As an independent doctor at the forefront of vaccinating seniors, I hope to answer some questions patients have been asking about the Johnson & Johnson single-shot vaccine’s impending release.
Is it safe for a senior?
It’s single shot, so isn’t that better?
And most frequently, “I heard it doesn’t work as well as Moderna (or Pfizer), should I wait?” I get the same questions from younger patients who have underlying medical conditions. I am writing to encourage all seniors to vaccinate as quickly as possible and provide scientific and reliable medical information about their choices.
Pfizer & Moderna Vaccines are Very Safe and Effective
Pfizer and Moderna, both mRNA-based vaccines, were the first to arrive on the U.S. market with emergency F.D.A. approval. Both were studies with patients receiving two doses, three and four weeks apart, respectively. They have been wildly successful from an efficacy standpoint, with at least 93% efficacy for both vaccines: According to the New York Times, “each company’s application to the F.D.A. includes two months of follow-up safety data from Phase 3 of clinical trials conducted by universities and other independent bodies. In that phase, tens of thousands of volunteers got a vaccine and waited to see if they became infected, compared with others who received a placebo. By September, Pfizer’s trial had 44,000 participants; no serious safety concerns have been reported.”
Johnson & Johnson’s Vaccine is Very Effective
If you compare a single dose of Moderna, Pfizer, and Johnson & Johnson, guess who wins? Hands down, it is Johnson & Johnson. The A.C.P. Medical Journal provided recent information yesterday on the Johnson and Johnson vaccine, which was studied in phase 3 trials as a one-dose vaccine: “According to press releases from Johnson & Johnson and the N.I.H. providing non-peer-reviewed data, their single-dose vaccine was 66% effective at preventing moderate to severe COVID-19 at 28 days after vaccination. It was 85% effective in preventing severe disease, defined as signs consistent with severe systemic illness, I.C.U. admission, respiratory failure, shock, organ failure, or death, among other factors. Moderate disease was defined as evidence of pneumonia, deep venous thrombosis, shortness of breath or abnormal blood oxygen saturation, abnormal respiratory rate, or two or more systemic symptoms. Protection was generally consistent across race, age groups, and virus variants studied. Fever occurred in 9%, and serious adverse events were higher with placebo. No anaphylaxis was observed.”
It is notably the only vaccine of the three that has been extensively studied against the South African Variant, which is generally accepted to be more contagious. However, with one dose, the vaccine’s efficacy rate dropped to 57 percent in South Africa, where the aforementioned variant is driving most cases.
The single shot is obviously more convenient. It is very possible that J&J will recommend a second shot at some time. They are presently conducting a study to see if a second shot significantly boosts immunity. So the convenience of a single shot may be a short-lived benefit.
But Moderna & Pfizer Are Better in the end – right?
Maybe, but maybe not. Moderna & Pfizer were benchmarked against only the initial strains of COVID. The Johnson & Johnson vaccine faced tougher strains. Also, Johnson & Johnson is testing the administration of a second dose 57 days after the first. There are some technical questions about how much of a boost this will provide, but if it does provide a significant boost, the Johnson & Johnson vaccine may be the most effective of all.
So, What Should I Do?
Where does all this information leave senior patients? It may sound as though the Johnson and Johnson option is inferior; however, it is important to note that the vaccine is significantly less fragile and easier to transport – a critical point in the race to vaccinate throughout the world, especially regions that may not have access to the temperature control technology on which the Pfizer and Moderna are dependent. While we have convincing (though less impressive) data on one dose of the Johnson and Johnson vaccine, there is currently a trial underway on the effects of a second dose – it is feasible that two doses of the Johnson and Johnson may result in a level of immunity that rivals that associated with Pfizer and Moderna. The results of the ongoing studies will hopefully be available to the public soon.
Diving deep into the data, we learn that the J&J vaccine is 72% protective in the United States, 66% protective in South America, and 57% protective in South Africa, but when you compare it against severe disease (the one most deadly metric that older people must care about) it was 85% protective. Most interesting is the fact that there did not seem to be a geographic difference in this key metric. In other words, for reasons that are unclear, it might be less effective against some variants in terms of you getting the disease, but it is equally protective in stopping the disease from progressing to a serious stage.
Ultimately, while the levels of protection against infection appear to vary, the levels of severe illness and death are almost nil with any of the three vaccines reviewed above. With the tremendous need to vaccinate the population as quickly as possible, especially those in older and harder-hit minority communities, my hope is that patients will consider whatever vaccine they may access the fastest.
The medical community and health officials simply can’t allow vaccines to sit unused in warehouses, red tape, and differing rules between states to slow the rollout, or those patients paying the highest price, the most vulnerable seniors and minorities in our society, to stand in the shadows, waiting. No one has enough information to decide which vaccine is truly the best and whether or not you should self-select among them. But one fact is certain, these are extraordinarily effective vaccines, and any one of these vaccines is far better than getting none.
As more data is available, I will post updates. Please check back.