Just days after this decision, President Joe Biden announced that his Administration had helped forge a historic manufacturing collaboration between Johnson & Johnson (J&J) and one of its competitors, Merck. Under the arrangement, Merck will dedicate two facilities in the United States to making the J&J vaccine. Up until this point, the federal government had expected to deliver enough of the two previously authorized vaccines, by Pfizer-BioNTech and Moderna, to immunize the entire country by the end of July. With the addition of the Johnson & Johnson vaccine, that timeline has been pushed up. Biden recently said, “We’re on track to have enough vaccine supply for every adult in America by the end of May.” William Schaffner, MD, an infectious-disease specialist and a professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, calls the Johnson & Johnson vaccine a game changer. “Having a new manufacturer that can provide millions of doses will enable us to vaccinate many more people more quickly,” says Dr. Schaffner. RELATED: Coronavirus Alert: The Latest News, Data, and Expert Insights on the COVID-19 Pandemic
How Well Does the Johnson & Johnson Vaccine Work?
Phase 3 trial data from J&J indicate that the J&J vaccine provided complete protection against COVID-related hospitalization and death, and that it was 85 percent effective at preventing severe disease. In trials conducted around the world, researchers found that the overall level of protection against moderate to severe COVID-19 infection varied by location: It was 72 percent in the United States, 66 percent in Latin America, and 57 percent in South Africa 28 days post-vaccination. With the vaccines from Moderna and Pfizer-BioNtech demonstrating 94 to 95 percent overall efficacy in clinical trials, results from the Johnson & Johnson studies may appear less impressive. “At first glance, the efficacy may not seem as good as 94 to 95 percent,” said Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, at a New York Press Club event. “But the important part was that for advanced, severe disease, it was quite effective. There were no hospitalizations or deaths in the individuals who were vaccinated.” David Hirschwerk, MD, an attending infectious-disease physician at Northwell Health in Manhasset, New York, cautions against directly comparing the study results from J&J with those from Moderna and Pfizer because of the timing of the research. “Pfizer and Moderna vaccine studies occurred predominantly during the summer — really before any of the [coronavirus] variants that we are now seeing were really a factor,” he says. He points out that when you take into account variants, which can be extra infectious, all the vaccines may be on a more equal playing field.
The Ability to Fight Variants
In recent weeks, more contagious variants of the coronavirus have been gaining ground in the United States. Centers for Disease Control and Prevention (CDC) tracking shows that variants have caused at least 2,580 infections in the country so far. In a recent episode of the podcast Track the Vax, Richard Nettles, MD, the vice president of U.S. medical affairs at Janssen, emphasized that none of the vaccine trial participants were hospitalized or died in South Africa or Brazil, where specific variants dominate. While Pfizer and Moderna are both looking into tweaking their vaccines to take on the variants, Dr. Nettles isn’t sure whether the Johnson & Johnson vaccine will need adjustments, judging by the study results so far. “We’re always looking at our vaccine carefully and monitoring the variant status,” he said on the podcast. “We are in a position where we could alter this vaccine if we need to.” Schaffner stresses that these factors should make the J&J shot more convenient for people while making distribution easier. “We don’t have to reach people twice and with conventional refrigeration, we will be more able to bring the vaccine to the people, rather than having to organize the people and bring them to the vaccine,” he said. A single-shot system requiring basic refrigeration may make it easier to immunize people who have issues with travel, transient populations, and homeless populations. “These advantages may make it easier to vaccinate hard-to-reach communities like those in extremely rural locations,” says Jennifer Horney, PhD, professor of epidemiology and core faculty with the Disaster Research Center at the University of Delaware in Newark. The altered adenovirus, which can enter human cells but not replicate within them, delivers a gene that tells the cells to make part of a so-called spike protein, similar to the spike protein on the surface of the coronavirus. The immune system responds by mounting a defense against the protein, creating “memory” T cells and antibodies that remain in the bloodstream to protect against future coronavirus infection. This is a different method from the Pfizer and Moderna vaccines, which use a genetic molecule called RNA (ribonucleic acid) to instruct human cells to make part of the spike protein. In large phase 3 studies involving tens of thousands of volunteers, neither the adenovirus-vectored vaccine nor the mRNA vaccines were shown to produce any serious side effects.
Addressing Racial Disparities
Public health authorities hope that the introduction of a third vaccine will help more people in Black and Latino communities get their shots. While people of color are at higher risk of getting sick and dying from the virus than their white counterparts, an investigation published in February 2021 by APM Research Lab found that only 3.5 percent of Latinos and 4.5 percent of Black Americans had so far received a vaccine shot compared with 9.1 percent of white Americans and 8.6 percent of Asian Americans. “Certainly we are seeing inequities in the vaccine distribution similar to the inequities that we see in the distribution of COVID cases, hospitalizations, and deaths,” says Dr. Horney. “I hope that as more states move to include more essential workers — such as those in food processing, postal, and grocery jobs — in their vaccination prioritization groups, we are able to diminish these vaccine disparities.” The Biden administration has recognized this problem and has been urging states to focus on getting the vaccine to underserved communities and lower-income people, as reported in The Wall Street Journal. On March 4, California said it would dedicate 40 percent of new vaccine doses to low-income communities. North Carolina has been targeting health centers in underserved communities to receive the vaccine. Other states are establishing similar initiatives.
On the Road to a New Normal
How well the Johnson & Johnson and other vaccines perform in the long run remains an open question. The longevity of the immunization is uncertain, although Dr. Hirschwerk estimates that the new vaccines should provide six months to a year of protection. “We’re only two and a half months into this, so it’s way premature to really know the impact of the vaccine,” he says. Also, while the vaccines are all highly protective, Hirschwerk doesn’t see COVID-19 disappearing. “It’s hard to imagine a scenario where we don’t have at least some degree of COVID circulating for a long period of time,” he says. “It’s likely something that we will need to figure out how to live with. Over time, there will probably be better treatments — not just vaccines, but therapeutics, and there will be wider availability of simple testing. All this will contribute to allowing us to get back to normal, but the timeframe in which all of that occurs is uncertain.” Still, to get anywhere near to normal, more people need to be vaccinated. “I strongly encourage people to get whichever vaccine they can, whenever it is available to them from their public health department, medical provider, or pharmacy,” said Horney. “Each person vaccinated helps the whole population be more protected.”
