It’s been less than two weeks since the new coronavirus vaccine from Johnson & Johnson won authorization for emergency use from the U.S. Food and Drug Administration, and it’s already developed something of a troubled reputation. The mayor of Detroit waved off thousands of doses—suggesting it was second-rate, before the White House tried to clean up the mess. The Archdiocese of New Orleans condemned the safe and effective one-shot vaccine as “morally compromised.” And a slew of media outlets have probed concerns about perceptions that the jab is less effective than the other two available vaccines.
Ignore the naysayers. By some measures, the Johnson & Johnson vaccine might actually be somewhat better than the two vaccines that the FDA green-lit back in December.
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The reason is simple. The Johnson & Johnson vaccine is the only vaccine that we know with a high degree of confidence works pretty well against some of the new, fast-spreading forms of SAR-CoV-2. “It has already been tested and demonstrated effectiveness against the new variants,” Angela Zhou, an information scientist with Ohio medical-data firm CAS, told The Daily Beast.
To be very clear, each COVID shot—Johnson & Johnson’s, and the two from Moderna and Pfizer rolled out in the U.S. in December—works great by historical standards. “All three vaccines are highly effective,” stressed Georges Benjamin, director of the American Public Health Association in Washington, D.C.
But of the three COVID jabs, Johnson & Johnson’s has a reputation for being the least good. And that’s just not fair, experts said. Neither Johnson & Johnson, Moderna, nor Pfizer responded to requests for comment for this story.
The Moderna and Pfizer vaccines both feature messenger-RNA technology. They use bits of genetic code to trick our immune systems into producing antibodies.
Johnson & Johnson passed over mRNA in favor of a more conventional vaccine design. The jab, which the company developed through its Belgian subsidiary Janssen, uses the “AdVac” platform that Janssen created for its HIV and Zika vaccine-candidates.
Besides the obvious advantages of requiring just one dose for full effectiveness, versus the two doses the earlier vaccines demand, the Johnson & Johnson shot has other attractive qualities.
Owing to its less stringent cooling requirements, the new vaccine is simpler to ship and store than the Moderna and Pfizer vaccines. That makes it a lot easier to administer in a wider variety of situations.
Perhaps more importantly, the Johnson & Johnson shot is arguably more thoroughly tested than the (very thoroughly vetted) Moderna and Pfizer shots—owing to an accident of timing.
Each of the three companies went through rigorous, large-scale testing before the FDA gave them the nod for distribution. But Johnson & Johnson happened to test its vaccine at a time when new, more dangerous mutations or variants of the basic SARS-CoV-2 virus—“lineages” is the scientific term—were more prevalent.
That gives experts greater confidence in the new vaccine’s ability to protect against those lineages. Johnson & Johnson’s shot might appear less effective on paper. But that’s only because we have fresher data on it.
The gap between the Johnson and Johnson vaccine’s actual benefits and perceptions of those benefits isn’t hard to explain. Measuring the “effectiveness” of a vaccine is complicated. Explaining the results is even more complicated.
And assessing relative effectiveness—that is, the merits of one vaccine compared to another vaccine for the same disease—is the most complicated proposition of all.
“Technical differences in how and where samples are collected, transported, and stored can also occur, impacting the quality and usefulness of the data produced and making comparisons between measurements in individual laboratories difficult,” the Norway-based Coalition for Epidemic Preparedness Innovations told The Daily Beast in a statement.
Don’t expect public perception of a vaccine to take into account all that nuance.
Around two-thirds of Americans are willing to get a COVID vaccine, according to recent polls from survey firms Gallup and Pew. But James Lawler, an infectious-disease expert at the University of Nebraska Medical Center, told The Daily Beast he has sensed greater hesitancy toward the Johnson & Johnson vaccine.
Detroit Mayor Mike Duggan even declined a shipment of the Johnson & Johnson vaccine. “So, Johnson & Johnson is a very good vaccine,” Duggan said Thursday. “Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best.”
