a prospect that was already very worrisome. 

Doctors are still trained in following the Hippocratic Oath which encompasses the principle of doing no harm. The field of public health has historically been influenced by the field of medicine. As such, experts in public health bring to the field a mentality where actions that they take with negative consequences are weighted more heavily than those with positive consequences.

The previous administration largely sidelined experts in a wide array of fields related to public policy making, including most notably those in public health. The consequences included (among many other things) a much more dangerous pandemic than would have happened had experts been more involved in the early response to COVID-19. But the FDA decision this week highlights the dangers of privileging certain experts from a particular field in a decision with society-wide consequences. 

By all means public health experts should weigh in on decisions regarding the halting of vaccines.

But statements that argue that there are enough vaccines without the J+J model, and that this halt will increase confidence in vaccinations leads to concerns that these experts are ignoring the warnings of those who understand how public opinion works and those who are on the ground administering and scheduling vaccines. If these perspectives are being ignored, the chance of this decision being a very harmful one is significant.

Stuart Shapiro is professor and director of the Public Policy Program at the Bloustein School of Planning and Public Policy at Rutgers University, and a member of the Scholars Strategy Network. Follow him on Twitter @shapiro_stuart.