Why The Johnson & Johnson Vaccine Has Gotten A Bad Rap — And Why That's Not Fair

Feb 22, 2021
Originally published on February 23, 2021 1:14 am

Two COVID-19 vaccines are being distributed in the U.S. right now, and this week an FDA advisory committee will vote on whether a third should join them.

If granted emergency use authorization, Johnson & Johnson's one-dose vaccine would become available in the U.S., along with those from Pfizer and Moderna.

In clinical trials, the Johnson & Johnson vaccine appears to be 66% effective at preventing moderate to severe cases of COVID-19 — compared to about 95% for Moderna and Pfizer. That has some people wondering if they should avoid the Johnson & Johnson vaccine.

Absolutely not, says Dr. Ashish Jha, dean of the Brown University School of Public Health.

"What I've been saying to my family is, as soon as the J&J vaccine is authorized, if that's what you can get, you should get it as soon as it's your turn in line," says Jha.

He points out that the 66% vs. 95% effectiveness isn't the right comparison for several reasons. He notes that the Johnson & Johnson vaccine was tested in different settings — the U.S., several Latin American countries and South Africa, where some worrisome variants of the virus were first seen.

"So that 66% number really represents an amalgamation of a variety of different clinical trials. Moderna and Pfizer were not tested in those circumstances," Jha tells All Things Considered. "And even if you just look at the U.S. data, the Johnson & Johnson number then starts getting much closer to the Moderna and Pfizer numbers."

But all of that misses what Jha says is the most important point.

"What you care about is hospitalizations and deaths," he says. "And Johnson & Johnson appears to be just as good as Moderna and Pfizer at preventing those."

Jha notes that among the vaccines that have reported results, almost all of them — including the Johnson & Johnson vaccine — have shown to be close to 100% effective at preventing hospitalizations and deaths.

In excerpts from his interview, Jha discusses the advantages of the Johnson & Johnson vaccine and how that might affect distribution.

Are there other significant differences among the vaccines?

Johnson & Johnson has the huge advantage of being one shot. So that's, of course, really helpful. There are a lot of differences in storage. The Johnson & Johnson vaccine can be stored basically in any refrigerator. [The Pfizer vaccine is shipped and stored at ultracold temperatures.] So transportation, widespread availability, much easier. But I certainly think for most people, the idea of a single-shot vaccine should be attractive for a lot of folks. And that also makes it easier for people to get.

As people organizing this vaccination effort look at which vaccine should go where, does the ease of administering a one-shot vaccine that can be kept in a refrigerator determine where the Johnson & Johnson vaccine is going to go?

I think you're going to see that play out. The two-shot Pfizer vaccine is particularly hard to manage in, let's say, rural settings, hard-to-reach places. Doable, but harder. J&J vaccine — much, much easier on that front. There are also certain people who may just decide they'd rather get a single shot than two shots. And, you know, and that may also influence who ends up getting what.

Some people are expressing concern that the vaccines that appear to be more effective — Moderna, Pfizer — are going to go to constituencies that have more political power, more clout, a louder voice, and that the so-called less effective vaccine, Johnson and Johnson, is going to go to more disenfranchised groups. What's your response to that?

First of all, I want to make the case that the J&J vaccine is not a lesser vaccine. And second is we absolutely should not be distributing these things based on socioeconomic status or any of those things. We should really be getting all these vaccines out everywhere, we should be focused on disenfranchised groups, actually, for priority because they've been hit so hard.

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ARI SHAPIRO, HOST:

There are two coronavirus vaccines being distributed in the U.S. right now. And this week, an FDA advisory committee will vote on whether a third should join them. If authorized, Johnson & Johnson's would become available along with Pfizer and Moderna's. And many people have been asking which vaccine is their best bet. Well, Dr. Ashish Jha has a simple answer to that question. He says, take any one you can get. He's dean of the Brown University School of Public Health.

And Dr. Jha, it's good to have you back with us.

ASHISH JHA: Thank you for having me back.

SHAPIRO: So there's a reason people want to get a particular vaccine in certain cases. The Johnson & Johnson one appears to be 66% effective at preventing severe and moderate cases of COVID-19, while Pfizer and Moderna are both up around 95%. So what is your answer to people who say, no Johnson & Johnson for me, thanks?

JHA: Right. So most importantly, people have to compare apples to apples, and that 66 to 95 isn't the right comparison for a couple of reasons. One is that Johnson & Johnson was tested in very different settings. It was tested in South Africa while that South African variant was spreading. So that 66% number really represents an amalgamation of, you know, a variety of different clinical trials. Moderna and Pfizer were not tested in those circumstances. And even if you just look at the U.S. data, the Johnson & Johnson number then starts getting much closer to the Moderna and Pfizer numbers.

But I think all of that actually misses the most important point, which is what you care about is hospitalizations and deaths. And Johnson & Johnson appears to be just as good as Moderna and Pfizer at preventing those.

SHAPIRO: So I just want to be clear. It's possible that when all of these vaccines are in circulation for a longer time with greater populations of people, the differences among them will seem to be much smaller than they seem right now.

JHA: Absolutely. They've been tested in different populations. They've been tested at different times. We get slightly different numbers, but we shouldn't focus on that. What we should really focus on is the most important issue, which is, do they save lives? And the Johnson & Johnson vaccine seems terrific at that. This is really remarkable, by the way, that across every vaccine that has reported results, almost all of them have been close to a hundred percent at preventing hospitalizations and deaths, which is terrific.

SHAPIRO: Are there other significant differences among the vaccines?

JHA: Yeah, absolutely. So Johnson & Johnson has the huge advantage of being one shot. So that's, of course, really helpful. There are a lot of differences in storage. Johnson & Johnson vaccine can be stored basically in any refrigerator. So transportation - widespread availability much easier. But I certainly think for most people, the idea of a single-shot vaccine should be attractive for a lot of folks. And that also makes it easier for people to get.

SHAPIRO: As people organizing this vaccination effort look at which vaccine should go where, does the sort of ease of administering a one-shot vaccine that can be kept in a refrigerator determine where the Johnson & Johnson vaccine is going to go as opposed to one that requires two shots and has to be kept super cold?

JHA: Yeah, I think you're going to see that play out. I mean, the two-shot Pfizer vaccine particularly hard to manage in, let's say, rural settings, hard-to-reach places - doable but harder - J & J vaccine much, much easier on that front. There are also a certain people who may just decide they'd rather get a single shot than two shots. And you know - and that may also influence who ends up getting what.

SHAPIRO: Some people are expressing concern that the vaccine that appears to be more effective - Moderna, Pfizer - is going to go to constituencies that have more political power, more clout, a louder voice and that the quote-unquote "less effective vaccine," Johnson & Johnson, is going to go to more disenfranchised groups. What's your response to that?

JHA: Yeah. Well, first of all, I want to make the case that the J & J vaccine is not a lesser vaccine.

SHAPIRO: Yeah.

JHA: And second is we absolutely should not be distributing these things based on socioeconomic status or any of those things. We should really be getting all these vaccines out everywhere. We should be focused on disenfranchised groups, actually, for priority because they've been hit so hard. And on a personal level, you know, what I've been saying to my family is, as soon as the J & J vaccine is authorized, if that's what you can get, you should get it as soon as it's your turn in line.

SHAPIRO: Dr. Ashish Jha is dean of the Brown University School of Public Health.

Thanks for joining us today.

JHA: Thank you for having me on. Transcript provided by NPR, Copyright NPR.

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