The mortal calculus in deciding whether or not to get a COVID-19 vaccine was never that hard: Take the shot and you are protected against the virus; don’t take it and you could get sick and die. But in the last few days, the equation has seemed more complicated, with new reports of six cases of blood clots among the 7 million people who have received the Janssen/Johnson& Johnson vaccine in the five weeks since the Department of Health and Human Services began allocating the one-dose shot.
Those reports prompted the U.S. government to pause the use of the J&J vaccine while the Centers for Disease Control and Prevention’s 13-member Advisory Committee on Immunization Practices (ACIP) looks into the half-dozen adverse incidents. As my colleague Alice Park reports, the committee’s task is not easy. Simply comparing the incidence of vaccine-related clotting to that which occurs in the general population is not the way to calculate the risk-reward balance in taking the J&J shot, since in the cases associated with the vaccine, the six people affected—all women, between 18 and 48 years old—also exhibited low platelet counts. That is typically not what happens in non-vaccine-related clotting.
Either way, the risk of clotting is for now low—less than one in a million—leading members of the ACIP to consider limiting the use of the vaccine to older people, who have not been affected so far, or perhaps simply resuming vaccination and allowing people to decide for themselves—with the help of their health care provider—whether the danger of clotting outweighs the danger of COVID. That is the position the Food and Drug Administration advocated at the initial meeting of the ACIP, but the members of the committee are not ready to rule.
“To be very frank I do not want to vote on this issue today,” said Dr. Beth Bell, professor of global health at the University of Washington and chair of the working group, during a discussion period yesterday. “I don’t feel I have enough information to make an evidence-based decision.” The ACIP has for now extended the J&J pause for at least another week
Also weighing on policy-makers’ minds is the impact continuing the vaccine pause will have on vulnerable populations. As my colleague Chris Wilson reports, the large majority of vaccinations in the U.S. so far have been with the Moderna or Pfizer-BioNTech shots, simply because they were approved first. For now, the J&J shot represents about 8% of all vaccines distributed since March 1 (when the J&J vaccine was introduced), meaning that pausing its use would not have as severe an impact as it might otherwise.
Still, some populations will likely be hit from the pause more than others. The homeless, as Chris points out, may face challenges showing up for the second shot that the Moderna and Pfizer-BioNTech vaccines require and benefit especially from a one-dose protocol like J&J’s. And young people, who, according to polling, are less likely to say they plan to be vaccinated than older adults, may be further dissuaded by any risk associated with any vaccine at all. For now, the mere fact that there are three vaccines available in the U.S. ameliorates the problem considerably, but nobody pretends that the issues with the J&J vaccine don’t represent a worrisome setback on the long road to herd immunity.
More than 255.4 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this morning, of which 198.3 million doses have been administered thus far, according to TIME's vaccine tracker. About 23.6% of Americans have been completely vaccinated.
The World Health Organization announced earlier today that it will issue rulings later this month or in early May on whether to approve China’s Sinovac and Sinopharm vaccines for emergency use, Reuters reports . WHO approval is necessary for the vaccines to be included among the shots distributed by COVAX, the WHO body that ensures vaccines get to poorer countries in the developing world. So far COVAX has three vaccines in its arsenal: Pfizer-BioNTech’s, as well as versions of AstraZeneca’s shot made by the Serum Institute of India and South Korea’s AstraZeneca-SKBio.
A new study out of the University of Oxford offers some comfort to people worried about the risk of blood clots from taking the J&J or AstraZeneca vaccines. The authors, (who, for what it’s worth, are not associated with the University of Oxford team that helped develop the AstraZeneca shot), found that the risk of blood clots among people who have contracted COVID-19 is about 39 in one million—higher than the 4.1 in a million among people who take an mRNA vaccine like Moderna or Pfizer-BioNTech; and five in a million for people who have taken the AstraZeneca vaccine. Overall, the study found that the risk of clotting from the disease is eight to 10 times higher than it is after vaccination.
Vaccine resistance continues to grow in the U.S., according to a new poll released by Monmouth University—and party politics are part of the problem. Roughly two thirds of Democrats have already received at least one vaccine dose, while only 47% of independents and 36% of Republicans have done so. Worse, 43% of Republicans say they have no intention of getting vaccinated—compared to 22% of independents and just 5% of Democrats—one more obstacle to America reaching the herd immunity needed to bring the pandemic to an end.
TODAY'S CORONAVIRUS OUTLOOK
The Global Situation
More than 138.2 million people around the world had been diagnosed with COVID-19 as of 1 a.m. E.T. today, and more than 2.9 million people have died. On April 14, there were 817,025 new cases and 13,533 new deaths confirmed globally.
