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Western Warnings Tarnish Covid Vaccines the World Badly Needs
Amid a deep residue of mistrust, American and European cautions on the AstraZeneca and Johnson & Johnson vaccines risk igniting anti-vaccine fervor in countries that can’t afford to be particular.
Safety worries about the AstraZeneca and Johnson & Johnson Covid-19 vaccines have jeopardized inoculation campaigns far beyond the United States, undercutting faith in two sorely needed shots and threatening to prolong the coronavirus pandemic in countries that can ill afford to be choosy about vaccines.
With new infections surging on nearly every continent, signs that the vaccination drive is in peril are emerging, most disconcertingly in Africa.
In Malawi, people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine. And in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.
The sense of uncertainty deepened on Wednesday when an advisory committee to the U.S. Centers for Disease Control and Prevention delayed a decision for seven to 10 days on lifting a pause on the Johnson & Johnson vaccine, saying it wanted more data on a rare blood clotting disorder. Those shots were halted on Tuesday over concerns about the disorder, which emerged in six women, and on Wednesday the panel learned of two more examples.
Also on Wednesday, the European Union said it would not make any more purchases of the AstraZeneca or Johnson & Johnson vaccines, but would pivot to relying solely on those, like Pfizer’s and Moderna’s, that are based on a newer technology and have not raised similar safety concerns.
The actions of American and European officials reverberated around the world, stoking doubts in poorer countries where a history of colonialism and unethical medical practices have left a legacy of mistrust in vaccines. If the perception takes hold that rich countries are dumping second-rate shots on poorer nations, those suspicions could harden, slowing the worldwide rollout of desperately needed doses.
Dr. Sara Oliver of the C.D.C. told the advisory panel that prolonging the pause in using the Johnson & Johnson vaccine “could have global implications.”
Already, doctors say, the recent pauses have vindicated vaccine skeptics and made many others feel duped.
“People, especially those who were vaccinated, felt like they had been tricked in a way — they were asking, ‘How do we get rid of the vaccine in our body?’” said Precious Makiyi, a doctor and behavioral scientist in Malawi, where health workers have been racing to empty their shelves of nearly expired AstraZeneca doses. “We fought so hard with vaccine messaging, but what has happened this past week has brought us back to square zero.”
African health officials have reacted with fury at the breezy reassurances of American and European lawmakers that people denied the AstraZeneca or Johnson & Johnson shots could be given another vaccine. In much of the world, there are no other vaccines.
And even as American health officials stressed that they paused use of the Johnson & Johnson vaccine on Tuesday in “an abundance of caution,” they forced global health officials to begin crafting the difficult case that shots that might not be safe enough for the world’s rich were still suited to its poor.
“It’s sending vaccine confidence into a crater,” Ayoade Alakija, a co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”
What rich countries call caution, poorer nations will experience as a devastating gamble with the survival of their citizens against Covid-19. “Out of an abundance of caution, let us not destroy vaccine confidence in places that only have access to one type of vaccine,” Dr. Alakija said.
Listen to ‘The Daily’: The Johnson & Johnson Vaccine Pause Explained
Scores of appointments were canceled after the U.S. called for a halt on the use of the Johnson & Johnson shot. Here’s the story behind that decision.transcript
Listen to ‘The Daily’: The Johnson & Johnson Vaccine Pause Explained
Hosted by Michael Barbaro; produced by Rachel Quester, Jessica Cheung and Leslye Davis, with help from Alexandra Leigh Young; edited by MJ Davis Lin; and engineered by Chris Wood.
Scores of appointments were canceled after the U.S. called for a halt on the use of the Johnson & Johnson shot. Here’s the story behind that decision.
- michael barbaro
From The New York Times, I’m Michael Barbaro. This is “The Daily.”
- [music]
Today, the decision-making process that led the U.S. government to suspend the use of Johnson & Johnson’s COVID-19 vaccine, how long it may last and the impact it could have. I spoke with my colleague, science reporter Carl Zimmer. It’s Thursday, April 15th.
