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Burk Declaration

Date
2021-12-17

Summary

Burk Declaration Exhibit 20, filed December 17, 2021 as Document 40-20 in Case 2:21-cv-00702-CLM in the U.S. District Court, N.D. of Alabama. The exhibit is an October 20, 2021 letter from the Food and Drug Administration to Janssen Biotech, Inc. reissuing the Emergency Use Authorization for the Janssen COVID-19 Vaccine under Section 564 of the FD&C Act. The letter authorizes a single booster dose at least 2 months after primary vaccination for individuals 18 years of age and older, and a heterologous booster following another authorized or approved COVID-19 vaccine. It summarizes the trial data FDA reviewed, sets out the criteria for issuance, the scope of authorization and product description, and conditions of authorization including export. It is signed by Jacqueline A. O'Shaughnessy, Ph.D., Acting Chief Scientist of the FDA.

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Case 2:21-cv-00702-CLM Document 40-20 Filed 12/17/21 Page 1 of 12            FILED
                                                                    2021 Dec-17 PM 01:27
                                                                    U.S. DISTRICT COURT
                                                                        N.D. OF ALABAMA




               Burk Declaration
                  Exhibit 20
        Case 2:21-cv-00702-CLM Document 40-20 Filed 12/17/21 Page 2 of 12




                                                                             October 20, 2021


Janssen Biotech, Inc.
Attention: Ms. Ruta Walawalkar
920 Route 202
Raritan, NJ 08869

Dear Ms. Walawalkar:

On February 4, 2020, pursuant to Section 564(b)(1)(C) of the Federal Food Drug and Cosmetic
Act (the FD&C Act or the Act), the Secretary of the Department of Health and Human Services
(HHS) determined that there is a public health emergency that has a significant potential to affect
national security or the health and security of United States citizens living abroad, and that
involves the virus that causes Coronavirus Disease 2019 (COVID-19). 1 On the basis of such
determination, the Secretary of HHS on March 27, 2020, declared that circumstances exist
justifying the authorization of emergency use of drugs and biological products during the
COVID-19 pandemic, pursuant to Section 564 of the Act, subject to terms of any authorization
issued under that section. 2

On February 27, 2021, the Food and Drug Administration (FDA) issued an Emergency Use
Authorization (EUA) for emergency use of the Janssen COVID-19 Vaccine for the prevention of
COVID-19 for individuals 18 years of age and older pursuant to Section 564 of the Act. On June
10, 2021, FDA reissued the Letter of Authorization to clarify the terms and conditions that relate
to export of Janssen COVID‑19 Vaccine from the United States.

On October 20, 2021, having concluded that revising this EUA is appropriate to protect the
public health or safety under Section 564(g)(2) of the Act, FDA is reissuing the June 10, 2021
letter in its entirety with revisions incorporated to authorize for emergency use the administration
of a single booster dose of Janssen COVID-19 Vaccine at least 2 months after the primary
vaccination to individuals 18 years of age or older, and to authorize a single booster dose of the
Janssen COVID-19 Vaccine as a heterologous booster dose following completion of primary
vaccination with another authorized or approved COVID-19 vaccine. The eligible population(s)
and dosing interval for the heterologous booster dose are the same as those authorized for a
booster dose of the vaccine used for primary vaccination.



1
 U.S. Department of Health and Human Services, Determination of a Public Health Emergency and Declaration that
Circumstances Exist Justifying Authorizations Pursuant to Section 564(b) of the Federal Food, Drug, and Cosmetic
Act, 21 U.S.C. § 360bbb-3. February 4, 2020.
2
 U.S. Department of Health and Human Services, Declaration that Circumstances Exist Justifying Authorizations
Pursuant to Section 564(b) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 360bbb-3, 85 FR 18250 (April
1, 2020).
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The Janssen COVID‑19 Vaccine is for active immunization to prevent COVID-19 caused by
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 18 years of age
and older. The vaccine contains a recombinant, replication-incompetent human adenovirus
serotype 26 (Ad26) vector, encoding the SARS-CoV-2 viral spike (S) glycoprotein, stabilized in
its pre-fusion form. It is an investigational vaccine not licensed for any indication.

