The Morning: The J.&J. conundrum

Should J.&J. recipients get a booster? And how?

Good morning. People who got the Johnson & Johnson Covid vaccine are often ignored. Today's newsletter is for them.

A nurse preparing a Johnson & Johnson shot in the Bronx in July.James Estrin/The New York Times

What about us?

We've heard the question from friends, family members and dozens of readers: Should people who received the single-shot Johnson & Johnson vaccine be getting a booster shot?

Karen, a Morning reader in Michigan, wrote to us: "Since receiving mine in March, I am wondering what the facts are. I am frightened." Leah in California wrote: "Information about J.&J. is not communicated at all!" Lauren from Nashville asked: "What's the guidance for us?"

Today's newsletter is for them. We will try to lay out the facts so you can make your own decision.

You can find a longer version of today's newsletter online, with more detail and explanation. In the email version, we will focus on nine main points.

The key points

1. From the start, J.&J.'s single-shot vaccine has appeared to be less effective than the two-shot vaccines from Moderna and Pfizer. The J.&J. shot still provides good protection against serious illness, but not as much as the others. And the Delta variant may be widening the gap.

2. Federal officials have suggested they are likely to approve a booster shot for J.&.J recipients eventually. But any approval seems to be weeks away, if not months.

3. Regardless, many J.&J. recipients are less interested in receiving a second J.&J. shot than in getting a follow-up shot with either the Moderna or Pfizer vaccine — sometimes known as a "mix-and-match" approach.

4. Many experts believe that this approach will be effective, maybe even more effective than two shots of the same vaccine. Britain has used this strategy, giving many people who received the AstraZeneca vaccine (which is similar to J.&J.'s) a second shot with Moderna's or Pfizer's.

5. But there is still not much data on the benefits or the risks of combining a J.&J. shot with a different vaccine.

6. Numerous doctors and experts who themselves received the J.&J. vaccine aren't waiting for the government to act. They have gotten a follow-up Moderna or Pfizer vaccine. "Sometimes public health requires making tough decisions without a complete data set to support it," Angela Rasmussen, a virologist who received a Pfizer shot after having received the J.&J. vaccine, has written. The city of San Francisco also began offering a Moderna or Pfizer booster shot to J.&J. recipients about a month ago.

7. When Dr. Rochelle Walensky, the director of the C.D.C., was asked whether she considered it a mistake for J.&J. recipients to pursue a Moderna or Pfizer follow-up shot, she said, "Not with what I've seen so far." From the head of a notoriously cautious agency, that was a remarkable and telling statement.

8. Getting a follow-up shot with the Moderna or Pfizer vaccines may not be easy. Because the government has not authorized them, doctors often refuse to give them. Many people are understandably frustrated by the situation: It can feel like there is one set of rules for people with medical connections and another set of rules for everyone else.

9. Still, if you want a shot, you have a few options. You can try different drugstores or clinics, hoping to find one that is willing to give a Pfizer or Moderna shot to a J.&J. recipient — or one that won't ask about your history. You can also choose to be less than fully honest. You won't be alone.

The bottom line

Here's the brief case for getting a Pfizer or Moderna shot as a follow-up to a J.&J. shot: The available evidence suggests you will benefit. There are no signs of worrisome side effects so far. And the Delta variant is an even bigger threat to human life than earlier versions of Covid. By waiting, you may be allowing bureaucratic caution to get in the way of your health.

Here's the brief case against a follow-up shot: A single shot of the J.&J. vaccine still provides good protection, and the government may soon allow a second J.&J. shot. There is not yet rigorous data on the benefits or risks of the mix-and-match approach with J.&J. And you may need to resort to some deviousness to get another shot.

We understand why so many people are flummoxed.

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Gail Collins and Bret Stephens discuss Biden's vaccine mandate and the California recall.

Maureen Dowd reflects on America's "perverse blunders" after Sept. 11. Ross Douthat looks at a prophetic foreign policy expert.

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ARTS AND IDEAS

The Met Gala returns

The Met Gala, the exclusive black-tie extravaganza known as the Oscars of the East Coast, is back tonight. The gala is a major fashion event, and it kicks off a blockbuster exhibition at the museum's Costume Institute, which this year focuses on American fashion.

Another unofficial theme, Vanessa Friedman writes in The Times, is youth. Many of the designers are young, as are the hosts: the inaugural poet Amanda Gorman, the actor Timothée Chalamet, the tennis champion Naomi Osaka and the pop star Billie Eilish.

For more on who gets to go, what they might wear and how to watch the red carpet, read Vanessa's explainer. — Sanam Yar, a Morning writer

PLAY, WATCH, EAT

What to Cook
Julia Gartland for The New York Times

Drizzle lemony roasted fish with caper-infused brown butter.

Awards Shows

See the red carpet looks from last night's MTV Video Music Awards. (Highlights included performances by Busta Rhymes and Normani.)

What to Read

Tarana Burke, who founded the MeToo movement, discusses her new memoir, "Unbound."

Now Time to Play

The pangram from Friday's Spelling Bee was complete. Here is today's puzzle — or you can play online.

Here's today's Mini Crossword, and a clue: Adventure story (four 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

P.S. A hidden haiku from The Times's coverage of a boxing match for which Donald Trump provided live commentary: "Of course it was a / circus — the kind that makes sense / in boxing these days."

"The Daily" is about Biden's vaccine mandate. On the Book Review podcast, Brandon Taylor talks about Sally Rooney. "Sway" features the author Dave Eggers.

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

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