Carl, walk us through how this very big decision was reached to pause vaccinations with Johnson & Johnson’s vaccine in the U.S. Where does that story start?
- carl zimmer
The story starts in Europe with another vaccine, one that’s made by AstraZeneca. AstraZeneca is going into widespread use in Europe. It’s not yet authorized in the United States. And after a while, the European regulators notice a few rare cases of blood clots, which start to get them concerned. And so they begin to investigate whether that has anything to do with the vaccine.
- michael barbaro
With the AstraZeneca vaccine. Got it.
- carl zimmer
So blood clots are a surprisingly common thing. Thousands of people get blood clots every day. So just because people who get vaccinated get a blood clot, that doesn’t really tell you anything in particular about whether the vaccine is dangerous. You have to take a closer look. And when European regulators took a closer look at people getting vaccinated, they noticed that there was a small amount of people who were all getting the same unusual kind of blood clot. They were taking place in the brain, and they were associated with very low levels of something called platelets.
- michael barbaro
And what are platelets?
- carl zimmer
Platelets are a component of the clotting process in our bloodstream. So when we get little wounds in our blood vessels, platelets jump into the wound and basically create a little patch. And that allows us to heal. So that’s good. What’s bad is when the platelets start to form a big clot, which can then break loose and go around in our bloodstream and end up in dangerous places, like in our brains.
- michael barbaro
Got it.
- carl zimmer
And so what puzzled and concerned European regulators is that you had this very strange condition where you had a combination of these particular kinds of clots with low platelets. So they thought, maybe we’re looking at a rare but distinct and serious condition. Now, it’s not clear why, in these people, they’re getting brain clots along with low platelets. One idea is that all the platelets in the blood are going into these clots, and so their level of platelets is going down. This is a hypothesis that’s coming out of the first studies of people who have gotten vaccinated with AstraZeneca and have developed these peculiar blood clots with the low platelets.
- michael barbaro
OK, so how do we get to Johnson & Johnson?
- carl zimmer
European regulators start to wonder if they could get some clues to what’s happening with AstraZeneca by looking at the Johnson & Johnson vaccine because it’s similar, in some ways, to AstraZeneca. They use the same basic technology, unlike Moderna and Pfizer. So last week, they start to look at data from the United States. Now, at first, there isn’t a lot of data that really points to something similar happening with Johnson & Johnson, but over the weekend, that changed. By the weekend, the C.D.C. and the F.D.A. have gotten six reports that are very similar to what European regulators were seeing with AstraZeneca, people who have suffered from this distinctive brain clot combined with low platelets. Six people out of seven million or so who have gotten the Johnson & Johnson vaccine, that’s tiny. But it’s a pretty unusual combination. Also, all of those six people were women, and one of those women actually died of her blood clot. And so that started to set off alarms in the government that maybe we need to stop and take a close look at what’s happening.
- michael barbaro
OK, and so how do U.S. regulators, who have been watching, I’m sure, what was happening in Europe with AstraZeneca, how do they start to think about how to respond to this very small — six — number of cases of blood clots in people who have gotten the Johnson & Johnson vaccine?
- carl zimmer
Once these six cases had come to light, government officials got together and talked about what their options were. And basically, it came down to two. On the one hand, they could issue a warning. In other words, they could let doctors know that they had seen this incredibly rare but very serious condition, and just have doctors be aware that this is an issue, and maybe keep an eye out for it. Or they could recommend a pause on vaccination. In other words, they would recommend that doctors and vaccination centers and so on stop for now giving out the Johnson & Johnson vaccine while they investigated it further.
- michael barbaro
Wow. Those are very different options. I mean, one is essentially send the medical world a memo saying heads up. The other is far more significant. It’s stopping temporarily the use of the Johnson & Johnson vaccine, which of course would be very disruptive. So what factors are influencing how they are considering these two options?
