But production problems at a Baltimore factory operated by Emergent BioSolutions, Johnson & Johnson's subcontractor, had serious consequences for the vaccine. Due to a major manufacturing accident that resulted in a two-month business interruption, Johnson & Johnson was essentially forced to sit out the brunt of the pandemic in the United States, while Pfizer and Moderna, the other federally licensed vaccine manufacturers, held almost all of the nation's vaccine supplies.
Johnson & Johnson had to throw away the equivalent of 75 million cans, and regulators in Canada, South Africa and the European Union have also decided to withdraw an additional million cans from the Baltimore facility. By the end of this month, the company was only able to deliver a quarter of the 100 million cans it had promised the federal government.
Dr. Alaska chief medical officer Anne Zink said Johnson & Johnson's shot in her state fell victim to its own timing. By the end of February, when it was approved by the Food and Drug Administration, Alaska had figured out how to get two-dose vaccines into remote areas, which made the one-time vaccination less critical than it originally imagined.
Dr. Clay Marsh, West Virginia's Covid-19 tsar, said the Johnson & Johnson hiatus and subsequent approval – more than two months after that of Pfizer and Moderna – deprived it of a "halo effect." By the time West Virginia had all three vaccines available in sufficient quantities, he said, "People were starting to understand this concept that maybe there is something better to be vaccinated with Pfizer and Moderna."
The Johnson & Johnson shot also suffered from a "social network effect," said Andrew C. Anderson, a professor of public health at Tulane University who studies vaccine reluctance. Most Americans who were vaccinated in the first few months of the vaccination campaign were given Moderna and Pfizer syringes, so their friends and family were less likely to deviate from them and accept another brand.
In Louisiana, hospitals in the New Orleans area have started offering the Johnson & Johnson shots to people on their way out of the emergency room. The assumption is that people are more likely to accept the vaccine if a doctor who treated them tells them to take it. And in Arkansas, where only a third of the population is fully vaccinated, state officials are offering Johnson & Johnson cans to farm, manufacturing, sewage and poultry workers with gift certificates for hunting and fishing licenses as rewards.