CDC panel recommends Pfizer, Moderna vaccines over J&J shot

Most Americans should be given the Pfizer or Moderna vaccines instead of the Johnson & Johnson shot that can cause rare but serious blood clots, U.S. health advisers recommended Thursday.

The strange clotting problem has caused nine confirmed deaths after J&J vaccinations — while the Pfizer and Moderna vaccines don't come with that risk and also appear more effective, advisers to the Centers for Disease Control and Prevention said.

It's an unusual move and the CDC's director, Dr. Rochelle Walensky, must decide whether to accept the panel's advice.

Until now the United States has treated all three COVID-19 vaccines available to Americans as an equal choice, since large studies found they all offered strong protection and early supplies were limited. J&J's vaccine initially was welcomed as a single-dose option that could be especially important for hard-to-reach groups like homeless people who might not get the needed second dose of the Pfizer or Moderna options.

But the CDC's advisers said Thursday that it was time to recognize a lot has changed since vaccines began rolling out a year ago. More than 200 million Americans are considered fully vaccinated, including about 16 million who got the J&J shot.

New data from unprecedented safety tracking of all those vaccinations persuaded the panel that while the blood clots linked to J&J's vaccine remain very rare, they're still occurring and not just in younger women as originally thought.

In a unanimous vote, the advisers decided the safer Pfizer and Moderna vaccines are preferred. But they said the shot made by J&J's Janssen division still should be available if someone really wants it — or has a severe allergy to the other options.

"I would not recommend the Janssen vaccine to my family members" but some patients may — and should be able to — choose that shot, said CDC adviser Dr. Beth Bell of the University of Washington.

Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health, said he agreed with the panel’s advice.

"They [the Pfizer and Moderna vaccination] are clearly more effective and safer vaccines," he said.

The J&J shot has largely fallen out of favor in the medical community, Farber said, and he hasn’t seen it used by Northwell in months.

"We’re not pushing it at our vaccination pods," he said.

Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine, also agreed with the decision of the advisory panel.

She said that about 16 million Americans got the J&J vaccine versus 115 million who received the Pfizer shot and 73 million who got the Moderna inoculation.

"It’s preferable not to get the J&J," Nachman said."I think it’s a reasonable decision."

She also said that fewer places are distributing the J&J shot than the other two.

The clotting problems first came up last spring, with the J&J shot in the United States and with a similar vaccine made by AstraZeneca that is used in other countries. Eventually U.S. regulators decided the benefits of J&J's one-and-done vaccine outweighed what was considered a very rare risk — as long as recipients were warned.

European regulators likewise continued to recommend AstraZeneca's two-dose vaccine although, because early reports were mostly in younger women, some countries issued age restrictions.

COVID-19 causes deadly blood clots, too. But the vaccine-linked kind is different, believed to form because of a rogue immune reaction to the J&J and AstraZeneca vaccines because of how they're made. It forms in unusual places, such as veins that drain blood from the brain, and in patients who also develop abnormally low levels of the platelets that form clots. Symptoms of the unusual clots, dubbed "thrombosis with thrombocytopenia syndrome," include severe headaches a week or two after the J&J vaccination — not right away — as well as abdominal pain and nausea.