If you can choose, which COVID-19 vaccine should you choose?
For now, experts are clear: the best vaccine is one that is about to enter your arm. But, as the vaccine supply increases, Americans may eventually find someone asking, “What vaccine do you want?”
The answer for most people will still be “Whatever is available”. But there are differences that can play a role, although doctors are unanimous in saying that all three authorized vaccines work extremely well to protect against serious illness, hospitalization and death.
An injection is now better than waiting for a different injection, said Dr. Kathryn Edwards, scientific director of the Vaccine Research Program at Vanderbilt University School of Medicine. It probably benefits the individual and society, reducing the general spread of the disease.
In addition, there are minor disadvantages when it comes to current vaccines. In general, Pfizer-BioNTech and Moderna vaccines require two doses and are slightly more effective. Johnson & Johnson requires a dose and is less likely to cause side effects.
The “ready and ready” aspect of J&J is a selling point for many.
Pedro Betancourt works at the Miami airport and “cannot take any risks,” he said. Your choice would be “Johnson & Johnson due to a single convenient shot”. But he said he was not picky because he and his wife had acquired COVID-19, which he described as “mild, but scary”.
Right now, “I hope everyone takes vaccines seriously so that we can start moving towards normality,” he said.
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Overall, Pfizer-BioNTech and Moderna had slightly higher efficacy rates in clinical trials than J&J.
That’s enough for Tom Cavanagh, from Lexington Park, Maryland. If he had a choice, he would choose any of them, but he would be open to everyone.
“Because I was in the United States armed forces, I received a lot of vaccines without having a little knowledge, so I’m going to get the vaccine I can and hope for the best,” he said.
One way to approach this could be deciding whether you are someone at high risk of getting very sick or dying from COVID-19 or if someone in your family is, said Hilda Bastian, a health scientist who writes about COVID-19 vaccines.
People in that group can choose Pfizer-BioNTech or Moderna vaccines.
For someone who has no one at home who is at risk, and who is also not at risk, this slightly better effectiveness would not matter so much. The ease of J&J’s unique vaccine may be more important.
“They might think, ‘As long as I’m doing my part for the community, if that’s enough for that, then that would be enough for me,'” said Bastian.
Immunity: How fast does it work?
How quickly vaccine protection takes effect and how long it lasts are still being determined. Long-term data are not available because none of the vaccines is more than a year old.
Vaccines do not offer immediate protection because there are biological limitations at work, said Otto Yang, professor of medicine and associate head of infectious diseases at UCLA’s David Geffen School of Medicine.
“It takes time for antibodies and T cells to reach adequate levels. Antibodies, in particular, also require ‘maturation’, ”he said.
It may seem that the J&J single vaccine would be faster, but it is not necessarily the case.
From published data on symptomatic infections, it appears that the Moderna and Pfizer vaccines are likely to achieve maximum protection 14 to 28 days after both vaccines, said Akiko Iwasaki, professor of immunobiology at Yale University.
The final protection against symptomatic infection was measured two weeks after the second injection for Moderna and one week after the second injection for Pfizer during the Phase 3 tests. That would be 42 days for Moderna and 28 days for Pfizer.
This is not so different from J&J. After 28 days, their protection against serious illness was 85% and after 49 days it was 100%, Iwasaki said.
She acknowledged that there is no good data on direct confrontation.
“He is comparing apples and oranges, since effectiveness was measured differently, Moderna and Pfizer-BioNTech as symptomatic infections, Johnson & Johnson as moderate to severe illness,” she said.
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How well vaccines work against the emerging new COVID-19 variants is another factor.
Scientists say it is difficult to know if any of the three works better against the variants, since the vaccines were tested at different times, when the variants were circulating.
Still, some Americans prefer J&J.
“If I had a choice, I would choose Johnson & Johnson. The reason is because this vaccine protects people against variants. Pfizer-BioNTech and Moderna were launched before the variants appeared, ”said James Bock, of Rockford, Illinois.
Side effects: Fever, chills and fatigue
All three COVID-19 vaccines in use in the United States can cause short-term side effects in some people, including pain at the injection site, fatigue, headache, muscle and joint pain.
These are a sign that the immune system is accelerating and it is not a bad thing – they do not mean that vaccines are not safe.
For Pfizer-BioNTech and Moderna, more than half of the people who contract them have chills and fever a few days later. If you have not taken COVID-19, the reaction tends to be stronger after the second dose, said Edwards de Vanderbilt.
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“If you have taken COVID before, you will be sicker with the first dose and less with the second,” she said.
These differences can be important for some people. For example, younger people tend to have stronger side effects because their immune systems are generally stronger.
“If I’m an older person, I might not need a few days off from work if I get one of the injections, so Pfizer-BioNTech or Moderna is fine,” said Bastian.
A younger person or someone to take a day off from is difficult, may prefer the J&J vaccine, she said.
For people who are not enthusiastic about the idea of vaccines in general, J&J may be preferable because it is just one dose.
“They can say, ‘This is not asking too much. I’ll do it, ‘”said Bastian.
Anaphylaxis: 4.5 cases per 1M dose
For the Pfizer-BioNTech and Moderna vaccines, there are reports of a small number of people experiencing anaphylaxis, an immediate and severe allergic reaction that requires a dose of epinephrine to stop. The average rate was 4.5 cases per million doses administered.
That is why people who receive these vaccines need to wait 15 minutes before leaving if they need available medical treatment.
J&J seems to have a lower rate of these reactions, although that may also be because it is more recent and has not been given to so many people.
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“We don’t know what will happen when millions of doses of Johnson & Johnson are administered,” said Dr. Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic and editor-in-chief of the journal Vaccine.
Among those who had the severe reaction, one-third had a previous history of anaphylaxis and three-quarters had a known allergy to one of the components of the vaccine, Edwards said.
“The important thing is to know that no one died because of these reactions,” she said.
For the few people who have an anaphylactic reaction to their first dose of a COVID-19 vaccine, experts are discussing whether to receive the J&J vaccine as their second dose, said Dr. Buddy Creech, director of the Vaccine Research Program at Vanderbilt.
“If you are concerned about allergies, you may want to talk to your doctor about how to get Johnson & Johnson for your second injection,” said Creech.
Get the vaccine available for you
In general, experts say, the vaccine you can get is the best one for you.
That’s how Paula Musich, in Ashland, Oregon, sees it. She will be happy with what is on offer.
“I called today and there were no commitments. I don’t think they are going to give us a choice anytime soon, ”she said.
But if you were offered the choice, which would you choose? Here are some considerations:
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If getting the vaccine is difficult for you for any reason, the complete J&J vaccine may be preferable.
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If you want maximum protection for belts and suspenders, then Pfizer-BioNTech and Moderna can be your choice.
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If you know you are prone to severe allergic reactions, you can choose J&J, although the chance of something happening is very small and the medical team is ready to deal with it.
One last thing: whatever you get, there are likely to be more COVID-19 vaccines in your future. Many scientists think that booster injections are likely to be necessary, although it is not known whether it is annually or every few years. COVID-19 hasn’t finished with us yet and we haven’t finished with COVID-19 yet.
Mike Cascone in Sunnyvale, California, likes this plan. Half jokingly, he said: “I tell my friends, I want one of each. Then I will be fully covered. “
This article was originally published in USA TODAY: Differences of the COVID vaccine: What to know about Pfizer, Moderna, J&J