MeIt’s always good for consumers to have options, right? And, in fact, the United States should soon have three Covid-19 vaccines being injected into people’s arms, with more potential on the way in the coming months, accelerating the race to vaccinate hundreds of millions of people as quickly as possible.
But all vaccines are not the same and, increasingly, authorities and healthcare providers will deal with injections with varying attributes: different storage requirements, efficacy, dosing regimes and manufacturing platforms. This, plus the possibility of a more demanding audience that may want a certain dose instead of another, can complicate an already confusing implementation. But the different features also open the door to greater access in addition to just more supplies – a more convenient single-dose vaccine is likely to be available soon.
The bottom line, experts emphasize, is how remarkable the fact that the United States has several Covid-19 vaccines just a year after the pandemic began. All immunizations that regulators authorize will have been shown to be safe and effective, so you should get any that you have the opportunity to get, they say.
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“In case you have the option to be vaccinated, I would encourage you to get the vaccine you were given,” said John Brooks, the medical director of the Covid-19 Response Center for Disease Control and Prevention at a meeting on Friday -market.
Johnson & Johnson, which on Friday reported that its vaccine was 66% effective in preventing moderate to severe illnesses and 85% effective in preventing severe Covid-19 in clinical trials, plans to file an application for emergency use authorization with to the Food and Drug Administration in early February. Assuming that regulators act quickly, health officials will have the advantage of a third injection to distribute with millions more in supplies.
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Unlike the two-dose mRNA vaccines already authorized by Moderna and Pfizer-BioNTech, the J&J vaccine requires only one dose. It is also inexpensive and can be stored in regular refrigerators, making it easier to store and transport than mRNA vaccines, which must be kept below freezing temperatures, sometimes in special freezers that smaller clinics may not have.
“This will be huge for rural populations,” said Alan Morgan, CEO of the National Rural Health Association, about the J&J injection.
Likewise, it may now be easier for vaccine campaigns to reach communities instead of requiring people to come to hospitals to get vaccinated, which could reach people who do not have access to health care or who do not trust institutions but they can listen to community leaders. Research data, for example, has shown that people of color, who have faced historical and ongoing abuse by healthcare professionals, are less likely to get vaccines against Covid-19 as quickly as others. In addition, initial vaccine distribution data shows a disproportionately low number of black and Latino adults who received vaccines.
“It is easier to take the vaccine to hard-to-reach areas,” said Mitchel Rothholz, American Pharmacists Association team leader, about the J&J vaccine.
Some people, however, may want to choose their vaccine as if it were a product they could squeeze to find the most suitable option. Results of clinical studies or reports about side effects can direct what people want.
It is difficult to compare clinical trials of different products with each other. The pandemic has also changed: the J&J trial occurred when at least one variant that appears to have an impact on the vaccine’s effectiveness was circulating, while the Moderna and Pfizer-BioNTech trials were completed before worrying variants began to spread widely. Without clinical data to evaluate each vaccine against the newest strains, it is difficult to determine whether existing Covid-19 vaccines could be less effective against variants of the virus.
Still, some people may remember the headlines for Moderna and Pfizer products offering more than 90% effectiveness compared to Covid-19 and question J&J’s 66% effectiveness announcement.
Public health officials were quick to disclose J&J data as a strong result, especially considering that regulators initially said that a vaccine would only have to be 50% effective to be authorized. A 66% effective vaccine is an incredibly powerful tool in fighting respiratory viruses, they emphasized. “We would be celebrating a 60% seasonal flu vaccine,” Jay Butler, CDC’s deputy director of infectious diseases, told reporters.
In the American arm of the clinical trial, the J&J vaccine was 72% effective, which, in the absence of mRNA data, “would have been said to be an absolutely spectacular result”, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said in a separate statement at the White House. Furthermore, immunization was 85% effective in preventing serious illnesses and, in the trial, all hospitalizations and deaths occurred among people who received the placebo. None of the vaccinated people diagnosed with Covid-19 became ill enough to need hospital care.
“If it is necessary to vaccinate my family, and all that is available is J&J or Novavax, I would tell them to take it,” said Robert Hancock, president of Texas College of Emergency Physicians.
Novavax is another vaccine manufacturer that on Thursday reported that its vaccine was 90% effective in one trial in the UK, but 49% effective in another trial in South Africa, probably because of variant B.1.351 circulating in that country, which seems to avoid some aspects of the immune response. The company did not say when it could apply for authorization from the FDA.
The different levels of effectiveness between vaccines can also complicate the logistical advantages that J&J injection offers. If states start allocating the J&J injection only to rural areas, “there may be concerns that this is unfair,” said Marcus Plescia, medical director for the Association of Territorial and State Health Officials. “People in rural areas may feel that they are receiving little attention.”
Julie Swann, head of the department of industrial and systems engineering at North Carolina State University, who advised the CDC during the H1N1 pandemic, agrees. She said providers should start researching their communities to see if people have a preference for the vaccines they receive. “It would be a real mistake to distribute J&J just based on the infrastructure,” she said.
Eventually, as more vaccines are authorized, health officials may recommend that certain people, based on age or other risk factors for more severe Covid-19, be prioritized for certain vaccines. Perhaps mRNA vaccines could be reserved for people most vulnerable to coronavirus, Swann suggested, while the J&J vaccine could be implanted in more general populations.
For now, federal health officials have not issued guidelines on who should receive which vaccines.
Another question hangs over the vaccination campaign: the variants. It appears that B.1.351 has some impact on at least some of the vaccines, although experts note that immunizations do not function as light switches that are on or off. Instead, vaccinated people may be less protected from being infected against B.1.351 than other forms of the coronavirus, but vaccines can still protect them from severe Covid-19.
For now, health officials and companies say that the emergence of B.1.351 and other variants serves as a signal that they need to be ready to adapt vaccine designs if and when a form of the virus emerges that could “escape” significantly. immunological protection provided by vaccines. Some vaccine manufacturers have begun studying booster injections designed specifically against B.1.351, and federal health officials said on Friday that they are reviewing contingency plans to adjust vaccines, if necessary.
“We will continue to see the evolution of mutants,” said Fauci. “We as a government, the companies, all of us who are in this together, will have to be nimble to be able to readily adjust to make versions of the vaccine … specifically targeting any mutation that is really prevalent at a given time.”
The variants add pressure to vaccine campaigns in other ways. B.1.351 and other variants that have been confirmed in the United States appear to be more infectious than previous forms of the virus, meaning that a larger proportion of the population will need to be vaccinated to stop the epidemic in the United States. If more people are vaccinated and the cases decrease, it decreases the chance of even more harmful variants appearing.
“The sooner we can immunize people, the better chance we have that it will not continue to happen with more and more emerging variants, because there is a large population of viruses,” Francis Collins, director of the National Institutes of Health, told reporters. Friday.
Rachel Cohrs and Matthew Herper contributed reporting.