For the February 27, 2021 authorization for individuals 18 years of age and older, FDA reviewed
safety and efficacy data from an ongoing phase 3 trial which enrolled 43,783 participants
randomized 1:1 to receive Janssen COVID‑19 Vaccine or saline control. The trial enrolled
participants 18 years of age and older. FDA’s review at that time considered the safety and
effectiveness data as they relate to the request for emergency use authorization. FDA’s review of
the available safety data from 43,783 participants 18 years of age and older, who were followed
for a median duration of eight weeks after receiving the vaccine or placebo, did not identify
specific safety concerns that would preclude issuance of an EUA. FDA’s analysis of the efficacy
data from 39,321 participants 18 years of age and older who were SARS-CoV-2 seronegative or
who had an unknown serostatus at baseline show that the vaccine was 66.9% effective (95%
confidence interval (CI): 59.0, 73.4) and 66.1% effective (95% CI: 55.0, 74.8) in preventing
moderate to severe/critical COVID-19 occurring at least 14 days and at least 28 days after
vaccination, respectively. Based on these data, and review of manufacturing information
regarding product quality and consistency, it is reasonable to believe that the Janssen COVID‑19
Vaccine may be effective. Additionally, it is reasonable to conclude, based on the totality of the
scientific evidence available, that the known and potential benefits of the Janssen COVID‑19
Vaccine outweigh its known and potential risks, for the prevention of COVID-19 in individuals
18 years of age and older. Finally, on February 26, 2021, the Vaccines and Related Biological
Products Advisory Committee voted in agreement with this conclusion.

For the October 20, 2021 authorization of a single booster dose of the Janssen COVID-19
Vaccine at least 2 months after administration of the primary vaccination, FDA reviewed, but did
not independently verify, safety and effectiveness data from studies evaluating a booster dose of
the Janssen COVID-19 Vaccine. Overall, in 5 clinical studies, approximately 9,000 participants
have received 2 doses of the Janssen COVID-19 Vaccine, administered at least 2 months apart
and approximately 2,700 participants had at least 2 months of safety follow-up after the booster
dose. An overall assessment of Janssen’s safety analyses from studies evaluating 2 doses of the
Janssen COVID-19 Vaccine did not reveal new safety concerns following a booster dose, as
compared with adverse reactions reported following the single-dose primary vaccination. In a
Phase 2 study, individuals 18 through 55 years of age and 65 years and older received a booster
dose of the Janssen COVID-19 Vaccine approximately 2 months after the primary vaccination.
Immunogenicity was assessed by measuring neutralizing antibodies to SARS-CoV-2
Victoria/1/2020 strain using a qualified wild-type virus neutralization assay. Available
immunogenicity data from 39 individuals showed that the booster dose elicited geometric mean
increases in neutralizing antibody titers of approximately 8-fold above pre-primary vaccination
baseline and approximately 2-fold above pre-booster baseline. Based on the totality of the
scientific evidence available, including data from the above-referenced clinical trials, FDA
concluded that a booster dose of the Janssen COVID-19 Vaccine may be effective, and that the
known and potential benefits of a booster dose at least two months after the primary vaccination
in individuals 18 years of age and older outweigh its known and potential risks. Finally, on
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October 15, 2021, the Vaccines and Related Biological Products Advisory Committee voted in
agreement with this conclusion.

For the October 20, 2021 authorization of a booster dose of the Janssen COVID-19 Vaccine as a
heterologous booster dose following completion of primary vaccination with another authorized
or approved COVID-19 vaccine, FDA reviewed data from an ongoing Phase1/2 clinical trial in
participants 19-85 years of age. In this trial, adults who had completed primary vaccination with
a Moderna COVID-19 Vaccine 2-dose series (N=151), a Janssen COVID-19 Vaccine single dose
(N=156), or a Pfizer-BioNTech COVID-19 Vaccine 2-dose series (N=151) at least 12 weeks
prior to enrollment and who reported no history of SARS-CoV-2 infection were randomized
1:1:1 to receive a booster dose of one of three vaccines: Moderna COVID-19 Vaccine, Janssen
COVID-19 Vaccine, or Pfizer-BioNTech COVID-19 Vaccine. Adverse events were assessed
through 28 days after the booster dose. An overall review of adverse reactions reported
following the Janssen COVID-19 Vaccine heterologous booster dose did not identify any new
safety concerns, as compared with adverse reactions reported following a Janssen COVID-19
Vaccine primary vaccination or homologous booster dose. Neutralizing antibody titers, as
measured by a pseudovirus neutralization assay using a lentivirus expressing the SARS-CoV-2
Spike protein with D614G mutation, were assessed on Day 1 prior to administration of the
booster dose and on Day 15 after the booster dose. A booster response to the Janssen COVID-19
Vaccine was demonstrated regardless of primary vaccination.