- carl zimmer
One important factor is that they were wondering how many more cases out there ar ethere. So they knew of six, but maybe there were more that people just hadn’t reported yet.
- michael barbaro
Right.
- carl zimmer
And so if they just give a quiet little warning, people might not pay attention to it. But if they say, hey folks, we’re taking this seriously, that might spur doctors and patients and so on to get in touch and say, hey, guess what, I’ve seen the same thing, or I’ve experienced the same thing. It’s also of concern because there’s some indication that some of the standard way to treat a blood clot, with a drug called heparin, might actually be bad for this particular condition. So you really want to make sure that people are aware that there is a potential risk of just treating a blood clot like any other blood clot.
- michael barbaro
That’s interesting. So these regulators are not just worried about the danger of these blood clots, but also about the danger of potentially mistreating them.
- carl zimmer
They’re concerned that this might be a risk. You know, again, they have to figure out what’s going on. You know, they really have to figure out if this is even a cause and effect that they’re looking at. But these kinds of concerns shifts the government officials away from just sending out a warning to actually going for a pause.
- michael barbaro
Right. And of course, a pause is what the regulators decide on. So how do they describe that decision to the American public?
- archived recording
Thank you. And thank you all for joining us.
- carl zimmer
Tuesday morning, there is a press conference.
- archived recording
This morning, the F.D.A. and C.D.C. announced that, out of an abundance of caution, we’re recommending a pause in the use of the Johnson & Johnson COVID-19 vaccine. With the acting director of the Food and Drug Administration, Janet Woodcock, and other officials. These events appear to be extremely rare.
- carl zimmer
And they present the data.
- archived recording
One case was fatal, and one patient is in critical condition. Right now, these events appear to be extremely rare. That said, COVID-19 vaccine safety is a top priority for the federal government.
- carl zimmer
Said that this is very, very rare, but on the other hand, it’s serious enough that they have to investigate it.
- archived recording
We are committed to an expeditious review of the available information.
- carl zimmer
And expected that this investigation might take only a few days.
- archived recording
The time frame will depend, obviously, on what we learn in the next few days.
- carl zimmer
And during those few days, they recommended that the Johnson & Johnson vaccine be paused.
- archived recording
This concludes today’s media briefing.
- michael barbaro
And Carl, you just used an important word, recommended. This is federal guidance. It is not a mandate. So what is the immediate response to U.S. health regulators giving the recommendation that the Johnson & Johnson vaccinations be paused?
- carl zimmer
The effect is really swift.
- archived recording
The F.D.A. and the C.D.C. has announced that they are now recommending a pause. Walgreens, CVS and Kroger among the national pharmacies that also will pause using J&J as well.
- carl zimmer
Walgreens and CVS both quickly say that they’re going to pause using Johnson & Johnson vaccines.
- archived recording
You might as well view it as a pause nationwide.
- carl zimmer
A number of states do the same thing.
- archived recording
Signs now flash this message outside the federally supported vaccine site — no J&J here.
- carl zimmer
There’s a huge wave of cancelations of appointments to get vaccinated.
- archived recording
It’s so rare, the side effects, that I really wasn’t worried about it.
- carl zimmer
There are mobile vaccination clinics that are just canceled in different cities.
- archived recording
I’m just disappointed there’s no shot at all. So I’m definitely disappointed.
- carl zimmer
So this has gigantic effects immediately. And by the end of Tuesday, Johnson & Johnson vaccination across the United States has pretty much ground to a halt.
- michael barbaro
Right. And in a sense, what that tells us is that the pause worked. Right? I mean, pharmacies and states do exactly what the C.D.C. and the F.D.A. have guided them to do.
- carl zimmer
Yes. So the pause is happening in exactly the way that government officials had hoped for, but that doesn’t mean that there aren’t some concerns about what the long-term effects could be of this pause.
