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We’ve heard the question from friends, family and dozens of readers: Should people who received the Johnson & Johnson Covid vaccine in a single injection be given a booster shot?

Karen, a Morning reader in Michigan, wrote: “Since I got mine in March, I have been wondering what the facts are. I’m scared. ”Leah in California wrote,“ Information on J.&J. Is not being released at all! Lauren from Nashville asked, “What is the advice for us?”

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

The issue of booster shots for the other two vaccines used in the United States – the double-shot vaccines from Moderna and Pfizer, both of which are based on a genetic technology known as mRNA – has received more attention. . Many experts believe that at least immunocompromised people and the elderly are likely to benefit from a third injection.

The situation is more murky with J. & J.’s single-injection vaccine, which uses more traditional viral technology. NOT A WORD. has not received as much attention because only 8 percent of vaccinated Americans have received the vaccine. But that still covers 14 million people, and a lot of them want advice.

From the start, J. & J. was found to be less effective than the other two American vaccines. The latest CDC data suggests the gap could widen over time, in part because of the Delta variant. “All the evidence we have has shown that J. & J. to be less effective in blocking both infections and hospitalizations, ”Dr. Michael Lin of Stanford University told us.

About one in 20,000 J. & J’s. Colorado recipients have been hospitalized with Covid at some point in a recent week, according to the state, which releases statistics by vaccine type. For Pfizer, the share was one in 27,000, and for Moderna, one in 32,000.

It is true that one of these chances remains extremely low. Dr. Linda-Gail Bekker of the University of Cape Town, who co-led a recent study by J. & J. and the Delta variant, told The Times: “We believe this vaccine does what it was designed to do, which is to keep people from going to the hospital and keep them from ending up in care. intensive and die. “

Yet offering people even greater protection against a severe case of Covid has enormous value. And given Delta’s contagiousness, the odds that a J. & J. recipient would be infected with a less severe case – and infect others – seems real enough to merit attention.

With many vaccines, not just for Covid, multiple injections are the norm.

That the Food and Drug Administration has approved J. & J. because a single injection vaccine has never been a statement as to whether a second injection would provide additional protection. It happened because the data showed that the J. & J. the vaccine was quite effective after just one injection, and scientists and regulators felt the urgency to put Covid vaccines in people’s arms.

Experts have long speculated that the government would possibly recommend a second move. Last month J. & J. announced internal research showing that second injections stimulate immune responses. President Biden’s surgeon general Dr Vivek Murthy has signaled that regulators are likely to approve a second injection in the coming months.

But a lot of J. & J. recipients are less interested in receiving a second J. & J. than a follow-up injection with the Moderna or Pfizer vaccine. They know that J. & J. appears to be less effective than other vaccines, and some J. & J. recipients were frightened by reports of a very rare but serious blood clot.

Notably, many physicians and some prominent experts who have themselves received the J. & J. vaccine chose to receive a Moderna or Pfizer follow-up vaccine. The list includes Bill Enright, CEO of Biotechnology; Zoe McLaren, health economist; and Angela Rasmussen, a distinguished virologist. The city of San Francisco has also started offering a Moderna or Pfizer booster to J. & J. recipients about a month ago.

There is little data on these vaccine combinations, which is probably the main reason for caution. But there is data on another relevant combination.

The AstraZeneca vaccine – which is given in many countries but not in the United States – is similar in design to the J. & J. vaccine. Many people in Europe and Canada received AstraZeneca for their first shot and Pfizer for their second, and they seem to be doing well.

This approach is sometimes described as “mix and match” and it makes intuitive sense. People get the immune benefits of two different types of vaccines.

“I think I did the right thing to make sure that I am as protected as possible from the Delta variant and therefore protect the others who only have one hit,” Rasmussen wrote in June. “Sometimes public health requires tough decisions to be made without a comprehensive data set to back it up. “

Dr. Leana Wen of George Washington University told us, “I have no doubts that the federal government should allow boosters for J. & J. recipients.

In a podcast interview this summer, Dr. Rochelle Walensky, the director of the CDC, refused to discourage J. & J. recipients to look for a Moderna or Pfizer photo. She said there was not enough data to be sure of the benefits and risks. But when Andy Slavitt, podcast host and former Biden advisor, asked her if she would describe it as a “huge mistake,” Walensky replied, “Not with what I’ve seen so far.”

From the head of a notoriously cautious agency, it was a remarkable and revealing statement.

This is a delicate question. Even if you want follow-up, the US government has not approved it, and doctors have generally said no to patients who have requested it.

Many people are understandably frustrated by the situation: some experts ask for a follow-up, pointing to the scientific evidence. And some doctors have figured out how to give themselves a second injection.

Yet if you walk into a doctor’s office and ask for one, you will likely be refused. It may seem like there is one set of rules for people with medical connections and another for everyone.

What to do? If you want a follow-up plan, you have several options. You can try out different pharmacies or clinics, hoping to find one that’s ready to give a Pfizer or Moderna a shot at a J.&J. recipient – or one who won’t ask about your story. Or you can choose to be less than honest. You won’t be alone.

As Allison, a reader from New Hampshire, wrote to us, “I had J. & J. Should I pretend I didn’t and also get Pfizer or Moderna? “

Here is the case to make a Pfizer or Moderna shoot followed by a J. & J. shot: The available evidence suggests that you will benefit from it. There are no signs of worrying side effects so far. And the Delta variant is an even greater threat to human life than earlier versions of the coronavirus. In the meantime, you may be allowing bureaucratic prudence to harm your own health.

Here’s the case against a follow-up shot: A single shot from J. & J. The vaccine still offers good protection and the government may soon authorize a second J. & J. Pull. There is no rigorous data yet on the benefits and risks of the mix-and-match approach with J. & J. And you may have to resort to underhandedness to get another hit.

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The Met Gala, the exclusive black tie extravaganza known as the East Coast Oscars, 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, writes Vanessa Friedman in The Times, is youth. Many of the creators are young, as are the animators: inaugural poet Amanda Gorman, actor Timothée Chalamet, tennis champion Naomi Osaka and pop star Billie Eilish.

For more on who can go, what they might wear, and how to watch the red carpet, read Vanessa’s explanation. – Sanam Yar, a morning writer