Why did the Johnson & Johnson vaccine fail to reach as many people as Pfizer and Moderna?

Johnson & Johnson covid vaccines
Photo via New York National Guard/Flickr (CC BY-ND 2.0)
  • This story is regularly updated for relevance. Last updated: July 19, 2021

When the Johnson & Johnson COVID-19 vaccine was first authorized for emergency use by the Food and Drug Administration on Feb. 27, most experts believed it would be a game-changer. Not only did the Johnson & Johnson vaccine require only one dose—unlike Pfizer and Moderna’s two-dose vaccines—it was versatile, easy to transport, and could be stored at refrigerated temperatures. Despite these factors in its favor, why did the Johnson & Johnson vaccine fail to reach as many people as the vaccines from Pfizer and Moderna?

Nearly four months after the so-called “one and done” vaccine became available, only 11.8 million doses have been administered in the United States. This totals less than 4% of all administered doses. With overall demand for vaccines generally decreasing, states are warning they may not find recipients for millions of doses set to expire.

This has prompted questions about why the Johnson & Johnson vaccine failed to corner a market it was almost guaranteed to dominate. Several factors, including initial complications and bad press, played into the Johnson & Johnson vaccine’s failure to launch.

Adverse reactions and blood clots sparked public distrust

Johnson & Johnson’s publicity woes began on April 13 when both the FDA and Centers for Disease Control and Prevention called for a halt on the vaccine following reports of blood clots.

A handful Johnson & Johnson vaccine recipients in the United States developed a rare and severe disorder called cerebral venous sinus thrombosis within about two weeks of vaccination. All of the affected patients were women between the ages of 18-48. One fatality was listed at the time of the report, along with another patient who was hospitalized in critical condition.

Symptoms for the disorder were determined to be “extremely rare.” Those who developed “severe headache, abdominal pain, leg pain, or shortness of breath” within three weeks of receiving the Johnson & Johnson vaccine were advised to contact their healthcare provider immediately.

The CDC and FDA lifted the suspension of the vaccine on April 23, but the stigma surrounding blood clots and the Johnson & Johnson vaccine never quite dissipated. As noted by experts, the risk of contracting COVID-19 is far more significant than a rare blood clot disorder.

The same reasoning stands for the about 100 patients (out of about 12.5 million vaccinated) who contracted Guillain–Barré syndrome after receiving the Johnson & Johnson vaccine. The risk of the coronavirus is much higher than possibly contracting GBS through the vaccine.

Manufacturing problems led to wasted vaccines 

Exacerbating Johnson & Johnson’s issues, manufacturing problems at a factory in Baltimore run by Emergent BioSolutions led to tens of millions of wasted vaccines. Even more troubling, testimony from the House Oversight select subcommittee released on May 19 detailed that the pharmaceutical giant had been aware of vaccine contamination issues with its manufacturing partner.

According to the Washington Post, “Johnson & Johnson documented serious contamination risks at a troubled Baltimore biodefense plant in June 2020—seven months before a contamination incident ruined 15 million doses of coronavirus vaccine and derailed Johnson & Johnson’s domestic vaccine production.”

The production mishap resulted in a two-month shutdown in operations just as the Pfizer and Moderna vaccines were ramping up production. This allowed Johnson & Johnson’s competitors to provide the vast majority of vaccines distributed in the states.

The vaccine took another hit in June when the FDA stepped in and forced Johnson & Johnson to discard an additional 60 million doses produced at the Emergent plant in Baltimore due to possible contamination. Between the two production issues, a total of 75 million doses were destoryed, and more than 100 million additional doses of the Johnson & Johnson and AstraZeneca vaccines produced by Emergent were left hanging in the balance.

Since Johnson & Johnson was cleared to resume production on April 23 over the blood clot issue, only about 3.5 million doses have been used.

Kim Deti, a spokeswoman for the Wyoming Health Department, told the New York Times that “the graph of uptake in her state told the vaccine’s story: a significant climb in the early weeks of its rollout, followed by a plateau that began around the pause.”

Social effect and efficacy helped cause the Johnson & Johnson vaccine to fail

With so few doses administered in total, Andrew C. Anderson, a professor of public health at Tulane University who researches vaccine hesitancy, said the Johnson & Johnson shot also suffered from a “social network effect.”

As people began sharing their vaccination status, it became a common refrain to ask whether family and friends had received the Pfizer or Moderna shot. As such, many Americans were less likely to seek out the different, lesser-known brand of vaccine.

The higher efficacy rate of two-dose vaccines also played a role. Pfizer and Moderna boast around 95% efficacy, whereas Johnson & Johnson provides just 72%. Many people continue to view the higher percentage as being safer and more effective. And as the delta variant becomes the dominant strain in the U.S., some who received the Johnson & Johnson vaccine are wondering whether they need to get a Pfizer booster just in case.

Between lack of public interest and fewer total number of doses produced, the U.S. missed a critical opportunity to reach vulnerable and harder to access Americans with Johnson & Johnson’s convenient one-shot dose.

Dr. Chip Riggins, a regional medical director who oversees vaccine events in south-central Louisiana—a state with one of the lowest vaccination rates in the country—told the New York Times that few organizers even request the Johnson & Johnson shot anymore. Riggins said he’s had limited success sending the vaccine to churches, casinos, and even gas stations.

“In the early days of J&J, working with the African American community and the churches, the faith community here, it was a very, very popular option,” Riggins said. “It pains me that it isn’t being accepted like it was before the pause.”

There is still hope for the Johnson & Johnson vaccine, even as the U.S. is nearing 70% herd immunity, to provide relief in developing countries struggling with COVID-19.

During a recent Tech Health Event hosted by the Wall Street Journal, Johnson & Johnson CEO Alex Gorsky said that, despite setbacks, the vaccine could still play a role in containing the global pandemic.

“We still believe that this is going to be a very important tool in the overall armamentarium to help overall contain COVID-19 and make a big difference for the world,” Gorsky said.

He added that the vaccine may still have a future domestically as a booster shot to sustain immunity and to protect against emerging variant strains. “We could be looking at this to be taken along with the flu shot likely over the next several years,” he said.

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Sources: New York Times, Washington Post, Wall Street Journal

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