The Johnson & Johnson vaccine pause and the media’s role in communicating risk

Early yesterday, the Food and Drug Administration and the Centers for Disease Control and Prevention recommended that the US pause distribution of Johnson & Johnson’s coronavirus vaccine following reports of blood clotting in six recipients, all of them women aged between eighteen and forty-eight, one of whom has died and another of whom is critically ill. States, businesses, and federal facilities quickly followed the guidance. Around seven million people have received the J&J vaccine in the US; the pause is intended to allow officials and experts to investigate the instances of clotting and whether there are more of them, and to communicate care protocols to doctors, given that typical clotting treatments could, in the type of cases at issue here, prove harmful. Bolstering public confidence is also at issue: a source with knowledge of the deliberations told the Washington Post that officials agreed that “there is a tremendous need for vaccines, but also a tremendous need for trust in the vaccine.”

The latter rationale, in particular, quickly sparked a debate in media circles. Some journalists and experts said that the pause ought to strengthen confidence among vaccine skeptics, by projecting high caution and transparency. Others disagreed. “I appreciate the people saying ‘we should feel *more* confident because they’re investigating,’ which is true—it works on me!” Zeynep Tufekci, a sociologist and prolific commentator on the pandemic, wrote on Twitter. “But the word ‘should’ is doing a lot of work there. Meanwhile, let’s check in on how this affects dynamics of human cognition, media, and social media.” On the cognition front, some observers made the case that many members of the public will interpret the pause not as reassuring, but as justification for their skepticism, not only around the J&J vaccine but also the Pfizer and Moderna shots; on the media front, press critics questioned the ability of news organizations to clearly separate the pause from unwarranted broader panic. Some experts argued that officials didn’t have any good communications choices around the clotting issue. Others, including Natalie Dean, a biostatistician at the University of Florida, suggested that the agencies erred in allowing “dead time” to elapse between the announcement of the pause and a briefing at which officials worked to contextualize it—a gap in which “the media scrambles for insights but everyone is short on details.”

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As the day went on, Nate Silver, of the data-driven news site FiveThirtyEight, observed a split, of sorts: “People in the public health sphere seem to be pretty agnostic on what effect the J&J pause will have on vaccine hesitancy (maybe leaning toward it being a slight positive), while the sentiment of people who cover politics/media is toward it being a clear negative.” Silver, who is in the latter camp, stressed that he could be wrong, but noted that both camps have “relevant expertise,” given “how much COVID is a political/media focal point.” As someone who covers media but has limited public-health expertise, my initial thoughts ran along similar lines to Silver’s. The idea that a pause will boost confidence seems, to me, to assume that skeptics will interpret it, and its attendant nuances, rationally, and not freak out about the alarming signal sent by the decision itself. Transparency is essential, but officials can be transparent about possible issues with a vaccine without suspending it; if anything, the pause recommendation was as much an act of amplification, turning exceedingly rare incidents into a wall-to-wall news story. And as we have seen, for example, with masks, the messaging judgments of health officials are open to question. Ezra Klein, of the New York Times, noted yesterday that “there’s no actual evidence the FDA knows how to manage public psychology correctly on this.”

Then again, I could be wrong. Much of the debate around the pause and vaccine confidence has been rooted in speculative behavioral assumptions that may not play out as we expect, and wrongly imply a uniformity of motivation among vaccine skeptics; plus, as G. Elliott Morris, a data journalist at The Economist, pointed out, “relentlessly tweeting ‘oh my GOD why would the CDC do something so STUPID!!’ is not really the way to convince people who are skeptical of scientists or medical institutions that the vaccine is safe.” It’s possible to go round in circles here; to forget, too, that the science here is complicated and contested, and that public confidence is far from the only reason for the pause. There are a multiplicity of factors to consider, including official reassurances that suspending J&J won’t impede the overall vaccine rollout, and the fact that pauses are common after a new medical product goes on the market.

Still, this isn’t a normal vaccine rollout—it’s universally urgent, and is thus occurring under an intense media spotlight. Some journalists argued yesterday that the messaging around the pause is the responsibility of health officials more than journalists, who, after all, are obliged to cover such interventions. Given the intense spotlight, however, the media is unavoidably a crucial actor in this story, and not just as a passive conduit. Our choices matter. Since COVID vaccines came on line, experts have advised news organizations not to hype stories about very rare potential side effects. Officials acting dramatically on such incidents is, clearly, a very big story. But their actions do not, in themselves, change the underlying available data. So how should we think about reconciling these seemingly contradictory newsworthiness dynamics?

