Los Angeles is scrambling to deal with the federal health officials' call for a pause in the use of single-dose Johnson & Johnson vaccines that have helped speed up local inoculations.
L.A. Mayor Eric Garcetti said city-run vaccination sites had more than 3,000 patient appointments scheduled for Tuesday that will now receive a first dose of Pfizer, instead of the planned Johnson & Johnson vaccine. It comes two days after Los Angeles County opened vaccinations to everyone 16 and older.
In Long Beach, officials said those with an appointment at mobile clinics where the Johnson & Johnson vaccine was scheduled to be given will be contacted and offered either a Pfizer and Moderna vaccination. So far, no local cases of the rare blood clotting that forced federal officials to stop use of the vaccination have been reported, Long Beach officials said in a statement.
The move comes after the Center for Disease Control (CDC) and the Food and Drug Administration (FDA) reported six cases of blood clots among individuals who received one of the 6.8 million Johnson and Johnson vaccines distributed nationally.
Already, 900,000 of the vaccines have been distributed to people in California, making up roughly 40% of all vaccinated adults in the state. But, Gov. Gavin Newsom said on Twitter Tuesday that only 4% of the state's current supply is Johnson and Johnson.
In a joint statement, the CDC and the FDA said the recommendation to pause the vaccines was made "out of an abundance of caution." The agencies will use this time to understand and prepare treatments for these blood clots.
"The system is working as it should," said Shira Shafir, a public health professor at UCLA. "If we suspect something might be happening, then we do evaluate whether or not we have enough information."
Shafir said the CDC and FDA may decide to update recommendations to better avoid the serious blood clots. Neither agency has determined that the vaccine does cause the blood clots.
The move will largely impact vulnerable populations, such as those who are homebound or live in rural areas, or who cannot take time off work.
That's because the Johnson & Johnson vaccine did not need to be stored in sub-zero temperatures like Moderna and Pfizer vaccines and is administered in a single shot.
Get Out the Shot, a 400-person volunteer program in Los Angeles dedicated to booking vaccine appointments for people who may not have proper documentation or have a language barrier, are informing people if there is a vaccine change.
"One of the big concerns with a lot of the people that we're helping is the wage loss that accompanies time off in order to get to that vaccine appointment," said founder Liz Schwandt. "So we don't want to have to double someone's time that they have to spend away from providing care for their families or from working."
But, Schwandt said, smaller community clinics who cannot pivot quickly to a different vaccine are cancelling appointments, making it difficult for people who took time off work to recoup those lost wages.
It is unclear if this will affect California's goal of opening its economy June 15, though the California Department of Public Health said in a press release, "we do not expect a significant impact to our vaccination allocations."
Every state is allotted a certain number of the Johnson & Johnson, Moderna and Pfizer vaccines to distribute. About 4% of the state's vaccine supply for the week came from Johnson & Johnson. It's unclear what effect that will have for people getting vaccines in the future.
Garcetti said Los Angeles has received about 60,000 doses of the Moderna vaccine and 56,000 of the Pfizer vaccine this week.
A facility in Baltimore that was making AstraZeneca vaccines (which has also been linked to rare blood clots and is not authorized for use in the U.S.) is being investigated after it mixed up ingredients meant for the Johnson & Johnson vaccines. The New York Times reports the vaccines in circulation are not from that facility.
Still, Shafir said the news shouldn't deter those hesitant to receive the vaccine from scheduling an appointment. The AstraZeneca vaccine (which has also been linked to rare blood clots and is not authorized for use in the U.S.) and the Johnson & Johnson vaccine are adenovirus vector vaccines, while Moderna's and Pfizer's are mRNA vaccines.
Though the two effectively operate the same way once in the body, adenovirus vector vaccines introduce a weak version of the virus while mRNA vaccines introduce a peculiarly shaped protein — called the spike protein — into the body. It's similar to the coronavirus spike protein. There is no evidence that mRNA vaccines, like the Moderna and Pfizer vaccines, have produced blood clots.
"The chances someone is going to get infected with COVID and get seriously ill as a result of being infected with COVID is still multiple times higher than the chance that they will develop this very serious complication as a result of COVID vaccination," Shafir said.
This story has been updated.
'It's Really a Myth': Even with More Supply, COVID Shots Are Inaccessible to LA's Most Vulnerable
Where are the vaccine clinics open at night?
