Reporting of recombinant adenovirus-based COVID-19 vaccine adverse events in online versions of three highly circulated US newspapers

ABSTRACT

Newspapers’ reporting of adverse vaccine events may influence their readers vaccination behaviors. The purpose of this study was to examine the nature and extent of coverage of Johnson and Johnson (J & J) vaccine’s adverse events reported in the online versions of the three most widely circulated US daily newspapers from April 13–25, 2021. Articles were identified in published online versions of the three most widely cited newspapers in the United States, using several databases. Dedoose software was used to apply a mixed methods approach to the 110 articles identified. The seven overarching themes were as follows: (1) J & J vaccine characteristics (n = 78); (2) Description of the adverse events (n = 183); (3) Emphasis that it is a rare event and vaccine is still safe (n = 89); (4) Health authorities’ investigation (n = 55); (5) Pause in administering J & J vaccine (n = 83); (6) Vaccine fear and anxiety and increased hesitancy (n = 58); (7) J & J role and impact (n = 108). Each theme included a series of subthemes. Overall, the newspaper coverage was aligned with handling of the pause from authoritative health agencies in the US. The findings of this study help to better understand how the US media covered adverse events related to the J & J vaccine, and provides insight for public health professionals regarding acceptance COVID-19 vaccines. Monitoring media coverage related to vaccine adverse events may help public health officials to develop new approaches to adequately inform the public, prevent misinformation, and maintain the optimal vaccination uptake.

KEYWORDS:

• COVID-19
• vaccines
• vaccine hesitancy
• newspapers
• adverse events
• health information seeking

Introduction

Deployment of safe and effective vaccines against the COVID-19 virus has been described as the most effective method and critical tool for controlling the pandemic, over 3.1 billion vaccine doses have been administered globally at the time of this study.^1,2 Global research efforts have led to the development of multiple vaccines, eight of which are currently listed on the World Health Organization (WHO) WHO Emergency Use Listing (EUL). In the United States (US) at this time, the Food and Drug Administration (FDA) has authorized for emergency use of three COVID-19 vaccines.^3,4

Two of these are messenger RNA (mRNA)-based vaccines, Moderna and Pfizer/BioNTech, which were granted emergency use authorizations (EUA) by the FDA in December of 2020.^4,5 On February 27, 2021, the FDA issued an EUA for the adenoviral vector-based vaccine, the Ad26.COV.2.S vaccine developed by Janssen Biotech, Inc., a Janssen Pharmaceutical company of Johnson & Johnson (J & J).⁶ The development of the J & J vaccine has been touted as an excellent complement to two previously available vaccines.⁷ As a single-dose vaccine, not requiring sub-zero storage temperatures, the J & J vaccine was said to provide additional flexibility, availability, and access for Americans wanting vaccination.⁸

On April 13, 2021, the Centers for Disease Control (CDC) and FDA recommended a pause of the administration of the J & J vaccine to allow for further review of reports of incidents of thrombosis with thrombocytopenia (TTS) and related cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination.⁹ CVST is a rare and serious condition that involves blood clots with low platelets. At that time, reports of six U.S. cases of CVST were identified out of 6.8 million doses of the (J & J) vaccine that had been administered in the U.S.^9,10 By April 21, six additional cases of CVST with thrombocytopenia and three cases of non-CVST TTS following administration of the J & J vaccine were reported to the Vaccine Adverse Event Reporting System (VAERS), a national early warning system used to detect unusual or unexpected patterns following vaccination.^11,12

Although reviews of this nature are standard procedures in vaccine development, media coverage of these events may have alarmed the general public and contributed to the inability to fully comprehend the issue. Public health officials from the National Institutes of Health (NIH) and other agencies attempted to reassure the public with the message that the federal agencies were responding quickly to review adverse events,^13,14 and that the systems are in place for reporting, tracking, and monitoring these occurrences. Yet, the lack of knowledge surrounding these adverse events, combined with information overload from social media, television, and the internet, often being incorrect or misleading, may lead the public to have serious concerns about the quality and safety of vaccines.^15,16 The news media can play an important role in increasing awareness of routine scientific processes. Providing correct information is essential for increasing public confidence in the safety of vaccines and quelling misrepresentation of adverse effects.^15–18