Based on the totality of the scientific evidence available, including data from the above-
referenced clinical trial, FDA concluded that a heterologous booster dose of the Janssen COVID-
19 Vaccine may be effective, and that the known and potential benefits of a heterologous booster
dose of the Janssen COVID-19 Vaccine following completion of primary vaccination with
another authorized or approved COVID-19 vaccine outweigh the known and potential risks of
the vaccine.

Having concluded that the criteria for issuance of this authorization under Section 564(c) of the
Act are met, I am authorizing the emergency use of the Janssen COVID‑19 Vaccine for the
prevention of COVID-19, as described in the Scope of Authorization section of this letter
(Section II) and subject to the terms of this authorization.

I.     Criteria for Issuance of Authorization

I have concluded that the emergency use of the Janssen COVID‑19 Vaccine for the prevention of
COVID-19 when administered as described in the Scope of Authorization (Section II) meets the
criteria for issuance of an authorization under Section 564(c) of the Act, because:

      A. SARS-CoV-2 can cause a serious or life-threatening disease or condition, including
         severe respiratory illness, to humans infected by this virus;

      B. Based on the totality of scientific evidence available to FDA, it is reasonable to believe
         that the Janssen COVID‑19 Vaccine may be effective in preventing COVID-19, and
         that, when used under the conditions described in this authorization, the known and
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              potential benefits of the Janssen COVID‑19 Vaccine when used to prevent COVID-19
              outweigh its known and potential risks; and

           C. There is no adequate, approved, and available alternative 3 to the emergency use of the
              Janssen COVID‑19 Vaccine to prevent COVID-19. 4

II.        Scope of Authorization

I have concluded, pursuant to Section 564(d)(1) of the Act, that the scope of this authorization is
limited as follows:

       •   Janssen Biotech, Inc. will supply the Janssen COVID‑19 Vaccine, either directly or
           through authorized distributor(s) 5 to emergency response stakeholders 6 as directed by the
           U.S. government, including the Centers for Disease Control and Prevention (CDC) and/or
           other designee, for use consistent with the terms and conditions of this EUA;
       •   The Janssen COVID‑19 Vaccine covered by this authorization will be administered by
           vaccination providers 7 and used only to prevent COVID-19 in individuals ages 18 and
           older with a single dose primary vaccination and to provide:
3
 Although Comirnaty (COVID-19 Vaccine, mRNA) is approved to prevent COVID-19 in individuals within the
scope of the Janssen COVID-19 vaccine authorization, there is not sufficient available, approved vaccine, as the
approved vaccine is not available for distribution to this population in its entirety at the time of reissuance of this
EUA (e.g., due to limitations in supply and/or storage requirements that may impact distribution, or potential
challenges for some individuals to complete a two-dose regimen). Additionally, there are individuals for whom
Comirnaty might not be an adequate alternative (e.g., due to allergies to components of the approved product or
allergic reaction following the first dose of the approved product).
4
    No other criteria of issuance have been prescribed by regulation under Section 564(c)(4) of the Act.
5
  “Authorized Distributor(s)” are identified by Janssen Biotech, Inc. or, if applicable, by a U.S. government entity,
such as the Centers for Disease Control and Prevention (CDC) and/or other designee, as an entity or entities allowed
to distribute authorized Janssen COVID‑19 Vaccine.
6
  For purposes of this letter, “emergency response stakeholder” refers to a public health agency and its delegates that
have legal responsibility and authority for responding to an incident, based on political or geographical boundary
lines (e.g., city, county, tribal, territorial, State, or Federal), or functional (e.g., law enforcement or public health
range) or sphere of authority to administer, deliver, or distribute vaccine in an emergency situation. In some cases
(e.g., depending on a state or local jurisdiction’s COVID-19 vaccination response organization and plans), there
might be overlapping roles and responsibilities among “emergency response stakeholders” and “vaccination
providers” (e.g., if a local health department is administering COVID-19 vaccines; if a pharmacy is acting in an
official capacity under the authority of the state health department to administer COVID-19 vaccines). In such cases,
it is expected that the conditions of authorization that apply to emergency response stakeholders and vaccination
providers will all be met.
7
  For purposes of this letter, “vaccination provider” refers to the facility, organization, or healthcare provider
licensed or otherwise authorized by the emergency response stakeholder (e.g., non-physician healthcare
professionals, such as nurses and pharmacists pursuant to state law under a standing order issued by the state health
officer) to administer or provide vaccination services in accordance with the applicable emergency response
stakeholder’s official COVID-19 vaccination and emergency response plan(s) and who is enrolled in the CDC
COVID-19 Vaccination Program. If the vaccine is exported from the United States, a “vaccination provider” is a
provider that is authorized to administer this vaccine in accordance with the laws of the country in which it is
administered. For purposes of this letter, “healthcare provider” also refers to a person authorized by the U.S.
Department of Health and Human Services (e.g., under the PREP Act Declaration for Medical Countermeasures
        Case 2:21-cv-00702-CLM Document 40-20 Filed 12/17/21 Page 6 of 12