The hesitance—outright skepticism, in Duggan’s case—seems to stem from a key set of figures: 66 percent versus 95 percent.
When Moderna crunched the numbers from the large-scale phase 3 trials of its vaccine back in November, it concluded that the shot was 95 percent effective in preventing symptomatic COVID-19 after two doses. A few weeks later, Pfizer reported its own two-dose jab was also 95 percent effective preventing symptomatic disease.
But when Johnson & Johnson reported its own data last month, it appeared the single-dose shot was just 66 percent effective, on average. To be more specific, the new vaccine was 72 percent effective in test subjects in the United States, but only 66 percent and 64 percent effective, respectively, in volunteers in Brazil and South Africa.
Crucially, the vaccine appeared to be 100 percent effective at warding off hospitalization or death.
The seemingly lower effectiveness has hurt the Johnson & Johnson shot’s reputation. Julia Swann, a systems engineering professor and vaccine-distribution expert at North Carolina State University, told The Daily Beast she’s reluctant to recommend the vaccine for small clinics targeting hard-to-reach groups, including people of color. “You don’t want to be in a position of giving a marginalized population a vaccine that they or others may perceive as less desirable,” Swann said.
But there’s a very good theory for why the Johnson & Johnson shot turned in “less desirable” numbers than the Moderna and Pfizer shots did: lineages, or variants.
Moderna and Pfizer ran their large-scale trials last summer in countries including the United States, Brazil, and South Africa. By the time Johnson & Johnson was conducting its own large-scale trials in many of the same countries last fall, both Brazil and South Africa were in the process of being overrun by new, more dangerous lineages of SARS-CoV-2.
The Brazilian P.1 and South African B.1.351 lineages appear to be more transmissible than older forms of the novel coronavirus. They also seem to somewhat reduce the effectiveness of vaccines—“vaccine evasion,” experts call it. There’s also a U.K. lineage called B.1.1.7 that shares key mutations with other major lineages and could increase transmissibility and possibly be more fatal. Early evidence suggests the latter variant, which some experts say will become predominant in the U.S. in the coming weeks, is dispatched effectively by the Pfizer and Moderna vaccines, while the Johnson & Johnson shot has not yet been tested as thoroughly against it.
P.1 and B.1.351, which have both spread across the United States alongside other new lineages, seem to partially evade the Johnson & Johnson vaccine. That apparently drove down the Johnson & Johnson jab’s average effectiveness—and might seem to justify Americans’ skepticism toward the new vaccine.
But here’s the catch: Yes, the Johnson & Johnson vaccine may be less effective against the new lineages. But the Moderna and Pfizer vaccines likely are, too.
The difference is that we have hard data on Johnson & Johnson’s effectiveness against the Brazilian and South African mutations. “We can’t say that in an experimental way with the other two vaccines,” Benjamin said. That’s because large-scale trials of both earlier jabs took place before the Brazilian and South African strains spread all over the world.
“It’s true that Johnson & Johnson is the only one with convincing real-world efficacy data against the South African variant—also probably the Brazil variant,” Lawler said.
Early, independent research indicates that the Moderna and Pfizer vaccines still work against the new lineages, albeit at lower levels of effectiveness in some cases. But the companies only recently launched their own major studies of the new lineages’ effects on their respective vaccines. Both Moderna and Pfizer are already leaning toward adding a third dose to the standard vaccination regimen in order to give their jabs the best chance against the lineages.
Once more robust studies are complete, it may turn out the Moderna and Pfizer vaccines are still highly effective against the Brazilian and South African lineages—even without additional booster shots. We just don’t know yet.
What we do know that is the Johnson & Johnson vaccine appears to work pretty well against P.1 and B.1.351. That’s a good reason to get behind the new jab.
And as ever, the differences between the various vaccines are likely to be minor in light of the potential consequences of not getting vaccinated at all.
“There are differences in the extent to which each vaccine may suppress the existing variants of the virus—more data to come,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast. “I would strongly advise people to take whatever vaccine is available to them.”
