Soon we will be turning another page in the pandemic playbook: A third vaccine, this one from Johnson & Johnson, looks headed to market by early March, joining vaccines from Pfizer and Moderna now going into arms across the nation. The arrival of a new vaccine — with hopes that others may soon follow — raises new questions about who should get which vaccine, and who decides. All of these vaccines are different in how they need to be transported, stored and administered. Importantly, they also are slightly different when it comes to effectiveness in preventing infections from the coronavirus. So which vaccine is best, and for whom? And should people hold out for one over another?
Though the Johnson & Johnson vaccine’s clinical trials might appear to show lower effectiveness than those of the Pfizer and Moderna shots, the answer to whether anyone should turn down one vaccine for another is clear: No. If you are able to get a vaccine — any vaccine — get it. The Johnson & Johnson vaccine, if it’s authorized for use, is not a lesser vaccine for lesser people. It is a safe, effective and powerful tool in our fight to end this pandemic, reduce suffering and save lives.
Once the Food and Drug Administration allows the use of the Johnson & Johnson vaccine, it will, inevitably, raise questions about who should receive which vaccine. The Pfizer and Moderna vaccines have had the combined advantages of being granted emergency-use authorization by the FDA only weeks apart, being the first coronavirus vaccines available to the public and building on very similar, new mRNA technology. Because of these factors and promising data from their clinical trials, few people have questioned the difference between the safety and effectiveness of these two vaccines. Both Pfizer and Moderna vaccines require two doses, and both are about 95 percent effective at preventing symptomatic COVID-19 by two weeks after the second dose. While there are differences in how each vaccine can be transported and stored — the Pfizer one requires subfreezing storage, which makes the logistics of delivering it more complicated — both are among the safest and most effective vaccines ever produced.
At first glance, the data on effectiveness for the Johnson & Johnson vaccine looks different. The company’s trials indicate that the vaccine is 66 percent effective at preventing moderate to severe COVID-19, and 85 percent effective at preventing severe disease — notably lower than the 95 percent of the mRNA vaccines. But we need to look closer. There are key differences in the underlying trial data that shape the reported effectiveness of the Johnson & Johnson vaccine, including the time frame for reporting cases. Unlike the mRNA vaccines, the Johnson & Johnson vaccine was tested extensively in three locations globally — the United States, South America and South Africa — and the overall figure on effectiveness (66 percent) is an average of trials against different variants of SARS-CoV-2, including variants from Brazil and South Africa that are now raising concerns. The overall results for the Pfizer and Moderna vaccines, which were developed and tested before any of these variants appeared, might more closely resemble the J&J vaccine when tested against these variants.
The most important data point is that the Johnson & Johnson vaccine is 100 percent effective at preventing hospitalizations and deaths from COVID-19: Not one individual in the Phase 3 vaccine study was hospitalized with or died of COVID-19 once recipients were 28 days out from their vaccination (it takes time for the vaccine to work). In the context of a pandemic that has killed nearly half a million Americans and more than 2.4 million people globally, this is crucial. Our imperative is to save lives — to stop serious illness and death from COVID-19. The Johnson & Johnson vaccine clearly passes that test.
That vaccine also is extremely safe, on par with both the Pfizer and Moderna vaccines. Its trial data shows no instances of severe allergic reactions following vaccination (which has been a concern of some with the mRNA vaccines), and it generally produced fewer and milder side effects than the vaccines currently available. While we await full data analysis by the FDA, the Johnson & Johnson vaccine is also likely to end up being an extremely safe vaccine.
Finally, Johnson & Johnson’s vaccine boasts two crucial qualities that neither the Pfizer nor Moderna vaccine can claim: It is delivered in one dose, and it can remain stable for at least three months at normal refrigeration temperatures. This allows for unprecedented convenience for both health-care professionals and vaccine recipients without sacrificing efficacy against the most severe forms of disease.
If the FDA authorizes the Johnson & Johnson vaccine in the coming weeks, we must be ready to ensure its effective distribution. Our goal must be to get as many people fully vaccinated as quickly as possible. This means leveraging the unique strengths of the newer vaccine by distributing it to areas with higher concentrations of young adults who might be less likely to return for a second dose, and to rural and remote areas that may lack cold chain storage capabilities. It means prioritizing distribution to communities where the convenience of one dose with minimal side effects can help outweigh the decision to not get vaccinated at all. And it means educating every American about the true effectiveness and safety of this new vaccine: Yes, it will prevent most infections, but even more important, if you do get COVID-19 after being vaccinated, it will help you avoid the worst consequences.
So the bottom line is clear: We are fortunate to now have multiple vaccines that are highly effective at preventing severe disease from the virus. Let’s remember that no vaccine is ever 100 percent effective at preventing all infections. Almost nothing in medicine does that. The vaccines in front of us exceed everyone’s expectations for safety and preventing hospitalizations and deaths. Any vaccine that turns COVID-19 from a deadly pandemic that has killed nearly half a million Americans into a mild disease that allows us to get our lives back is a vaccine worth taking.
Ashish K. Jha is a physician, health policy researcher and the dean of the Brown University School of Public Health.
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