Joshua Sharfstein, M.D.

Two days after federal officials pressed pause on Johnson & Johnson’s COVID-19 vaccine, health and public policy leaders predicted it will return to use — but not without causing ongoing concern among key long-term care stakeholders.

Advisers for the Centers for Disease Control and Prevention are now reviewing whether J&J’s single-shot vaccine can be definitively linked to a rare type of blood clotting that has led to severe strokes in some recipients. On Wednesday, the CDC learned of a seventh case similar to those that initiated the pause.

About 7 millions Americans have already received a J&J vaccine. Its single-shot formulation made it a promising tool for long-term care residents and staff. All the reported incidents have been in women under age 48. 

Joshua Sharfstein, M.D., vice dean for public health practice and community engagement at Johns Hopkins University, said Thursday afternoon that he believes the pause could last a matter of days or a couple of weeks. But he ultimately expects J&J’s vaccine will return to use after health officials have a chance to review data and broadcast warnings to clinicians about clotting concerns.

“It’s pretty likely this will be recommended again for older adults,” Sharfstein said during a COVID-19 conference call for LeadingAge members Thursday. “That’s reasonable at this point given the epidemiology of who’s been affected.”

Such a move would be similar to the European reaction to clotting concerns in the AstraZeneca vaccine, which has been restricted for use in those 60 and over in some nations.

Skilled nursing providers have asked for priority access to the Pfizer and Moderna vaccines while awaiting a federal re-start or further limits on use.

Building confidence or dashing it?

The CDC is “deeply committed” to preventing any interruption to the flow of vaccines to LTC settings, said Ruth Katz, senior vice president of public policy and advocacy for LeadingAge on Thursday. 

“They are definitely on this case and working on it,” she added shortly after meeting with CDC and CMS officials. Katz expects another update Monday on the agency’s plan to adjust distribution plans.

Sharfstein said providers need to stay updated on the availability of all three approved vaccines, and consider how they’ll roll out messaging if or when the J&J option returns. 

“A point to be made here is the public health agencies are taking vaccine safety very seriously,” he said. People “should have confidence … that the benefit of the vaccine is enormous. There’s no need for this pause to fundamentally change the dynamic.”

He noted that COVID-19 itself is far more likely to cause clotting than a vaccine and likened the odds of being affected to winning the lottery.

On the same call, Ashley Kirzinger, Ph.D., associate director of public opinion research for the Kaiser Family Foundation, said it’s too early to measure whether the pause will affect vaccine hesitancy among long-term care staff.

Her organization last week reported 24% of long-term care workers didn’t plan to get vaccinated at all, while 15% planned to do so and another 11% were undecided. Fifty percent said they had already been vaccinated.

“What we do know is there is a large portion of the population that is what we call the ‘movable middle,’ ” Kirzinger said. “We know that the one-dose option was something persuadable to them.”

Many liked the idea of having to arrange vaccination just once and that the science behind the shot was more familiar. 

“We are very concerned about how even this short pause may impact this group,” Kirzinger added.

Nursing homes are under increasing pressure to get more staff members vaccinated. CMS last week proposed a final payment rule for 2022 that would require providers to report staff uptake through the National Healthcare Safety Network.

Agency officials outlined the proposed requirement on an Open Door Forum Thursday, when one participant asked if staff reporting would factor into the 2% wage index adjustment. 

 “This will become a part of the SNF QRP, so noncompliance with reporting this measure by the NHSN, if finalized, would impact the annual payment update,” a staff member warned.