- [music]
- michael barbaro
We’ll be right back.
Carl, once this pause is in effect, it raises tons of questions. So let’s spin through those questions. The first is, what will be the consequence of the pause on the U.S. vaccination campaign, on the deadlines and the schedule for returning to normalcy?
- carl zimmer
Johnson & Johnson has been a crucial component of the Biden administration’s plans for getting the United States back to normal. They were supposed to be delivering 100 million doses by the end of May.
- michael barbaro
Wow.
- carl zimmer
And they’ve already been having some problems with manufacturing their vaccines, and had to essentially throw out 50 million doses. So now, even pausing for a few days can throw that plan into even further uncertainty.
- michael barbaro
Right. So on a logistical, scheduling level, this is a meaningfully big deal.
- carl zimmer
It’s a big deal, especially in parts of the country where the other two vaccines, by Moderna and Pfizer, are not so easy to give out.
- michael barbaro
And what kinds of places would those be?
- carl zimmer
Well, Moderna and Pfizer’s vaccines both need to be frozen.
- michael barbaro
Right.
- carl zimmer
Johnson & Johnson’s is a lot easier to use. You just throw it in the fridge. And so you can have these mobile clinics driving around with them. You can bring them to rural areas, where they don’t have the facilities for keeping frozen vaccines. I mean, you can do things with the Johnson & Johnson vaccine that you just couldn’t do with the other vaccines. So for example, there are people who can’t get to a clinic. They’re homebound. And so if you’re going to send out public health workers to get to them with the vaccine, you don’t want them to have to be lugging around big freezers. It’s really easy, relatively speaking, to send them out with the Johnson & Johnson vaccine, going to people’s homes and vaccinate them. And do it once, and then you’re done. And it also had the advantage of just being one shot. And so a lot of people just really liked the prospect of getting just one dose, as opposed to two with Moderna and Pfizer. So there were going to be a sizable number of people who were going to really benefit from having this option of Johnson & Johnson. And now, for the next few days at least, that’s not an option.
- michael barbaro
Carl, what about hesitancy? What might this pause do to and for a U.S. public that already showed signs in some demographics, in particular, of being skeptical of COVID vaccines, despite data, as we’ve talked to you about many times, that shows how historically safe and effective all three of these vaccines are?
- carl zimmer
Well, if people just hear a few words, they might get concerned. They might hear vaccine, blood clot, oh my gosh, that’s bad.
- michael barbaro
Right.
- carl zimmer
So really, we’re going to have to see how well the U.S. government handles the messaging of what they’re doing in the days to follow, because what’s crucial for people to understand is that, first of all, this is so far an incredibly rare condition. If you look at 7 million people who have gotten this vaccine so far in the United States, and we only know of six cases of this particular condition, you know, that means that 99.999999% of people who got the vaccine didn’t get that condition.
- michael barbaro
Right.
- carl zimmer
So if you’re thinking about your odds, well, your odds of getting COVID are way higher right now, and the risks you face from COVID of ending up in the ICU and potentially dying are also, by comparison, incredibly high. So this is going to be the kind of information that public health officials are going to have to get out, and get out clearly, in the days to follow.
- michael barbaro
What you’re describing is essentially a messaging battle for the government, how easily can it communicate safety and the rarity of these blood clots. Do you have any sense yet, based on your reporting, of how the government is thinking of approaching the question of communicating that?
- carl zimmer
I think that the theme that the government is hammering on over and over again is that this is how government regulators keep us safe, that they are keeping a very careful eye on these new vaccines, and at even the slightest suggestion of a problem, they’re are going to take it very seriously and look very closely at it. That’s the message.
- michael barbaro
Carl, so far we have been talking about the domestic impacts of this decision on Johnson & Johnson’s vaccine, but every vaccine maker is attempting to put doses into arms across the world. So is the U.S. government. We all want as many people to be vaccinated as possible in every country. So how, if at all, does this pause impact people outside the U.S.?