While professional reports intended for healthcare workers and public health officials, i.e., the CDC’s Morbidity and Mortality Weekly Report,¹⁰ include specific medical terminology, newspaper reports more frequently employ plain language as the goal is to help consumers understand complex topics. The NIH supports the use of plain language to improve the effective communication of health information to the general public.¹⁹ Most of the news media strives to be a trusted source of reliable health information that is written and presented in a manner that is easy for its readers to understand, and research has shown that media reporting can influence vaccination rates.²⁰

Similarly, newspapers’ reporting on the J & J vaccine’s adverse events may influence their readers and their vaccination behaviors.¹⁵ Hence, the purpose of this study was to examine the nature and extent of coverage of J & J vaccine’s adverse events reported in the online versions of the three most widely circulated US daily newspapers from April 13–25, 2021. This coincided with the period of the pause and subsequent lift of the pause.

Methods

We identified articles published in the online versions of the three most widely cited newspapers in the United States, The New York Times (NYT), USA Today, and The Wall Street Journal (WSJ).²¹ These newspapers report a combined daily (print and digital) circulation of roughly 11.06 million.^22–24 Newspapers were identified using the following databases: Factiva, a Dow Jones company; EBSCO’s Academic Search Premier, and the New York Times online search engine, www.nytimes.com. To understand and capture the widest coverage, we searched the headlines and full text of articles published in those sources for the following terms: “blood AND clot*” or “clot*” AND “J & J” or “Johnson & Johnson” or “Johnson and Johnson” or “Janssen.” Using the Factiva database, we also executed this search filtering the results to include articles with the company name: Johnson & Johnson. The * symbol expands the search to include plural and other suffix endings.

The search yielded 110 articles, which were uploaded to Dedoose, a web-based software program for a mixed methods research.²⁵ A codebook was developed consisted of pre-established codes as well as those generated from the data. A hybrid approach to data analysis was applied, whereby the data were first explored deductively to examine a priori domains of interest (descriptions of the adverse events, vaccine fear, anxiety, and hesitancy) and then inductively to allow posteriori themes to emerge from the analysis.²⁶ An initial round of coding was conducted by one researcher (CHB) and refined by a second (AK). Developing and refining themes was thus an interpretative process.²⁷ The institutional review board at William Paterson University does not review studies such as this, as human subjects are not involved.

Results

A total of 110 articles were published about blood clots and J & J during this 13-day time period (Table 1).

Table 1. The source and number of reviewed articles related to J & J vaccine’s adverse events

Newspaper source	The number of reviewed articles
New York Times	54
The Wall Street Journal	32
USA Today	24
Total	110

Below we present results from the content analysis, highlighting major themes related to TTS/CVST events and the J & J vaccine and covered by the three most widely circulated US daily newspapers. Multiple themes were identified, grouped into seven overarching topics (Table 2). Within each overarching topic, multiple subthemes were identified.

Table 2. The count of major themes and subthemes appearing in coverage of Johnson & Johnson’s vaccine adverse events in online versions of three widely circulated US newspapers

Theme	Subtheme	Count
1. J & J vaccine characteristics	Similarities to Astra-Zeneca vaccine Importance of single-shot vaccine for underserved populations. Lauding of single-dose vaccine as a“ game-changer.” Preference for the J & J vaccine over mRNA vaccines.	50 16 7 5
2. Description of the adverse events	Conveying health authorities’ description of blood clots adverse events. Description of blood clots adverse events. Noted that women are at increased risk.	121 65 5
3. Health authorities’ investigation	Reports on CDC investigation.	55
4. Emphasis that it is a rare event and vaccine is still safe	Emphasizing that this is a rare event. Noting that COVID-19 infection puts people at risk of blood clots. Conveying the message that the vaccine is safe.	89 28 23
5. Pause in administering the J & J vaccine	Reports on decision by CDC and FDA to pause the J & J vaccine. Reports on critiques of pause. Reports on lifting the pause.	86 6 22
6. Vaccine fear and anxiety and increased hesitancy	Reports of fear and anxiety among the public. Reports on increased hesitancy as the consequence	20 40
7. J & J role and impact	J & J role and investigation of adverse events. Reports on problematic J & J facility. Impact on J & J finances.	89 8 11