It's a question volunteers from Get Out the Shot hear often as they book appointments for people who have a hard time doing it themselves — many of them without internet or much free time.
"My fear is the technology and the way you book appointments is not getting easier," said Rebecca Lehrer, who started helping in February when the effort was still driven by a Facebook group.
California's COVID-19 vaccine eligibility tiers will become obsolete next week when anyone 16 or older is free to book an appointment. On Thursday, Long Beach made shots available to all residents 16 and over, while Cal State Los Angeles opened its site up to people at least 18, before it was overwhelmed and started turning crowds away.
The rush at the Los Angeles university may be a sign of what's to come.
Known as GOTS, the volunteer collective of more than 300 is expecting its caseload to get bigger even as more vaccine appointments become available. The group is one of a handful that have cropped up since vaccines landed in California.
Recently, software developers across the country started launching automated websites and Twitter bots to blast out new slots. But those platforms haven't proven to be the solution for everyone.
"It's really a myth," said Liz Schwandt, an L.A. preschool program director who started Get Out the Shot. "Even if supply increases — even if there are more appointments — they're still not grab-able or accessible for the most vulnerable."
Many have specific concerns and requests — ones that make getting a shot much more complicated than just clicking a button on MyTurn.
Some call in because their employers won't give them time off to get vaccinated. Others want to secure an appointment at night, when most clinics are closed. Occasionally, callers are looking for a certain vaccine brand.
And many are nervous about navigating a health care system in which insurance and immigration status are often barriers to care, Schwandt said.
"They're used to having a system that doesn't work for them," said Schwandt.
The issue speaks to the enormous feat of implementing a national vaccination strategy that relies on people having stable internet, job flexibility and free time.
"One of the neighbors I'm trying to book for — who doesn't have internet — is not on Twitter looking at Walgreens' latest appointment drop," said Schwandt.
As the state inches towards an appointment free-for-all, public health officials say they will continue to use single-use "access codes" for target groups and residents in zip codes in the bottom half of the Healthy Places Index.
In February, misuse of state-issued vaccine access codes designed to serve Black and Latino communities rattled California's equity program. Many of the L.A. residents who used and circulated those credentials were not yet eligible.
"Our team is also working closely with community-based organizations that are trusted voices on the ground," added Sami Gallegos, spokesperson for the California Department of Public Health.
Schwandt hopes to secure blocks of appointments next week for those calling in. So far, every person who gets a shot through the service refers about 10 people back.
"People are already calling this week to pre-schedule," said volunteer Michael Altneu, an EMT who plans to administer vaccinations in Del Mar later this month. "I think people are going to try to do it first on their own. A few days after, when all the shots get booked up, we're going to see a deluge of calls."
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The shelf life of a thawed coronavirus vaccine is only a few hours, and expired vaccines have to be thrown out.
That inspired the New York-based startup Dr. B, the COVID-19 company meant to reduce vaccine waste created by ZocDoc cofounder Cyrus Massoumi. It's just arrived in Los Angeles, as the eligibility for vaccinations lifts next week.
Dr. B aims to reduce vaccine waste and the chaos that comes with it by matching vaccine providers with prospective patients within hours.
The company said it has secured three providers in the region so far.
To enroll in the waitlist, people have to sign up online at Dr. B's website and share certain health and geographic information to inform the site of local guidelines it needs to follow. When a free appointment pops up, one will receive a text notification. If they don't accept the appointment within a certain time frame, it gives the appointment to someone else.
Its test will come next week when anyone over the age of 16 can make an appointment.
Those using Dr. B would need to drop everything to travel to a vaccination site in a matter of hours. People with inflexible jobs or child care often don't have that luxury.
Already, a slew of community- and company-run sites are helping folks in L.A. find vaccine appointments, including Get Out the Shot and Find My Vax LA, run by recent college graduate Andrew Freidman. Health care startups like Carbon Health and Curative have made efforts to help people find vaccine appointments.
Dr. B's arrival also comes as the region's thinking on "cutting the line" for vaccine doses has shifted.
In February, when L.A. County began administering vaccines to health care workers those who lined up to see if they could score extra doses were often called "vaccine vultures" and chided on social media for not waiting in line.
But as more doses become available, the disdain some felt has faded, with the general consensus now shifting to use the vaccine, no matter what. L.A. County officials have urged health care workers to not throw away vaccines.
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