- carl zimmer
The ramifications of these findings are pretty big right now. Johnson & Johnson was in the process of seeking authorization in Europe for their vaccine. They’re putting that on pause for now. There were such concerns in Australia that they decided that they’re not going to buy Johnson & Johnson vaccines at all.
- michael barbaro
Wow. That’s a very big deal.
- carl zimmer
It is. Johnson & Johnson had promised half a billion doses to an effort called COVAX to get vaccines to lots of countries that might not be able to afford to get them on their own. This development throws that into question. It’s not clear what COVAX is going to do about this. South Africa had been planning on using AstraZeneca to treat their health care workers. Then it turned out that AstraZeneca might not be effective against their particular variant of COVID, and so they said that’s OK, we’ll use Johnson & Johnson. Well, they’re probably not going to use Johnson & Johnson for now. So this is having impacts across the world.
- michael barbaro
So given just how high the stakes are, here and globally, for resuming J&J vaccinations, do you have any sense of how long this pause may last?
- carl zimmer
If it follows the example of what happened in Europe with AstraZeneca, I think this will be resolved in a few days. I think what’s happening now is that the F.D.A. and the C.D.C. are taking in new reports that might or might not represent more of these cases of these peculiar blood clots, and then they’re going to look at the data and figure out, well, what do we do next? Is this as significant a risk that we need to adjust how we give the vaccines out? One possibility is that they might restrict who gets the vaccine, simply to minimize risk. So far, the six cases are in women between 18 and 48. Does that mean that this vaccine represents a very small, but significant risk specifically for women? We don’t know yet. It could be that a bunch of cases involving men might come in today and tomorrow and in the next few days. We’ll see. But you could imagine decisions based on age or on sex or other things that might come out in the next few days.
- michael barbaro
Interesting. So this could result in an unpausing of the vaccine pretty quickly, but one where there are now restrictions and different guidelines about who can get the Johnson & Johnson vaccine in the U.S..
- carl zimmer
Yes. And what people have to recognize is that pauses happen all the time in the world of vaccines and drug development. There’s a huge amount of attention on this particular pause because we’re in a pandemic, right? But you just have to bear in mind that pauses happen, and they happen a lot. And then generally what happens is that the pause ends and things go forward.
- michael barbaro
That said, Carl, if you’ve just gotten the J&J vaccine, this pause period is one where you’re craving information. And I wonder what guidance, based on your reporting, should be given to people in that position.
- carl zimmer
First off, if you’ve just gotten the Johnson & Johnson vaccine, take a deep breath and remember that this condition seems to be incredibly rare. It may or may not have anything to do with getting this vaccine in the first place. Then just monitor your health. The F.D.A. and the C.D.C. have given a list of symptoms, including severe headache, for example. So if, in the three weeks after you get your Johnson & Johnson vaccine, you experience a severe headache, maybe a pain in your leg, call your doctor. Let your doctor know that you’re not feeling great, and tell them that you got the Johnson & Johnson vaccine. And then you and your doctor can take things from there. The chances are overwhelmingly likely that you’re not going to have these problems, that you’re not going to be calling your doctor about it, and you’re going to come out of this protected from COVID.
- michael barbaro
Which is a very good thing.
- carl zimmer
Which is a very, very good thing.
- michael barbaro
Well, Carl, thank you. We, as always, appreciate your wisdom.
- carl zimmer
Thank you.
- [music]
We’ll be right back.
Here’s what else you need to know today.
- archived recording (joe biden)
I’m now the fourth United States president to preside over American troop presence in Afghanistan. Two Republicans, two Democrats. I will not pass this responsibility on to a fifth.
- michael barbaro
In a speech on Wednesday, President Biden explained his decision to withdraw all American troops from Afghanistan by September 11th, saying that the United States had achieved its goal of ensuring that Afghanistan would never again serve as a launching pad for a terrorist attack on the United States.
