The Morning: Serious and rare

The Johnson & Johnson problem creates a tough situation for regulators.

Good morning. Will the Johnson & Johnson pause do more harm or good?

Administering the Johnson & Johnson vaccine in Florida on Saturday.Lynne Sladky/Associated Press

'A hard spot'

The apparent problem with Johnson & Johnson's Covid-19 vaccine is both serious and rare, which makes it a thorny issue for policymakers to address and for the rest of us to think through.

Six U.S. women between 18 and 48 developed blood clots within two weeks of receiving vaccine shots. One of the six died, and another is in critical condition. Some Europeans have developed similar complications after receiving the AstraZeneca vaccine, raising the possibility that the problem is broader than Johnson & Johnson's version. (It does not appear to affect the Moderna or Pfizer vaccines, which use a different technology.)

Federal regulators responded very aggressively, calling for a national pause in the use of the Johnson & Johnson vaccine. That approach has the advantage of focusing the country on the problem, so that doctors and patients can be on the lookout for the symptoms of the clots, which are highly unusual and require different treatment from most clots. A pause also prevents more people from suffering any side effects.

Some experts praised the move. "Any time there is a possible serious side effect," Dr. Tom Frieden, a former head of the Centers for Disease Control and Prevention, wrote, "it's time to stop, listen, learn and plan." Natalie Dean, a biostatistician at the University of Florida, argued that federal officials had to respond aggressively, to protect the long-term credibility of vaccines. Dr. Megan Ranney of Brown University wrote, "I'm glad that we do good science and post-vaccine monitoring."

But other experts believe the national pause may do more harm than good. Even if the vaccine did cause the clots, it did so in a tiny fraction of cases. Almost seven million Americans have received the Johnson & Johnson vaccine, including more than one million women between 18 and 48.

One way to think about those numbers: While the chances of a fatal blood clot from the vaccine may be something like one in a million, roughly 125 out of every one million Americans between 18 and 48 have died of Covid since early last year.

'Not losing sleep'

For that reason, health experts emphasized that the benefits of the Covid vaccines far outweigh the risks for most people, as this Times Q. and A. explains. Dr. Angela Rasmussen, a Georgetown University virologist, wrote that she had received the vaccine last week and that "I'm not losing sleep over this." Dr. Scott Gottlieb, a former head of the Food and Drug Administration, said on CNBC, "For most consumers, I wouldn't be concerned about this."

Realistically, though, many Americans will be concerned, and the damage to Johnson & Johnson's credibility may be lasting. Vaccine skepticism was already a problem, and many unvaccinated people may now be deeply hesitant to receive the Johnson & Johnson shot — and perhaps any vaccine. "There's nothing we can do to restore confidence," one Republican state official told CBS News.

The Biden administration and state governments will almost certainly try to restore confidence if they conclude that the side effects are in fact rare and manageable, because Johnson & Johnson is a key part of the country's vaccination plan.

So far, its shots have accounted for only about 9 percent of fully vaccinated Americans, according to the C.D.C. But that was about to change. Over the next few months, Johnson & Johnson was scheduled to account for more than one-third of vaccinations. Without it, the country would still have enough shots to inoculate all adults by midsummer, although more slowly.

Regulators did have options other than a full pause, some experts argued. "People should be given the info & allowed to choose," Govind Persad of the University of Denver wrote on Twitter. "Deaths from Covid b/c you weren't vaccinated are permanent."

"There's no actual evidence the F.D.A. knows how to manage public psychology correctly on this," my colleague Ezra Klein wrote.

For more:

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Live Event

On Thursday, April 15, at 7 p.m. Eastern, David Leonhardt will host a special live edition of The Morning — created just for Times subscribers. Join us for poetry with Rupi Kaur, Spelling Bee with William Jackson Harper and the latest updates on the Covid vaccine rollout. If you'd like to become a subscriber, and enjoy free access to this event, go here to learn more.

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On friendship

T Magazine's annual Culture issue is dedicated to friendship in all its forms, "how sustaining it is and how elastic it can be," as Hanya Yanagihara, the editor in chief, writes. "There are no rules about what a friendship can be: It needs only effort, and mutual commitment."

There is art and photography and essays on life-defining relationships; the kinds that drift apart and the ones that always pick up right where they left off. See the issue here.

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Here's today's Mini Crossword, and a clue: Computer screen dot (five letters).

If you're in the mood to play more, find all our games here.

Thanks for spending part of your morning with The Times. See you tomorrow. — David

A correction: Yesterday's newsletter contained a chart with an incorrect label. It showed deaths per 10 million residents in Britain and the U.S., not deaths per 1,000 residents.

P.S. The word "hotelification" — about the rise of cafes, rooftop gardens and other office amenities — appeared for the first time in The Times yesterday.

Today's episode of "The Daily" is about the Supreme Court. On "The Argument," Ross Douthat and Michelle Goldberg debate the future of abortion rights.

Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.

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