Why Americans shouldn’t turn their noses up at Johnson & Johnson’s vaccine

Americans are taking another look at Johnson & Johnson’s Covid-19 vaccine and its data after the vaccine received emergency use authorization by the US Food and Drug Administration on Saturday. And what they see might initially give them pause.

For several months, public health experts have praised the approximately 95% efficacy seen in vaccines by Pfizer-BioNtech and Moderna. But the data surrounding the Johnson & Johnson vaccine, developed by the company’s vaccine arm, Janssen, falls short of that figure.

But those comparisons aren’t fair, experts say. They say the Johnson & Johnson vaccine is an effective vaccine that offers good protection against severe forms of Covid-19. Anyone should take it if given the opportunity.

“My big concern here is that the Johnson & Johnson is being labeled as the inferior vaccine,” said Dr. Leana Wen, a CNN medical analyst and former Baltimore public health commissioner, “when that’s not a fair assessment to make.”

It’s very effective against severe disease

On Wednesday, the FDA released an analysis of vaccine clinical trial data submitted by Johnson & Johnson, saying the vaccine met the FDA’s requirements for emergency use authorization.

According to that analysis, the single-dose vaccine showed about 66% efficacy globally against moderate to severe/critical Covid-19 cases 4 weeks after inoculation. But in the United States, the vaccine showed a 72% efficacy. Against severe forms of the disease, it’s even higher, offering nearly 86% protection.

And that’s what people should be focused on, experts say.

“That’s probably the most important part of this vaccine or any of the Covid vaccines is the protection against hospitalizations and severe disease and dying,” said Dr. Paul Goepfert, professor of medicine in the Division of Infectious Disease at the University of Alabama at Birmingham and director of the Alabama Vaccine Research Clinic.

“If we could prevent people completely from dying or getting hospitalized with Covid, we don’t have a problem anymore,” Goepfert said.

Dr. Wen said what really matters is a vaccine’s ability to prevent severe disease, and beyond that, disease that’s severe enough that leads to hospitalization or even death. She pointed to Johnson & Johnson’s vaccine trial, in which there were no individuals who had a severe enough case of Covid-19 that they ended up in the hospital or on a ventilator or died.

“In this regard,” she said, “all of the vaccines are essentially a hundred percent.”

While preventing infections would be great — and there is evidence Johnson & Johnson’s vaccine is effective against asymptomatic infection — its avoiding severe cases that will save lives.

“The key here isn’t that we want to prevent infections, though we do,” said Dr. Ashish Jha, dean of Brown University’s School of Public Health, in an interview last week with CNN’s Poppy Harlow. “We want to prevent people from getting really sick and obviously prevent people from dying. And all three of these vaccines appear terrific for that goal.”

You can’t make head-to-head comparisons

After Johnson & Johnson released its data last month, Dr. Anthony Fauci told CNN the vaccine had “very good efficacy against severe disease,” and that the results would have looked even better if it weren’t for the fact it had to compete with the vaccines from Pfizer-BioNTech and Moderna.

“We would have said wow, a 72% effective vaccine that’s even more effective against severe disease is really terrific,” he said.

While it might be an easy point of reference, Wen said it’s not correct to compare the Johnson & Johnson vaccine to its counterparts by Pfizer-BioNTech and Moderna.

“That’s because the trials were not done head-to-head,” she said. “It’s not as if we had several groups of people — one group got placebo, one group got Pfizer, one group got Moderna and one group got Johnson & Johnson. That’s not how this was done.”

The vaccines were also tested at different times, she said, and different types of strains were more prevalent than others depending on the location.

Notably, Johnson & Johnson’s vaccine was tested in South Africa, where the dominant strain was the B.1.351 variant, which is believed to be more contagious. There, the vaccine showed a 64% efficacy rate.

Offering protection against the variant could give the Johnson & Johnson vaccine a “slight edge,” Wen said, since neither Pfizer’s nor Moderna’s vaccine was tested in that environment.

Regardless, the Johnson & Johnson vaccine’s efficacy numbers exceed the 50% effectiveness bar that was previously set by the FDA.

“All three (vaccines) are way, way better than I think any of us had even hoped these vaccines would be,” Jha said previously.

“I had hoped these vaccines would give us 60%, 70% effectiveness,” he added. “They’re all way better than that.”

Take what you can get

At this point in the pandemic, however, Americans don’t have the luxury of choice. When it comes to Covid-19 vaccines, experts say to take what’s offered you.

“If people are offered the Johnson & Johnson vaccine, they shouldn’t say, ‘I don’t want it,'” Goepfert said. “We are not in a scenario where we can pick and choose vaccines.”

Asked about which vaccine Americans should get, Wen said, “You should get whatever is available to you at the time that you are first eligible.

“At some point, there will be plenty of supply for everyone,” she said. “That’s not the case right now. Supply is the limiting factor.”

She also noted the Johnson & Johnson vaccine has an ongoing trial testing a two-dose vaccine program — a trial she’s a part of. And while she hopes the one-dose program will get authorization soon, she said getting one vaccine now doesn’t necessarily mean you’ll be unable to get another later.

“Getting the vaccine now, as soon as possible, it helps you, it protects you and gives you some level of immunity,” she said. “And it also helps us come to an end of this pandemic sooner.”