J & J vaccine characteristics

In 78 instances, articles provided some description of the J & J vaccine. In 50 instances, the vaccine was compared to the Astra-Zeneca vaccine as using a similar technology: “Both viral-vector vaccines use a modified common-cold virus to carry genetic instructions that teach a human cell to make a version of the spike protein found on the surface of the COVID-19 virus” [WSJ, April 18th]. In addition, similarities between the two vaccines were noted as the blood-clotting disorder manifested among recipients of J & J’s COVID-19 and Astra-Zeneca vaccine: “The reports echo similar ones involving rare clotting disorders seen in Europe among recipients of the COVID-19 vaccine manufactured by AstraZeneca PLC” [WSJ, April 13th]. Being a single-shot vaccine was noted in 7 articles, often described as a “game changer” or a breakthrough strategy in combating COVID-19 pandemic: “The one-shot vaccine played an important role in the country’s strategy to combat COVID-19 as it meant more people could become protected sooner as vaccine eligibility opened to millions of younger people” [USA Today, April 13th]. In 16 articles, the single-shot vaccine was described as particularly important for high-risk and underserved populations: “Johnson & Johnson vaccine has been lauded as a way to reach high-risk and underserved communities, such as people who are homebound” [NYT, April 15th]. In 5 articles, it was noted that the J & J vaccine may be preferential for those who may be skeptical of mRNA technology used in Pfizer and Moderna vaccines: “Some people are more comfortable with the vaccine because it doesn’t use the relatively new messenger RNA technology used by Pfizer and Moderna” [WSJ, April 25th].

Description of the adverse events

There were 183 observed instances in which the articles described the adverse event related to the vaccine. Most commonly (n = 121), articles cited reports from the health authorities on the vaccine recipients who developed blood clots, often reporting details such as the number of cases, their age, and gender: “Health authorities are investigating six reported cases of blood clots, including one death. Six women, ages 18 to 48 years, were reported to have experienced the clots as well as low levels of platelets, which help with clotting” [WSJ, April 13th]. Several reports (n = 5) emphasized that younger women are at increased risk: “Thirteen of the 15 cases following the J & J vaccine were among women between 18 and 48 years, suggesting younger women might be at higher risk. Two cases were in women 50 and older” [WSJ, April 13th]. Articles (n = 67) provided a description of the event for their readers, i.e., “The type of blood clot seen in some people receiving the J & J vaccine was called a cerebral venous sinus thrombosis, which can prevent blood from draining out of the brain and can lead to a hemorrhage” [WSJ, April 13th]. Articles further described symptoms that vaccine recipients should look for: “Anyone who develops an unusual or severe headache during that time, severe abdominal pain or a painful, swollen leg, possibly accompanied by a skin rash of tiny reddish-purple spots, should seek immediate medical attention” [USA Today, April 14th].

Health authorities’ investigation

A subset of reviewed articles reported specifically on the CDC investigation in response to blood clot reports (n = 55). For example, NYT reported: “CDC advisory panel suggested that it would be a week to 10 days before they had enough information to assess the vaccine’s risks and could make a decision about its future” [NYT, April 15th].

Emphasis that it is a rare event and vaccine is still safe

While providing information on the event, articles routinely (in 89 instances) emphasized that this is an extremely rare event: “It’s six out of the 6.85 million doses, which is less than one in a million” [USA Today, April 13th]. One article quotes the NYC mayor who credits the vaccine with slowing down coronavirus: “More than 230,000 of the company’s vaccine doses had been administered without blood clots. Hospital admissions and the case positivity rate are falling [WSJ, April 13th].” Some articles (in 28 instances) noted that COVID-19 itself puts people at risk of serious blood clots, even more so than any plausible estimate of the vaccine effect. However, as one article noted, vaccines have a higher threshold for safety: “For vaccines, the threshold for safety is generally higher than for other kinds of medications” [NYT, April 13th]. Furthermore, in 23 instances, reviewed articles attempted to convey the health experts’ message that vaccines are still safe and that the benefits of the vaccine outweigh the risks: “Health experts say J & J’s vaccine is plenty effective. Importantly, it was 85% effective against severe COVID-19 at least 28 days after vaccination” [WSJ, April 13th].

