april 2021

For weeks, Americans looked on as other countries grappled with case reports of rare, sometimes fatal blood abnormalities among those who had received the AstraZeneca vaccine against COVID-19. That vaccine has not yet been authorized by the FDA, so restrictions on its use throughout Europe did not get that much attention in the United States. But Americans experienced a rude awakening this week when public-health officials called for a pause on the use of the Johnson & Johnson vaccine, after a few cases of the same, unusual blood-clotting syndrome turned up among the millions of people in the country who have received it.

The world is now engaged in a vaccination program unlike anything we have seen in our lifetimes, and with it, unprecedented scrutiny of ultra-rare but dangerous side effects. An estimated 852 million COVID-19 vaccine doses have been administered across 154 countries, according to data collected by Bloomberg. Last week, the European Medicines Agency, which regulates medicines in the European Union, concluded that the unusual clotting events were indeed a side effect of the AstraZeneca vaccine; by that point, more than 220 cases of dangerous blood abnormalities had been identified. Only half a dozen cases have been documented so far among Americans vaccinated with the Johnson & Johnson vaccine, and a causal link has not yet been established. But the latest news suggests that the scope of this problem might be changing.

In 2015, in the Dallas suburb of Irving, the fates of two very different Texans collided.

One was 14-year-old Ahmed Mohamed, a precocious kid in a NASA T-shirt who had built a clock out of spare parts and brought it to school in a pencil case. His English teacher decided it might be a bomb, and the school called the police, who arrested Mohamed for bringing in a “hoax bomb.” Because Mohamed’s family was part of Irving’s large Muslim minority, many liberals saw this as a baseless case of Islamophobia.

The other Texan was Irving Mayor Beth Van Duyne, a blond 44-year-old with Disney-princess bone structure. She defended Mohamed’s arrest on Facebook, then went on The Glenn Beck Program to repeat the “hoax bomb” lie and complain that the child hadn’t given police enough information. “We’ve heard more from the media than the child ever released to the police when we were asking him questions,” she said calmly.

A year ago, when the United States decided to go big on vaccines, it bet on nearly every horse, investing in a spectrum of technologies. The safest bets, in a way, repurposed the technology behind existing vaccines, such as protein-based ones for tetanus or hepatitis B. The medium bets were on vaccines made by Johnson & Johnson and AstraZeneca, which use adenovirus vectors, a technology that had been tested before but not deployed on a large scale. The long shots were based on the use of mRNA, the newest and most unproven technology.

The protein-based vaccines have moved too slowly to matter so far. J&J’s and AstraZeneca’s vaccines are effective at preventing COVID-19—but a small number of recipients have developed a rare type of blood clot that appears to be linked to the adenovirus technology and may ultimately limit those shots’ use. Meanwhile, with more than 180 million doses administered in the U.S, the mRNA vaccines have proved astonishingly effective and extremely safe. The unusual blood clots have not appeared with Pfizer’s or Moderna’s mRNA technology. A year later, the risky bet definitely looks like a good one.

The president was insistent as he left office: “We’re not going anywhere.” It had been a turbulent end of the presidency—impeachment, appalling pardons, and a lengthy dispute over the outcome of the presidential election—but he knew that he had a devoted following, and he had every intention to remain a force in politics. And not just him: His family was eager to cash in on his electoral success, too. Usually a former president laid low for a while after leaving office. He wasn’t going to do that. He’d remain a political force, and the dominant figure in his party.

But the plan didn’t go well. The president sat at his new home—he had decamped from his longtime home state—guzzling Diet Cokes and calling friends to rage about how unfairly he’d been treated and complain about overzealous prosecutors. “You get tired of listening to it,” one friend confessed.

Illustrations by Leonardo Santamaria

This article was published online on April 15, 2021.

The Motel El Encanto in Hermosillo, Mexico, served a lavish breakfast that John and Andra Patterson liked to eat on the tiled deck near their suite. The couple would discuss the day ahead over fresh pineapple and pan dulces while their 4-year-old daughter, Julia, watched the gray cat that skulked about the motel’s Spanish arches.

On the morning of March 22, 1974, the Pattersons’ breakfast chatter centered on their search for a permanent home. They were nearing their two-month anniversary of living in Hermosillo, where John was a junior diplomat at the American consulate, and the motel was feeling cramped.

After breakfast, Andra dropped John off at work. Because this was his first posting as a member of the United States Foreign Service, the 31-year-old Patterson had been given an unglamorous job: He was a vice consul responsible for promoting trade between the U.S. and Mexico, which on this particular Friday meant driving out to meet with a group of ranchers who hoped to improve their yield of beef.