Image of gloved hand holding a vial of Johnson & Johnson's investigational COVID-19 vaccine

The Centers for Disease Control and Prevention has endorsed a recommendation that Americans preferably be vaccinated with the Pfizer-BioNTech or Moderna COVID-19 vaccines over Johnson & Johnson’s shot.

The CDC’s late Thursday action came hours after a panel of its independent advisers voted unanimously to recommend favoring the two mRNA-based vaccines after a review of updated evidence on vaccine effectiveness, safety and rare adverse events.

The Advisory Committee on Immunization Practices’ (ACIP) vote hinged partly on the risk of blood clots seen with the J&J vaccine, and the relatively high level of protection against COVID-19 afforded by the other two options, according to the CDC. Out of approximately 16 million Americans who have received the J&J shot, there have been nine confirmed deaths due to rare but serious instances of blood clotting problems, the Associated Press reported.

The matter of vaccine supply also was considered. “The U.S. supply of mRNA vaccines is abundant – with nearly 100 million doses in the field for immediate use,” the agency said in announcing its decision.

But ACIP has also reaffirmed that “receiving any vaccine is better than being unvaccinated,” CDC noted.

“Individuals who are unable or unwilling to receive an mRNA vaccine will continue to have access to Johnson & Johnson’s COVID-19 vaccine,” the agency stated.

The drugmaker said it continues to stand behind its vaccine’s risk-benefit profile, and said that it remains a necessary option for some recipients.

“Given its strong durability, the Johnson & Johnson COVID-19 vaccine remains an important choice in the U.S. for people who can’t or won’t return for multiple vaccinations or who would remain unvaccinated without an alternative to the mRNA vaccines,” it said in a statement.

CDC emphasized that the unusual decision to favor some drugs over others authorized for the same use was based on recent evidence and in line with decisions made in other countries, including Canada and the United Kingdom.

“Today’s updated recommendation emphasizes CDC’s commitment to provide real-time scientific information to the American public,” CDC Director Rochelle Walensky, M.D., stated. “I continue to encourage all Americans to get vaccinated and boosted.”

J&J’s shot uses a traditional virus-based technology, whereas the mRNA technology used by the other two federally authorized COVID-19 vaccines is relatively new. 

Deja vu for LTC? 

Renewed questions about the J&J vaccine may remind providers of an earlier investigation by federal health officials. In April, they recommended a pause in its use to allow for a review of safety data. The pause lasted less than two weeks, but caused logistics and safety problems for long-term care operators who had been hurriedly vaccinating residents and staff as part of a new vaccination campaign aimed at stemming horrific COVID-19 infection and mortality rates.

Once the recommendation for use was reinstated, LTC facilities immediately resumed using the drug, McKnight’s reported

FDA revises guidelines on administering J&J vaccine

In related news, the Food and Drug Administration has made updates to its provider fact sheet for administering the J&J COVID-19 vaccine.

The new guidance, announced Tuesday, includes a contraindication to administering the shot to people who have a history of blood clots combined with a low platelet count (thrombosis with thrombocytopenia, or TTS) with this or other adenovirus-vectored COVID-19 vaccines such as AstraZeneca’s.

The agency does not recommend against taking the vaccine. Its benefits — preventing COVID-19 and severe COVID-19 outcomes — continue to outweigh its risks, it said in the update.