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Yesterday, I posed a version of this question on Twitter. Jay Rosen, a journalism professor at NYU, advised covering the pause as “a high risk maneuver,” while also pulling in various points of view: “Only multiperspectival reporting gets you there,” he wrote. Katya Zimmer, a science journalist (and friend of mine), said that “whether official advice or mere observation,” her approach would be similar: “find a ton of experts and let them guide the story.” Steve Katz, the publisher of Mother Jones, said that his newsroom had debated the same question, and shared a resultant story, by Kiera Butler, concluding that officials had no good options but ultimately made the right decision. Other outlets published nuanced explorations of the issues at stake, including vaccine confidence, without reaching a judgment. Multiple outlets produced explainers aimed at people who recently got the J&J shot. Numerous reporters, or the experts they cited, found different ways of stressing the minuteness of the clotting risk, should a link to the J&J vaccine be proven—by visualizing it, or by comparing it to the greater likelihood of being in a car accident, or dying of COVID. Some headlines centered the extreme rareness of the clots. Others made (sometimes greatly) more sweeping references to blood clot “concerns” or “fears.”

Being specific, and not sensationalist, is usually a good idea, especially when it comes to headlines, tweets, and other brief formats. But there are no easy, failsafe answers here. The J&J pause is yet another example of a profound media challenge that I’ve explored throughout the pandemic—the absence of certainty and ready-made expert consensus, within a media ecosystem that prizes those things. And there’s a newer challenge here, too: With vaccinations and reopenings proceeding apace, but COVID still very prevalent, we are in a moment where our collective interpretation of risk, and what constitutes it, is being stretched. The public-health risks of failing to impose tough restrictions last year were comparatively clear; the J&J pause is both highly risk-averse and highly risky, depending on how you look at it. It’s the media’s job to communicate these competing calculations and the increasingly complex—and ambiguous—variables that go into them. That is a very hard job indeed.

Below, more on vaccines:

  • The Europe precedent?: The type of clotting observed in the six Johnson & Johnson recipients is similar to that observed in very rare cases that regulators in Europe have linked to AstraZeneca’s coronavirus vaccine, which has been widely distributed there; many European countries suspended their AstraZeneca rollouts and, in some cases, have continued to recommend restrictions on its use, especially among younger people. According to one recent poll, more than half of respondents in France, Germany, and Spain now view the AstraZeneca vaccine as unsafe—a datapoint that Silver wielded on Twitter yesterday to bolster his criticism of the J&J pause. The situations, however, aren’t entirely comparable: vaccine skepticism manifests differently in different places, and the AstraZeneca vaccine has been embroiled in a string of controversies in Europe related to supply issues and apparent geopolitical sniping. As I wrote in February, news organizations both furthered that confusion and got stuck in the middle.
  • Boosting confidence?: On Sunday, Brian Stelter, CNN’s chief media correspondent, said that Fox News personalities should be more forthcoming in sharing their vaccine stories, especially given high levels of skepticism among Republican voters. “Live on-air vaccinations and personal testimonials and videos and ‘selfies’ are all helpful,” he argues. “They show that it’s safe and easy.” Since then, Fox stars and other right-wing media figures have ridiculed Stelter’s suggestion; Glenn Beck tweeted a picture giving CNN the middle finger. “They can mock me, they can downplay their influence, they can say that getting vaccinated is a personal choice—fine,” Stelter responded yesterday. “But big platforms come with big responsibilities.”
  • “Vaccine hesitancy”?: Writing on Twitter yesterday, Stefanie Friedhoff, a journalist and faculty member at Brown University’s School of Public Health, argued that we should retire the term “vaccine hesitancy,” which in her view has become “a catch-all that misrepresents, blames people over systems, and doesn’t help anything.” Instead, she wrote, “the words to start using are: Vaccine confidence. Intent to get vaccinated. But most importantly, we need to stop saying any of these words when it’s not actually about behavior but about the two most important drivers of why people don’t get vaccinated: access and misinformation.”

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Jon Allsop is a freelance journalist. He writes CJR’s newsletter The Media Today. Find him on Twitter @Jon_Allsop.