Vaccine mystery: Why J&J’s shots aren’t reaching more arms

Johnson & Johnson’s single-shot Covid vaccine was supposed to be the catalyst for the country’s return to normal. Instead, it’s sparking confusion and finger-pointing between the states and the Biden administration over why millions of doses are sitting unused.

Almost three weeks after the Food and Drug Administration authorized the shots, no one appears to be able to explain why immunizations are lagging. Some states are thought to be intentionally holding back shots, while others say it takes time to inoculate populations like the homebound.

Over the course of the past two weeks, senior Biden administration officials have met privately to try and determine what happened. Two senior administration officials believe states are conserving their J&J supplies until there’s enough to reach underserved communities and specific groups, like teachers or the disabled. But multiple state officials say they’re using whatever they get as soon as they get it.

What is clear is that around 2.3 million of the 4.3 million doses of the vaccine delivered have actually been administered. Between 140,000 and 200,000 doses have made it into people’s arms in recent days, according to the Centers for Disease Control and Prevention.

The bumpy J&J rollout highlights the challenges the White House still faces ensuring a timely and steady administration of Covid-19 vaccines with President Joe Biden eyeing July 4 as "Independence Day" from the virus. Because it takes just two weeks to achieve immunity with the J&J shot — compared with five or six weeks for two-dose shots from Pfizer and Moderna, respectively — the absence of enough "one and done" vaccinations has a ripple effect, slowing the overall pace of the rollout.

Biden administration officials had repeatedly warned the initial J&J deployment would be rocky, since there was only a limited supply of shots available in the opening weeks. Problems could also be compounded by reporting lags. But they expect the distribution to smooth out when more of the vaccine becomes available at the end of this month.

“You can’t distribute the vaccine equitably if there aren’t enough doses to distribute,” one senior health official said.

The White House did not immediately respond to a request for comment.

Because states have final say in how their allotments are distributed, some are using the J&J vaccine on populations harder to reach for a second-shot appointment. Others are putting speed over equity and sending out the shots broadly.

“It may be a little bit slower rollout because everybody is trying to decide how to best use this particular vaccine,” said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.

West Virginia is initially using the J&J shot to inoculate its homeless and homebound population, as well as those with intellectual and developmental disabilities living in congregate settings. By next week, health officials anticipate they will use up the entire first shipment of 15,500 J&J shots, and those vaccine appointments are already lined up, according to Clay Marsh, West Virginia’s Covid-19 czar.

“I think that people are getting a feel for how to do this the best,” Marsh said. “We’re just trying to build that framework, the logistics, the processes so that we can most effectively and efficiently take advantage of this new opportunity.”

Pennsylvania is using its 107,600 doses of J&J to vaccinate teachers and other school staff in an effort to get kids back into classrooms. As of Friday, nearly 83,900 shots have been administered, according to a health department spokesperson.

Maryland deployed its shots to a variety of settings, such as health departments, hospitals and two mass vaccination sites.

“We want to make sure that we're always being flexible, and giving people the most amount of options, so we wanted to get in as many settings as we could,” said Bryan Mroz, the state’s assistant health secretary.

Earlier this month, scientists and public health experts cautioned against recommending J&J’s shot for specific groups, worried about perceptions the shot is "different" from others. White House coronavirus coordinator Jeff Zients even warned states that the White House could intervene with “technical assistance” if it learned states were doing so. The J&J shot was shown in trials to be less overall effective than Pfizer or Moderna, but provides strong protection against hospitalization and death.

“I think the federal government's tried to provide some leadership on that — that's helpful,” Plescia said. “But as we've seen states are attentive to and respectful of federal guidance, but they then do what works for them.”

Meanwhile, governors are sensitive to how vaccination data is displayed. In private weekly calls with the White House, they’ve pressed Biden administration officials to break out how many doses the federal government is responsible for administering, worried CDC’s public tracker holds states accountable for doses that aren’t under their control.

The CDC will be providing additional reports that show vaccination data in states by both federal and state channels, according to a senior administration official.

The official emphasized that the agency has focused on the number of Americans who have been vaccinated as a whole, "which is relevant for disease control," rather than the channel by which the shot was administered. States have access to that information through a system called Tiberius.

It’s unclear how many doses of the J&J vaccine have been administered by federal vaccine sites, retail pharmacies and federally qualified health centers, which states don't control. As of March 10, about 50,000 J&J doses were shipped to California, Texas and Florida for administration at federal sites run by the Federal Emergency Management Agency, according to a spokesperson. An additional 23,000 were in transit at that time, the official said. FEMA did not answer additional requests for comment about how many more doses of the vaccine were delivered in the past two weeks and how many have been administered overall.

Weekly allocations for the J&J vaccine have changed in recent days as well, according to accounts of several internal senior leadership briefings obtained by POLITICO. At the beginning of the month, the administration allocated 3.9 million doses to states, a federal program that funnels doses to retail pharmacies, safety net health providers and to pilot vaccination sites run by FEMA. Since that time, the doses have rolled out sporadically.

The administration originally told states that they may not receive more doses of the vaccine until the end of March. Then, according to one briefing dated March 11, the administration said it planned on allocating another 400,000 doses across the country the following week. Another briefing dated March 15 said the administration had actually bumped up that allocation total to 600,000. It is still unclear exactly how many J&J doses have gone through quality control and are awaiting shipment.

Despite the increasing allocation numbers over the past two weeks, the vaccination rate remained low.