Page 5 – Janssen Biotech, Inc.


            o a single booster dose of Janssen COVID-19 Vaccine at least 2 months after the
               primary vaccination in individuals 18 years of age and older; and
            o a single booster dose of the Janssen COVID-19 Vaccine as a heterologous booster
               dose following completion of primary vaccination with another authorized or
               approved COVID-19 vaccine, where the eligible population(s) and dosing interval
               for the heterologous booster dose are the same as authorized for a booster dose of
               the vaccine used for primary vaccination.
    •   The Janssen COVID‑19 Vaccine may be administered by a vaccination provider without
        an individual prescription for each vaccine recipient.

Product Description

The Janssen COVID-19 Vaccine is supplied as a suspension in multi-dose vials. The Janssen
COVID-19 Vaccine does not contain a preservative.

Each 0.5 mL dose of the Janssen COVID-19 Vaccine is formulated to contain 5x1010 virus
particles of the Ad26 vector encoding the S glycoprotein of SARS-CoV-2. Each dose of the
Janssen COVID-19 Vaccine also includes the following inactive ingredients 2.19 mg sodium
chloride, 0.14 mg citric acid monohydrate, 2.02 mg trisodium citrate dihydrate, 0.16 mg
polysorbate-80, 25.5 mg 2-hydroxypropyl-Β-cyclodextrin, 2.04 mg ethanol. Each dose may also
contain residual amounts of host cell proteins (≤0.15 mcg) and/or host cell DNA (≤3 ng).

The manufacture of the authorized Janssen COVID‑19 Vaccine is limited to those facilities
identified and agreed upon in Janssen’s request for authorization.

The Janssen COVID-19 Vaccine vial label and carton labels are clearly marked for “Emergency
Use Authorization.” The Janssen COVID‑19 Vaccine is authorized to be distributed, stored,
further redistributed, and administered by emergency response stakeholders when packaged in
the authorized manufacturer packaging (i.e., vials and cartons), despite the fact that the vial and
carton labels may not contain information that otherwise would be required under the FD&C
Act.

The Janssen COVID‑19 Vaccine is authorized for emergency use with the following product-
specific information required to be made available to vaccination providers and recipients,
respectively (referred to as “authorized labeling”):

    •   Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers):
        Emergency Use Authorization (EUA) of the Janssen COVID‑19 Vaccine to Prevent
        Coronavirus Disease 2019 (COVID-19)



against COVID-19) to administer FDA-authorized COVID-19 vaccine (e.g., qualified pharmacy technicians and
State-authorized pharmacy interns acting under the supervision of a qualified pharmacist). See, e.g., HHS. Fourth
Amendment to the Declaration Under the Public Readiness and Emergency Preparedness Act for Medical
Countermeasures Against COVID-19 and Republication of the Declaration. 85 FR 79190 (December 9, 2020).
           Case 2:21-cv-00702-CLM Document 40-20 Filed 12/17/21 Page 7 of 12

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       •   Fact Sheet for Recipients and Caregivers: Emergency Use Authorization (EUA) of the
           Janssen COVID‑19 Vaccine to Prevent Coronavirus Disease 2019 (COVID-19) in
           Individuals 18 Years of Age and Older

I have concluded, pursuant to Section 564(d)(2) of the Act, that it is reasonable to believe that
the known and potential benefits of the Janssen COVID‑19 Vaccine, when used to prevent
COVID-19 and used in accordance with this Scope of Authorization (Section II), outweigh its
known and potential risks.

