Photo of vaccination by Fiona Goodall/Getty Images.
There’s been lots of good news on the vaccine front.
Not only are Pfizer and Moderna quickly ramping up production of their vaccines. Johnson & Johnson last week received approval for the one it developed. Then the company quickly announced a partnership with Merck to vastly increase production.
These developments and others have President Joe Biden predicting that enough vaccines will be available in the United States by the end of May for every adult to be inoculated. That doesn’t mean, however, that all those vaccines will be fully distributed by then.
But amid all this good news are questions about whether the newest vaccine is inferior to the others. While the Pfizer and Moderna products went to hospitals and giant pharmacy chains, the Johnson & Johnson vaccine last week was sent to independent pharmacies, which often are in less populated parts of Ohio.
That raises a question: Is a second-rate vaccine being sent out to folks in the sticks?
The answer appears to be an emphatic no.
“This is the question that’s coming to me all the time now: Should I get a second-rate vaccine, or should I wait for Moderna or Pfizer? And I recommend that they get the J&J vaccine,” said Michael Mina, Assistant Professor of Epidemiology at Harvard University’s T. H. Chan School of Public Health. “I actually think it might be better in the long run.”
Barry Klein, owner of Klein’s Family Pharmacy in Cuyahoga Falls, was ecstatic last week after he and his staff administered their first patients with the Johnson & Johnson vaccine.
“We got 50 knocked out in three hours,” Klein said, delighted to finally be vaccinating patients.
He described his frustration as vaccines trickled into the state, always going elsewhere.
“We were saying, ‘Get us vaccine. Let us do our jobs. We’ve been sidelined for six weeks,'” Klein said. “How many vaccines could we have given in that time?”
At the same time, people were raising questions. Superficially, the Pfizer and Moderna products seemed superior. The numbers seemed to say they were both more than 90% effective preventing covid, while the Johnson & Johnson vaccine was only 66% effective.
“There’s definitely been some people who are concerned with the numbers reported,” Klein said.
Turns out that comparing those numbers is a particularly egregious case of comparing apples to oranges.
The Johnson & Johnson vaccine is of a different type than the others, and it was tested during a more advanced phase of the epidemic and in different places. The trials also asked differing questions.
The Pfizer and Moderna vaccines were shown to be more than 90% effective against symptomatic covid after two doses.
After a single dose, the Johnson & Johnson vaccine was 66% effective at preventing a positive covid test and a single symptom such as a fever. Crucially, even though it was tested against variants that might not have existed when the other two were in trials, the single-dose Johnson & Johnson vaccine was 100% effective at preventing hospitalizations and deaths.
In addition to all that, it’s much easier to store. So the Johnson & Johnson vaccine might be the best way to get shots into lots of arms across a broad geographic area and help bring herd immunity rapidly.
But all those upsides invite perception problems, said Mina, of Harvard.
“It’s going to be a pretty hard message to confront because the J&J vaccine specifically — it doesn’t have the same freezer requirements, so it’s going to go to lower-income areas,” he said. “It’s going to go to places that don’t have minus-70-degree freezers at their disposal. So there’s going to be this very clear dichotomy in terms of where this vaccine is going. When you couple that with the message that it’s less effective, that’s a pretty hard thing to change.”
Klein said that’s where pharmacists can play a vital role.
Ohio Gov. Mike DeWine on Friday announced a mass vaccination site in Cleveland and many pop-up sites across Ohio. While they can rapidly vaccinate lots of people, they’ll only be effective vaccinating those who show up.
Sadly, there’s been a high degree of vaccine reluctance in Ohio. Shortly after the state started administering vaccines, DeWine said 60% of nursing home workers were refusing shots. Late last month, he said that after weeks of vaccinating Ohioans 80 and older, the percentage vaccinated reached 58 and then slowed to a crawl across the 60% mark.
Klein said he and other independent pharmacists have long-standing relationships with their patients. They’re often the first medical professionals patients seek out with problems or questions and that builds trust, he said.
“We’re trying to help patients understand the numbers and the science,” he said, explaining that on Day 1, patients seemed satisfied with his explanations.
Unfortunately, after just a few days of administering the Johnson & Johnson vaccine, Klein and other independent pharmacists are seeing a one-week interruption in supplies.
DeWine Press Secretary Dan Tierney said the interruption was related to the startup of the vaccines’ production and that supplies would resume next week. A Johnson & Johnson spokesman referred questions to the federal government.
When supplies do resume, there’s a good case to be made for the Johnson & Johnson shot, Mina said.
“This isn’t a second-rate vaccine,” he said. “The data shows that this vaccine is working essentially as well (as the other vaccines.) We need to show that there’s a chance that it will actually work better.”
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