Johnson and Johnson and the Black American family: a broken relationship?
I was talking to a friend about the new vaccine coming from Johnson and Johnson, and his immediate response was, “Isn’t that the company that was killing Black people?” I admit that I was only peripherally aware of the history behind Johnson and Johnson (JnJ) with the Black community. After a little deep diving, I found that their company has a long history involving ovarian cancer lawsuits, targeting Black women, and propagating the myth that a fresh vagina is a sweetly-scented vagina.
By Dr. Aldene Zeno
What is the JnJ COVID-19 Vaccine?
On February 27, 2021, the FDA approved an emergency use authorization for a third vaccine to protect against COVID-19, called the Janssen COVID-19 Vaccine. Janssen is a pharmaceutical company based in Belgium, which JnJ acquired in 1961. The Janssen COVID-19 vaccine uses a “non-replicating viral vector.” When you breakdown that mouthful, “non-replicating” means that the virus doesn’t grow in the body, unlike when you get a cold, where the virus can grow in the body using the host’s proteins in a process called replication. The “viral vector” is an inactivated adenovirus, which causes the common cold, but inactivated means it’s rendered unable to cause the cold. The “vector” part means that the inactivated virus functions as a vehicle, or a vessel.
JnJ has also coined the term “adenovector vaccine,” to describe the Janssen COVID-19 vaccine, further illustrated in this video. Inside of this vector is genetic material from a coronavirus. This induces the vaccine recipient to create proteins, in this case, the coronavirus spike protein, and the body responds to those proteins with protective antibodies. This is a more traditional vaccine technology, in contrast to mRNA vaccines (see this post for more on mRNA vaccines like those from Pfizer and Moderna). As a single-dose vaccine that is easier to store than the other FDA-approved vaccines, it has the potential to be more feasibly distributed to clinics, and ultimately, to patients.
JnJ’s History in Black and Hispanic Communities
I grew up on JnJ. All my Black friends used their baby oil, and my Mexican-American babysitter rubbed it on my skin when I was sick, so I assumed it helped people feel better. As a child I had less exposure to the baby powder. JnJ baby powder is made with talc, which contains magnesium, silicon and oxygen. However, in its natural form talc also contains asbestos, a known carcinogen. Studies linking talcum powder to ovarian cancer have been mixed, demonstrating either no increased risk or potentially increased risk, according to the American Cancer Society (ACS). ACS also mentions that The International Agency for Research on Cancer (IARC) “classifies the perineal (genital) use of talc-based body powder as ‘possibly carcinogenic to humans.’” The cancers of concern are ovarian cancer and potentially uterine cancer. The ACS goes on to states that in 1976, the Cosmetic, Toiletry and Fragrances Association had an advisory stating that talc-containing products should be free of asbestos. This suggests that concerns about talc and cancer have existed for decades.
A Reuters investigation found that in the 2000's, JnJ targeted primarily African-American women in selling its talc-based baby powder, despite knowing that it may cause ovarian cancer. Sales for their baby powder started declining in the 1970s, when pediatricians advised against use due to concerns about infants inhaling it. The Reuters report states that in the 2000s, 90% of baby powder was for adult use. The IARC warning came in 2006, but internal documents show concerted efforts from the company to preserve sales by targeting African-American women. Additionally, they marketed to warm, humid areas where they knew customers may be more likely to have talcum powders for personal use. Focus areas included marketing in salons, churches, and to weight-loss companies like Weight Watchers. As you can imagine, the lawsuits soon followed.
JnJ Marketing Plagues on the Messaging that Women Need to “Stay Fresh”
Americans are obsessed with smelling un-human. This is not to suggest that other cultures are not hygenic, but rather that many Americans equate smelling flowery or sweet with smelling “fresh.” For Americans that have travelled to parts of the world where normal body odor is the norm, it’s immediately noticeable.
As a gynecologist, I frequently have patients who apologize for not “freshening up,” or for being on their period during a medical pelvic exam. I even have women who apologize for not shaving. Sadly, decades of marketing in our society have pushed this idea that normal human odors are not hygenic, particularly physiologic female odors. The Reuters investigation showcases decades of JnJ marketing targeting all women, especially young women. One Seventeen Magazine, JnJ baby powder ad from 1972 states, “If you’d rather be fresh and natural, you’re our baby.”
When patients come to me with groin rashes, or concerns about persistent groin skin itching or dryness, the first thing that I ask them is about their hygiene routine. Frequently I’ve found that women are swayed into using perfumed, unnatural products, or that they’re wiping too frequently and aggressively, douching, or wearing tight synthetic clothing or underwear. In these cases, the most “natural” thing to do is to just wash the skin with warm water and dry with a cotton towel. Women may even need to scale back after going to the bathroom and rinse with water instead of using scented towelettes.
How Might JnJ’s Legacy Affect its Vaccine Distribution to People of Color?
JnJ’s breakthrough vaccine has a lot of potential to be widely distributed. It can be stored more similarly to common vaccines and doesn’t require the special temperatures for the mRNA vaccines already in use in the U.S. It’s also a single injection instead of two shots. However, I worry that the perception around JnJ may be tough for Black and Latinx people in trusting the vaccine. Given JnJ’s history with talcum powder, ovarian cancer, and communities of color, how can Black and Brown folks buy into the idea of a vaccine that’s considered suboptimal to the other COVID vaccines?
As a physician, I hope that I can do two things for my patients concerned about the JnJ vaccine. First, acknowledge that there is absolutely a history of race-based marketing that was harmful to Black and Brown women. But secondly, now that I know more about how the vaccine works and that it is efficacious, I want to help my patients make a scientifically-based decision to get the vaccine. These are unprecedented times. This is a pandemic, and Black and Brown people are being disproportionally affected by the virus as well as by decreased vaccine access. As Dr. Anthony Fauci has stated, the best vaccine right now is the one you get. “All three of them are really quite good, and people should take the one that’s most available to them,” Fauci said on NBC’s “Meet the Press.”