I have concluded, pursuant to Section 564(d)(3) of the Act, based on the totality of scientific
evidence available to FDA, that it is reasonable to believe that the Janssen COVID‑19 Vaccine
may be effective in preventing COVID-19 when used in accordance with this Scope of
Authorization (Section II), pursuant to Section 564(c)(2)(A) of the Act.

Having reviewed the scientific information available to FDA, including the information
supporting the conclusions described in Section I above, I have concluded that the Janssen
COVID‑19 Vaccine (as described in this Scope of Authorization (Section II)) meets the criteria set
forth in Section 564(c) of the Act concerning safety and potential effectiveness.

The emergency use of the Janssen COVID‑19 Vaccine under this EUA must be consistent with, and
may not exceed, the terms of the Authorization, including the Scope of Authorization (Section II)
and the Conditions of Authorization (Section III). Subject to the terms of this EUA and under the
circumstances set forth in the Secretary of HHS's determination under Section 564(b)(1)(C)
described above and the Secretary of HHS’s corresponding declaration under Section 564(b)(1), the
Janssen COVID‑19 Vaccine is authorized to prevent COVID-19 in individuals 18 years of age and
older as described in the Scope of Authorization (Section II) under this EUA, despite the fact that it
does not meet certain requirements otherwise required by applicable federal law.

III.       Conditions of Authorization

Pursuant to Section 564 of the Act, I am establishing the following conditions on this authorization:

Janssen Biotech, Inc. and Authorized Distributor(s)

             A. Janssen Biotech, Inc. and authorized distributor(s) will ensure that the authorized
                Janssen COVID‑19 Vaccine is distributed, as directed by the U.S. government,
                including CDC and/or other designee, and the authorized labeling (i.e., Fact Sheets)
                will be made available to vaccination providers, recipients, and caregivers consistent
                with the terms of this letter.

             B. Janssen Biotech, Inc. and authorized distributor(s) will ensure that appropriate storage
                and cold chain is maintained until delivered to emergency response stakeholders’
                receipt sites.

             C. Janssen Biotech, Inc. will ensure that the terms of this EUA are made available to all
                relevant stakeholders (e.g., emergency response stakeholders, authorized distributors,
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                 and vaccination providers) involved in distributing or receiving the authorized
                 Janssen COVID‑19 Vaccine. Janssen Biotech, Inc. will provide to all relevant
                 stakeholders a copy of this letter of authorization and communicate any subsequent
                 amendments that might be made to this letter of authorization and its authorized
                 labeling.

            D. Janssen Biotech, Inc. may develop and disseminate instructional and educational
               materials (e.g., video regarding vaccine handling, storage/cold-chain management,
               preparation, disposal) that are consistent with the authorized emergency use of the
               vaccine as described in the letter of authorization and authorized labeling, without
               FDA’s review and concurrence, when necessary to meet public health needs during
               an emergency. Any instructional and educational materials that are inconsistent with
               the authorized labeling are prohibited.

            E. Janssen Biotech, Inc. may request changes to this authorization, including to the
               authorized Fact Sheets for the Janssen COVID-19 Vaccine. Any request for changes
               to this EUA must be submitted to the Office of Vaccines Research and Review
               (OVRR)/Center for Biologics Evaluation and Research (CBER). Such changes
               require appropriate authorization prior to implementation.8

            F. Janssen Biotech, Inc. will report to Vaccine Adverse Event Reporting System
               (VAERS):
               • Serious adverse events (irrespective of attribution to vaccination);
               • Cases of Multisystem Inflammatory Syndrome in adults; and
               • Cases of COVID-19 that result in hospitalization or death, that are reported to
                   Janssen Biotech, Inc.
               These reports should be submitted to VAERS as soon as possible but no later than
               15 calendar days from initial receipt of the information by Janssen Biotech, Inc.