Pause in administering J & J vaccine

Related to the CDC investigation, articles also report on the decision made by the CDC and FDA to pause administering the J & J vaccine (n = 83). Articles emphasize that the decision was taken “as the CDC gathered more information on the condition and more cases could potentially be identified” [USA Today, April 23rd], and justify CDC response as taken out of abundance of caution, i.e., “CDC and FDA acknowledged the blood clots appear to be rare and recommended the pause out of an “abundance of caution” to alert health care providers and investigate the cases” [USA Today, April 15th]. Another article points out that “Vaccination and infectious disease experts praised the government’s quick recommendation to pause the use of J & J’s vaccination and then hold an open meeting to evaluate the data” [WSJ, April 14th]. However, articles (n = 6) also quote health experts who critiqued the pause as the halt sends an alarming message to the public: “The longer the pause lasts, the more it could damage the public’s perception of the COVID-19 vaccines and ultimately hinder government efforts to combat the pandemic” [WSJ, April 16th]. As the pause came to an end, articles report (n = 22) on the FDA decision: “The FDA ended its recommended pause on the J & J COVID-19 vaccine on Friday and will add a warning to its label to note the potential risk of rare blood clots” [NYT, April 23rd].

Vaccine fear, anxiety, and hesitancy

Reviewed articles often discussed impact of blood clots reports on fear, anxiety, and hesitancy related to vaccine among the public (n = 58). While health experts attempted to reassure the public that the J & J vaccine pause is no reason to panic: “The overwhelming opinion of public health officials is: Don’t panic. Getting protected against the coronavirus is still undeniably the right choice for your health and the safety of others” [USA Today, April 20th], they also acknowledged that the pause adds to uncertainty among the public: “The decision to pause the use of this vaccine is also controversial; many public health experts are worried that this will hinder vaccination rates and erode confidence in people who are reluctant or skeptical of vaccines” [NYT, April 15th]. Of particular concern is that the pause may contribute to vaccine hesitancy, “particularly in communities of color that have been hit hardest by COVID-19” [USA Today, April 16th]. As the vaccine became available again, articles reported a relief that the single-dose will help protect hard-to-reach populations: “States are counting on the easier-to-store, one-dose option to help protect hard-to-reach populations, including people who are experiencing homelessness, the homebound and incarcerated individuals” [USA Today, April 24th].

J & J role and impact

Articles also reported on a variety of themes related to the company (n = 108). These articles reported that J & J also is investigating the clot-related risk of its vaccine. One article noted that, “Company researchers said there wasn’t sufficient evidence to establish that the vaccine causes the rare condition” [WSJ, April 20th]. In 8 instances, articles reported on an FDA report regarding conditions and training at a Baltimore factory where the J & J vaccine was being manufactured. However, articles stated that “no vaccines from the plant have been distributed in the U.S.” [USA Today, April 21st] Additionally, in 11 instances, articles discussed the financial impact of the vaccine pause on J & J. While pointing out that U.S. stock futures wavered after health authorities recommended a pause, one article states: “J & J has provided the shots on a nonprofit basis and that investors are overreacting by selling the stock” [WSJ, April 13th].

Discussion

The news media play an important role in disseminating vaccine-related information to the public, including provision of information regarding COVID-19 vaccines. Previous studies have shown significant media attention influences vaccination uptake.^28,29 It comes as no surprise that COVID-19 vaccines have received abundant media coverage as they may be seen as the way out of pandemic, but also because of the issues of safety and occurrence of adverse events. The side effects and safety of the vaccine are often cited as a major reason for vaccine hesitancy by the general public.^30,31 Hence it comes as no surprise that three widely circulated US newspapers provided a significant amount of coverage to the J & J blood clotting events.

The reviewed articles often described J & J vaccine as a “breakthrough” in combating COVID-19 as it requires a single shot, which may appeal to high-risk and underserved populations, as well as those who may be skeptical of mRNA technology used in Pfizer and Moderna vaccines. Like the Oxford AstraZeneca vaccine, the Janssen vaccine uses a viral vector platform. In describing adverse events parallels were often drawn to similar cases among those who had received the Oxford AstraZeneca vaccine. However, most articles emphasized that this is a rare event, and that the vaccine is still safe. In their coverage, newspapers also often informed those who received the vaccine to seek medical attention if they experience specific symptoms within 3 weeks of vaccination.

