The pause on the Johnson & Johnson COVID-19 vaccine may be jeopardizing access for some of the trickiest people to vaccinate, public health experts say.

While the pause won’t make much of a dent in overall supply because of pre-existing manufacturing issues, the vaccine has unique properties that make it easy to use.

It’s stable at refrigerator temperatures and can be transported without cumbersome freezers or dry ice. The single-shot vaccine was ideal for reaching people without cellphones and remote homebound seniors who required long trips to reach.

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The pause will have a ripple effect at the thousands of neighborhood pharmacies working with the federal government toward President Joe Biden’s promise of placing a vaccination site within five miles of every American’s home. The CDC did not respond to a question about how many pharmacies had only been offering the Johnson & Johnson vaccine.

The role of the Johnson & Johnson vaccine in remediating the pandemic’s racial and economic inequity was addressed during the Advisory Committee on Immunization Practices meeting Wednesday, when a panel of experts voted to delay making recommendations on how to move forward.

“We are in a situation where not making a decision is tantamount to making a decision. Any extension of the pause will invariably result in the fact that the most vulnerable individuals in the United States, who were prime candidates for the Johnson & Johnson vaccine, will remain vulnerable,” said Nirav Shah, a Maine public health official and president of the Association of State and Territorial Health Officials.

Still, the experts elected to extend the pause for another seven to 10 days to gather more information about exceedingly rare but serious blood clots called cerebral venous sinus thrombosis.

The ability of public health officials, health care providers and volunteers to quickly adapt depends on supply and demand. Some say they will be able to continue vaccinating with one of the two other vaccines, while other efforts are in limbo.

State and county public health officials typically find out Friday how many vaccines they can expect for the following week. Since the announcement from the Food and Drug Administration of the recommended pause came so abruptly, in some places, all of the Moderna and Pfizer/BioNTech vaccines had already been claimed, according to Adriane Casalotti, spokesperson for the National Association of County and City Health Officials.

“You’ve already signed folks up for those other doses,” she said.

In Utah and Colorado, mobile vaccinations will continue with one of the two other authorized vaccines.

Los Angeles County plans to have more than 300 mobile vaccination clinics in the coming weeks and that will not be impacted by the pause, according to Director of Public Health Barbara Ferrer. They will schedule second doses of the two mRNA vaccines at mobile sites.

But the pause has delayed efforts to vaccinate people experiencing homelessness in Clarksville, Tenn., and a pilot project for homebound patients in Philadelphia.

The vaccine was powering pilot programs to reach transient populations like migrant farmworkers, seafood workers, and people experiencing homelessness, according to Claire Hannan, executive director of the Association of Immunization Managers, which works with the Centers for Disease Control and Prevention on vaccination campaigns.

“The White House was encouraging use of J&J for those being released from hospitals or those treated in hospital emergency rooms. And yes, those who are homebound,” Hannan said.

Those efforts were fledgling as it is, according to some.

Michael Wasserman, the former president of the California Association of Long Term Care Medicine and an advocate for vaccinating people in long-term care, said vaccinating frail seniors and disabled people at home wasn’t much of a priority because of logistical challenges, so the Johnson & Johnson pause won’t make much of a difference.

“No one has really come up with a comprehensive approach. That’s been a blind spot. Many won’t be getting vaccinated soon whether it’s Pfizer, Moderna or [Johnson & Johnson],” Wasserman said.

Establishing trust

The pause also delays efforts to push out more vaccines to primary health care providers for their patients, who were largely left out of the campaign’s early weeks and struggled to even get their own frontline health care workers vaccinated.

These family doctors could play a greater role as establishing trust becomes more important, Hannan said.

“These are key, trusted providers in their communities and play a critical role particularly in rural areas. However, the Pfizer and Moderna products don’t lend themselves for use by these small-throughput providers,” she said.

About a dozen states told CQ Roll Call that mass vaccination clinics would continue unabated, since the vaccine comprised just 5 percent of vaccines distributed, with the Moderna and Pfizer/BioNTech vaccines making up the bulk of the national supply.

Emergent BioSolutions, a U.S. company making the active ingredient in the vaccines, awaits clearance from the FDA following contamination issues that spoiled 15 million doses.

But the pause has set back some mass vaccination clinics in Florida and Maryland, some of which were located strategically according to socioeconomic data to reach at-risk populations.

Many public health officials and governors have expressed concern the FDA’s move could erode public confidence in the single-shot vaccine, which could set back these efforts well beyond the temporary pause.

Casalotti said a major focus in the next few weeks will be answering every call from someone with concerns about the news.

“It was already a challenge to explain the lower efficacy against mild and moderate disease, and direct the focus to its efficacy against hospitalization and death. We tried to emphasize that the vaccines were not studied head-to-head under the same circumstances,” she said. “But this makes a nuanced situation more difficult.”