            G. Janssen Biotech, Inc. must submit to Investigational New Drug application (IND)
               number 22657 periodic safety reports at monthly intervals in accordance with a due
               date agreed upon with the Office of Biostatistics and Epidemiology (OBE)/CBER,
               beginning after the first full calendar month after authorization. Each periodic safety
               report is required to contain descriptive information which includes:
               • A narrative summary and analysis of adverse events submitted during the reporting
                   interval, including interval and cumulative counts by age groups, special
                   populations (e.g., pregnant women), and adverse events of special interest;


8
  The following types of revisions may be authorized without reissuing this letter: (1) changes to the authorized
labeling; (2) non-substantive editorial corrections to this letter; (3) new types of authorized labeling, including new
fact sheets; (4) new carton/container labels; (5) expiration dating extensions; (6) changes to manufacturing
processes, including tests or other authorized components of manufacturing; (7) new conditions of authorization to
require data collection or study. All changes to the authorization require review and concurrence from OVRR. For
changes to the authorization, including the authorized labeling, of the type listed in (3), (6), or (7), review and
concurrence is also required from the Preparedness and Response Team (PREP)/Office of the Center Director
(OD)/CBER and the Office of Counterterrorism and Emerging Threats/Office of the Chief Scientist.
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              •   A narrative summary and analysis of vaccine administration errors, whether or not
                  associated with an adverse event, that were identified since the last reporting
                  interval;
              •   Newly identified safety concerns in the interval; and
              •   Actions taken since the last report because of adverse experiences (for example,
                  changes made to Healthcare Providers Administering Vaccine (Vaccination
                  Providers) Fact Sheet, changes made to studies or studies initiated).

          H. No changes will be implemented to the description of the product, manufacturing
             process, facilities, or equipment without notification to and concurrence by FDA.

          I. All manufacturing facilities will comply with Current Good Manufacturing Practice
             requirements.

          J. Janssen Biotech, Inc. will submit to the EUA file Certificates of Analysis (CoA) for
             each drug product lot at least 48 hours prior to vaccine distribution. The CoA will
             include the established specifications and specific results for each quality control test
             performed on the final drug product lot.

          K. Janssen Biotech, Inc. will submit to the EUA file quarterly manufacturing reports that
             include a listing of all Drug Substance and Drug Product lots produced after issuance
             of this authorization. This report must include lot number, manufacturing site, date of
             manufacture, and lot disposition, including those lots that were quarantined for
             investigation or those lots that were rejected. Information on the reasons for lot
             quarantine or rejection must be included in the report. The first report is due June 1,
             2021.

          L. Janssen Biotech, Inc. and authorized distributor(s) will maintain records regarding
             release of Janssen COVID‑19 Vaccine for distribution (i.e., lot numbers, quantity,
             release date).

          M. Janssen Biotech, Inc. and authorized distributor(s) will make available to FDA upon
             request any records maintained in connection with this EUA.

          N. Janssen Biotech, Inc. will conduct post-authorization observational studies to evaluate
             the association between Janssen COVID-19 Vaccine and a pre-specified list of
             adverse events of special interest, along with deaths and hospitalizations, and severe
             COVID-19. The study population should include individuals administered the
             authorized Janssen COVID-19 Vaccine under this EUA in the general U.S.
             population (18 years of age and older), individuals who receive a booster dose,
             populations of interest such as healthcare workers, pregnant women,
             immunocompromised individuals, subpopulations with specific comorbidities. The
             studies should be conducted in large scale databases with an active comparator.
             Janssen Biotech, Inc. will provide protocols and status update reports to the IND
             22657 with agreed-upon study designs and milestone dates.
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Emergency Response Stakeholders

          O. Emergency response stakeholders will identify vaccination sites to receive authorized
             Janssen COVID‑19 Vaccine and ensure its distribution and administration, consistent
             with the terms of this letter and CDC’s COVID-19 Vaccination Program.

          P. Emergency response stakeholders will ensure that vaccination providers within their
             jurisdictions are aware of this letter of authorization, and the terms herein and any
             subsequent amendments that might be made to the letter of authorization, instruct
             them about the means through which they are to obtain and administer the vaccine
             under the EUA, and ensure that the authorized labeling [i.e., Fact Sheet for Healthcare
             Providers Administering Vaccine (Vaccination Providers) and Fact Sheet for
             Recipients and Caregivers] is made available to vaccination providers through
             appropriate means (e.g., e-mail, website).

          Q. Emergency response stakeholders receiving authorized Janssen COVID‑19 Vaccine
             will ensure that appropriate storage and cold chain is maintained.