Articles provided significant coverage of the decision made by CDC and FDA to pause administering J & J vaccine. While the coverage was mostly supportive of the health authority’s decision, articles also quoted health experts who critiqued the pause as potentially contributing to vaccine fears, anxiety, and hesitancy among the public. Newspapers noted that public health officials have a complicated task of communicating risk and the challenge of balancing caution and the urgent need for vaccination during this pandemic. Overall, the newspaper coverage was aligned with handling of the pause from authoritative health agencies in the US, which often stated the reasons for the pause, the need for review of data, and the subsequent lift, coupled with details about updated risk factors.^32–34

In describing events surrounding the J & J vaccine, reviewed articles generally relied on health authorities and J & J sources. Our findings confirm the previous findings that the government, professional associations, and scientific companies’ sources are the most frequently used by journalists when reporting scientific controversies.³⁵ Journalistic efforts about the temporary halt required a nuanced approach to avoid contributing to decreased public confidence in vaccine safety and reduced vaccination uptake. Newspaper journalists may have the complicated task of informing the public but also being cautious and not sensationalistic. However, the use of other sources, i.e., patient stories, in addition to scientific experts, may encourage the coverage of novel issues with different perspectives.³⁶ Maintaining public confidence in vaccines, and public understanding that regulators take potential problems seriously, requires that the messaging should not contribute to hesitancy.

The COVID-19 pandemic, including events related to vaccines, has resulted in an ‘infodemic’ given the overabundance of media coverage for consumers to absorb.³⁷ Prior studies on newspaper coverage of the COVID-19 pandemic indicated that newspapers captured a wide range of shifting information and messaging from mitigation efforts and related policies and recommendations, to rates of infection and death.^38–40 Thus, public health professionals may face difficulty in sifting through information to rebuke inconsistencies and to make sound recommendations among a competitive informational situation. Randolph and Viswanath point out that, “Public health practitioners have to capture not only the attention of the public amid such competition, but also motivate them to change health behaviors that are often entrenched or to initiate habits that may be new or difficult.”¹⁵

Events surrounding J & J vaccine adverse events have highlighted that a strong communication plan is an essential tool for public health officials. By translating complex and data-driven information, health officials can provide clear and accurate information to the media and the public. Similarly, news reporters are an essential link in the communication chain as their stories contribute to the public’s understanding of complicated medical topics such as vaccine delivery mechanisms and risks and benefits. News stories can help to illustrate and simplify complicated processes like clinical trials, scientific and medical research, systems for reporting adverse effects, and crafting of health policies so that members of the public gain a better understanding of information they will need to make individual and family health decisions.

There are limitations of this study that necessitate mention. The cross-sectional design does not allow for representation of the data over time. Furthermore, the findings are not generalizable to other newspapers and only represent coverage and observations in the three widely circulated newspapers included, which are based in the United States. Inclusion of additional newspapers may have revealed different results. It should also be noted that the calculation of circulation can utilize different formulas and inclusion criteria in calculations, this could alter the ranking of most circulated. The limited number of days of observation could also limit the results, despite being intentionally chosen to represent the period of time this topic was being highly discussed. Furthermore, the time frame of the study encompassed the pause and subsequent lift, when it could be assumed news on this would be most relevant. Therefore, viewpoints were not captured outside of this timeframe. We did not analyze the use of sources in the articles and their relation to the message of articles. Despite these limitations, this study revealed comprehensive coverage of the J & J pause in the most widely circulated newspapers in the United States.

The findings of this study help to better understand how the U.S. media covered adverse events related to the J & J vaccine, and provide insight for public health professionals regarding acceptance of COVID-19 vaccines. Although relying on media and journalists to improve vaccine acceptance and to calm the public fears would be naïve, monitoring media coverage related to vaccine adverse events may help public health officials to develop new approaches aimed to adequately inform the public, prevent misinformation, and maintain the optimal vaccination uptake.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.