Here's how the world as a whole is currently trending:
Here's where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
And here is every country with over 2 million confirmed cases:
Europe just surpassed one million COVID-19 deaths, while tallying some 1.6 million new cases per week, according to the Associated Press. In a press conference today in Greece, Dr. Hans Kluge, the WHO’s regional director for Europe, described the situation as “serious,” but did remark on “early signs that transmission may be slowing across several countries.” Europe now accounts for a third of the nearly three million COVID-19 deaths worldwide.
India reported a staggering 200,000 new cases of COVID-19 on Thursday, becoming only the second country, after the U.S., to record so high a daily number, according to The Washington Post. India now has more than 14 million total infections, leading the government to convert some entertainment venues and other tourist sites in New Delhi into vaccination centers. An 8:00 p.m curfew was also imposed in Mumbai and surrounding Maharashtra state.
Fewer than 10% of Hong Kong residents have stepped up to be vaccinated since the shots were rolled out there. In response, the government is expanding eligibility for vaccines, reports The New York Times. China’s Sinovac vaccine will now be offered to anyone 18 years old and older while the Pfizer-BioNTech shot is now available to people as young as 16. Part of the problem with vaccine uptake might be complacency: Hong Kong has seen only 209 COVID-19 deaths in a city of 7.5 million.
The Situation in the U.S.
The U.S. had recorded more than 31.4 million coronavirus cases as of 1 a.m. E.T. today. More than 564,000 people have died. On April 14, there were 75,375 new cases and 956 new deaths confirmed in the U.S.
Here's how the country as a whole is currently trending:
Here's where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
Good news on the U.S. economy, as the Department of Labor announced today that the number of Americans applying for unemployment last week fell to 576,000, a new low since the onset of the pandemic and a steep drop since the record 900,00 per week in January. The accelerated rollout of vaccines and the slow-but-steady reopening of portions of the economy are at least partly responsible, according to the Associated Press.
Dr. Joneigh Khaldun, the chief medical executive of the Michigan Department of Health and Human Services pronounced herself “incredibly concerned,” about the state’s soaring COVID-19 caseload, according to local news outlet Click on Detroit. Khaldun reported yesterday that the state’s case rate is 574 per million people, or a five-fold increase over what it was in mid-February. More than 18% of hospital beds are being used for COVID-19 patients, she also announced. Restaurants, retail settings and youth sports teams have all been associated with recent clusters of infections.
The U.S. is on track to have a surplus of up to 300 million vaccine doses as early as July, reports The Washington Post, citing a study by the Duke Global Health Innovation Center . The report comes as many parts of the developing world struggle to gain access to any vaccines at all. The U.S. has not made clear what it plans to do with such a vaccine glut, but at a virtual event on Thursday, Secretary of State Anthony Blinken urged wealthy countries to increase their donations to COVAX, estimating that an additional $2 billion in overall donations could help the group reach 30 percent, rather than 20 percent, of needy nations this year.
All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of April 15, 1 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.
WHAT ELSE YOU SHOULD KNOW
Optimism Despite Variants
While acknowledging that new variants of SARS-CoV-2 may evade vaccines and natural immunity gained by contacting COVID-19, experts around the world remain optimistic that the new strains can be kept in check by familiar steps such as mask-wearing and social distancing, reports The Wall Street Journal. Read more here.
A Stigma for Johnson & Johnson?
One recipient of the J&J vaccine argues in The Atlantic that the U.S. government is exhibiting a “fraidy-cat approach” in pausing the use of the shot, worrying that the stigma associated with it will never lift, at the very moment a one-dose vaccine can do a lot of good. Read more here.
Tokyo Olympics in Growing Jeopardy
One member of Japan’s governing party admitted publicly that the government might consider canceling the upcoming summer Olympics if rising caseloads could not be brought under control, reports The New York Times. A public uproar led him to walk back the remarks, but the games now seem more endangered than they have been in recent months. Read more here.
The Homeless Start Getting their Shots
With crowded conditions in shelters causing spikes in infections, the homeless are at last being included in priority lists for vaccines, reports The Associated Press. Complicating the effort: poor data on infections and vaccinations in so itinerant a population. Read more here.
Thanks for reading. We hope you find the Coronavirus Brief newsletter to be a helpful tool to navigate this very complex situation, and welcome feedback at coronavirus.brief@time.com. If you have specific questions you'd like us to answer, please send them to covidquestions@time.com.
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Today's newsletter was written by Jeffrey Kluger and edited by Elijah Wolfson.
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