- archived recording (joe biden)
I’ve concluded that it’s time to end America’s longest war. It’s time for American troops to come home.
- michael barbaro
Biden said that the drawdown would begin on May 1st, the deadline for withdrawal set by his predecessor, Donald Trump. But in a pointed warning, Biden admonished the Taliban against seeking to attack U.S. forces as they left Afghanistan.
- archived recording (joe biden)
And the Taliban should know that, if they attack us as we draw down, we will defend ourselves and our partners with all the tools at our disposal.
- michael barbaro
And.
- archived recording (david fowler)
So in my opinion, Mr. Floyd had a sudden cardiac arrhythmia, or cardiac arrhythmia due to his atherosclerotic and hypertensive heart disease, or —
- michael barbaro
On Wednesday, defense lawyers in the murder trial of Derek Chauvin sought to rebut claims that George Floyd died because Chauvin deprived him of oxygen, calling to the stand a former medical examiner for Maryland, Dr. David Fowler, who said that Floyd’s heart condition, drug use, and even carbon monoxide from the tailpipe of a nearby car contributed to his death.
- archived recording (david fowler)
All of those combined to cause Mr. Floyd’s death.
- michael barbaro
As medical examiner in Maryland, Fowler had previously ruled that the 2018 death of another Black man in police custody, Anton Black, was an accident, prompting a lawsuit from Black’s family. Finally, prosecutors in Minnesota said they would charge the white police officer who fatally shot Daunte Wright, a 20-year-old Black man, with second-degree manslaughter. Police officials have said that the officer, Kim Potter, appeared to have shot Wright by accident after mistaking her gun for her taser. Today’s episode was produced by Rachel Quester, Jessica Cheung, and Leslye Davis, with help from Alexandra Leigh Young. It was edited by M.J. Davis Lin, and engineered by Chris Wood.
- [music]
That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.
The Johnson & Johnson and AstraZeneca shots have been considered especially crucial for less developed and hard-to-reach parts of the world, because they are less expensive and easier to store than Moderna’s or Pfizer’s, and the Johnson & Johnson vaccine requires just one dose.
AstraZeneca’s shot is being used in at least 118 countries. Lately, amid shortages of that vaccine, some regions have pivoted to Johnson & Johnson’s: Two weeks ago, the African Union acquired 400 million doses.
Together, the two vaccines account for a third of the portfolio of Covax, the international effort to procure and distribute vaccines.
But it is becoming more apparent by the day that those shots are becoming afterthoughts in wealthy nations. After canceling Johnson & Johnson appointments, American states offered people the pricier Pfizer or Moderna vaccines instead.
The European Union said on Wednesday that it had acquired another 50 million doses of the Pfizer vaccine, allowing it to curb use of AstraZeneca’s vaccine and phase it out altogether next year. Many European nations have already restricted the use of that shot, after clotting problems emerged in a small number of recipients.
Those decisions, intended for domestic audiences, have nevertheless resounded in countries where variants are spreading, physical distancing is a luxury and there is no choice of shots.
Health officials fear that any setbacks in vaccinations could sow the seeds of the next calamitous outbreak, one that deluges hospitals and exports new mutations around the world. In those places, doctors said, the math is obvious: Many more people will die without the AstraZeneca and Johnson & Johnson vaccines than with them.
Amid the clotting concerns, the World Health Organization and African Union have not wavered in recommending the use of the AstraZeneca and Johnson & Johnson’s vaccines. In Britain, AstraZeneca’s vaccine remains the backbone of the country’s speedy inoculation campaign, despite people under 30 being offered alternatives. Congo, after spurning the AstraZeneca shot in light of unease in Europe, said on Tuesday that it would start the much-delayed inoculations next week.
And in Dakar, the capital of Senegal, people continued to line up on wooden benches on Wednesday for the AstraZeneca shot as they watched their children run through the corridors of a medical center.