Vaccination Providers

          R. Vaccination providers will administer the vaccine in accordance with the
             authorization and will participate and comply with the terms and training required by
             CDC’s COVID-19 Vaccination Program.

          S. Vaccination providers will provide the Fact Sheet for Recipients and Caregivers to
             each individual receiving vaccination.

          T. Vaccination providers administering the Janssen COVID‑19 Vaccine must report the
             following information associated with the administration of the Janssen COVID‑19
             Vaccine of which they become aware to VAERS in accordance with the Fact Sheet
             for Healthcare Providers Administering Vaccine (Vaccination Providers):
             • Vaccine administration errors whether or not associated with an adverse event
             • Serious adverse events (irrespective of attribution to vaccination)
             • Cases of Multisystem Inflammatory Syndrome in adults
             • Cases of COVID-19 that result in hospitalization or death
             Complete and submit reports to VAERS online at
             https://vaers.hhs.gov/reportevent.html. The VAERS reports should include the
             words “Janssen COVID‑19 Vaccine EUA” in the description section of the report.
             More information is available at vaers.hhs.gov or by calling 1-800-822-7967. To
             the extent feasible, report to Janssen Biotech, Inc. by contacting 1-800-565-4008
             or by providing a copy of the VAERS form to Janssen Biotech, Inc.; Fax: 215-
             293-9955, or by email JNJvaccineAE@its.jnj.com.

          U. Vaccination providers will conduct any follow-up requested by the U.S.
             government, including CDC, FDA, or other designee, regarding adverse events to
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              the extent feasible given the emergency circumstances.

          V. Vaccination providers will monitor and comply with CDC and/or emergency
             response stakeholder vaccine management requirements (e.g., requirements
             concerning obtaining, tracking, and handling vaccine) and with requirements
             concerning reporting of vaccine administration data to CDC.

          W. Vaccination providers will ensure that any records associated with this EUA are
             maintained until notified by FDA. Such records will be made available to CDC,
             and FDA for inspection upon request.
Conditions Related to Printed Matter, Advertising, and Promotion

          X. All descriptive printed matter, advertising, and promotional material, relating to the
             use of the Janssen COVID‑19 Vaccine shall be consistent with the authorized
             labeling, as well as the terms set forth in this EUA, and meet the requirements set
             forth in Section 502(a) and (n) of the FD&C Act and FDA implementing regulations

          Y. All descriptive printed matter, advertising, and promotional material relating to the
             use of the Janssen COVID‑19 Vaccine clearly and conspicuously shall state that:
               • This product has not been approved or licensed by FDA, but has been
                   authorized for emergency use by FDA, under an EUA to prevent Coronavirus
                   Disease 2019 (COVID-19) for use in individuals 18 years of age and older; and
               • The emergency use of this product is only authorized for the duration of the
                   declaration that circumstances exist justifying the authorization of emergency
                   use of the medical product under Section 564(b)(1) of the FD&C Act unless the
                   declaration is terminated or authorization revoked sooner.

       Condition Related to Export

          Z. If the product is exported from the United States, conditions C, D, and O through Y
             do not apply, but export is permitted only if 1) the regulatory authorities of the
             country in which the vaccine will be used are fully informed that this vaccine is
             subject to an EUA and is not approved or licensed by FDA and 2) the intended use of
             the vaccine will comply in all respects with the laws of the country in which the
             product will be used. The requirement in this letter that the authorized labeling (i.e.,
             Fact Sheets) be made available to vaccination providers, recipients, and caregivers in
             condition A will not apply if the authorized labeling (i.e., Fact Sheets) are made
             available to the regulatory authorities of the country in which the vaccine will be
             used.

IV.    Duration of Authorization

This EUA will be effective until the declaration that circumstances exist justifying the
authorization of the emergency use of drugs and biological products during the COVID-19
      Case 2:21-cv-00702-CLM Document 40-20 Filed 12/17/21 Page 12 of 12

Page 11 – Janssen Biotech, Inc.


pandemic is terminated under Section 564(b)(2) of the Act or the EUA is revoked under Section
564(g) of the Act.

                                           Sincerely,

                                                  --/S/--

                                           ____________________________
                                           Jacqueline A. O'Shaughnessy, Ph.D.
                                           Acting Chief Scientist
                                           Food and Drug Administration


Enclosures


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