“We don’t have a choice,” said Alioune Badara Diagne, 34, who lives in the city’s lively Ouakam neighborhood. Despite talk of vaccination pauses in wealthy nations and rumors of vaccine makers using Africans as “guinea pigs,” he said, Westerners themselves were continuing to be injected. He added, “The vaccine is our only hope.”
But in much of the world, the American regulators who endorsed Tuesday’s pause on Johnson & Johnson vaccinations act as sort of surrogate decision makers on drugs and vaccines, giving their hesitation extra weight in African nations.
“I became even more skeptical when I heard that the United States suspended Johnson & Johnson,” said Lawmond Lawse Nwehla, 32, an engineer in Dakar. “They said it was effective and then they stopped it. So I wonder why.”
In immediately pausing the use of Johnson & Johnson’s shot, American regulators reacted more aggressively than did their British counterparts, who backed the AstraZeneca vaccine even as they investigated clotting cases.
The costs of the American approach were already evident in Europe, where many nations stopped and then restarted AstraZeneca vaccinations, only to find that it had become a pariah. Most people in France, Germany and Spain distrusted the vaccine.
“Once you take the cork out of the bottle, I’m not sure you can get it back in particularly easily,” said Anthony Cox, a vaccines safety expert at the University of Birmingham in England.
South Africa immediately copied the American pause on Johnson & Johnson vaccinations, infuriating doctors who are still clamoring for shots, especially in remote parts of the country. In February, health officials dropped the AstraZeneca vaccine over its limited efficacy against a dangerous variant there.
To date, only half of 1 percent of the population is vaccinated, and a mere 10,000 shots are being given each day. At that rate, it could take weeks, if not longer, for a single rare blood clotting case to emerge, said Jeremy Nel, an infectious disease doctor in Johannesburg. He was dismayed by the decision to pause shots, given the risk to vaccine confidence in a country where two-fifths of the people say they have no intention of being vaccinated.
“The slower you go, that failure is measured in death,” Dr. Nel said. “Even if you delay for a week, there is a non-trivial chance that will cost lives.”
The solution in many European countries — to stop using seemingly riskier vaccines in younger people, who are at lower risk from Covid-19 — would be unworkable in Africa, where the median age in many countries is below 20.
And any further restrictions would compound the hurdles facing Covax, among them a paucity of funding for every part of inoculation programs beyond the touchdown of doses at airports.
Mali, in western Africa, has administered 7 percent of the AstraZeneca doses that Covax has delivered. Sudan, in eastern Africa, has given 8 percent of the doses it has received.
Skittishness over the AstraZeneca and Johnson & Johnson vaccines, analysts fear, could stoke demand for Russian- and Chinese-made shots about which far less is known. As it is, some global health officials have turned their attention to the Novavax vaccine, which is not yet authorized but makes up a third of Covax’s portfolio.
“Even at this stage of the pandemic, we have our fingers crossed that some vaccine will work to help vaccinate developing countries, instead of ramping up production of vaccines we know work,” said Zain Rizvi, an expert on medicines access at Public Citizen, an advocacy group.
In Kenya, where enthusiasm for vaccines is high in cities but perilously low in rural areas, “the story about blood clots from Europe could not have come at a worse time,” said Catherine Kyobutungi, the director of the African Population and Health Research Center there. “Even those who were perhaps on the fence, and leaning toward getting vaccinated, all of a sudden had second thoughts,” she said.
The American pause on Johnson & Johnson shots promised a second media furor.
“When the F.D.A. suspends, it makes headlines for days,” she said. “When it lifts the suspension, it doesn’t make as many headlines.”
Mady Camara contributed reporting from Dakar, Senegal.
Benjamin Mueller is a United Kingdom correspondent for The New York Times. Before that, he had been a police and law enforcement reporter on the Metro desk since 2014. More about Benjamin Mueller
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