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It’s always good for consumers to have options, right? And indeed, the United States should soon have three Covid-19 vaccines being injected into people’s arms, with more potentially 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 equal, and increasingly, health authorities and providers will be dealing with shots with varying attributes: different storage requirements, efficacy, dosing regimens, and manufacturing platforms. That, plus the possibility of a pickier public who may want a certain shot over another, could complicate an already-messy rollout. But the different features also open the door to greater access beyond just more supply — a more convenient one-shot vaccine will likely soon be available.

The main point, experts stress, is how remarkable it is the U.S. has multiple Covid-19 vaccines just a year into the pandemic. All the immunizations that regulators authorize will have been shown to be safe and effective, so you should get whichever one you have the opportunity to get, they say.

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“In the event that you have the choice to get vaccinated, I’d encourage you to take the vaccine that you’re given,” John Brooks, the chief medical officer of the Centers for Disease Control and Prevention’s Covid-19 response, said at a briefing Friday.

Johnson & Johnson, which on Friday reported its vaccine was 66% effective in preventing moderate to severe disease and 85% effective in preventing severe Covid-19 in clinical trials, plans to file for emergency use authorization with the Food and Drug Administration in early February. Presuming regulators move quickly, health authorities will have the advantage of a third shot to distribute with millions more in supply.

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Unlike the two-dose mRNA vaccines already authorized from Moderna and Pfizer-BioNTech, the J&J vaccine requires only one dose. It is also cheap, and can be kept in normal refrigerators, making it easier to store and transport than the mRNA vaccines, which have to be kept at subzero temperatures, sometimes in special freezers that smaller clinics might not have.

“That’s going to be huge for rural populations,” Alan Morgan, the CEO of the National Rural Health Association, said about J&J’s shot.

Similarly, it could now be easier for vaccine campaigns to go out into communities instead of requiring people to come to hospitals to get vaccinated, which could reach people who don’t have access to health care or who are mistrustful of health institutions but may listen to community leaders. Polling data, for example, have shown that people of color, who have faced historic and ongoing mistreatment by medical providers, are less likely to get Covid-19 vaccines as quickly as other people. Plus, early vaccine distribution data show disproportionately low numbers of Black and Latino adults have received shots.

“It’s easier to bring the vaccine to hard-to-reach areas,” Mitchel Rothholz, chief of staff of the American Pharmacists Association, said about J&J’s vaccine.

Some people, however, may want to pick their vaccine as if it were a piece of produce they could squeeze to find the choicest option. Clinical trial results or reports about side effects could steer what people want.

It’s difficult to compare clinical trials of different products against each other. The pandemic has also changed: J&J’s trial occurred as at least one variant that appears to have some impact on vaccine efficacy was circulating, while the Moderna and Pfizer-BioNTech trials were completed before variants of concern started transmitting widely. Without clinical data to evaluate each vaccine against the newer strains, it’s difficult to determine if the existing Covid-19 vaccines could be less effective against variants of the virus.

Still, some people might remember the headlines of Moderna’s and Pfizer’s product offering greater than 90% effectiveness against Covid-19 and question J&J’s announcement of 66% effectiveness.

Public health officials were quick to tout J&J’s data as a strong result, particularly given that regulators initially said a vaccine would only have to be 50% effective to be authorized. A vaccine that’s 66% effective is an incredibly powerful tool in fighting respiratory viruses, they stressed. “We would be celebrating a seasonal influenza vaccine with 60% efficacy,” Jay Butler, the deputy director for infectious diseases at the CDC, told reporters.

In the U.S. arm of the clinical trial, J&J’s vaccine was 72% effective, which, in the absence of the mRNA data, “one would have said this was an absolutely spectacular result,” Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said at a separate White House briefing. What’s more, the immunization was 85% effective at preventing severe disease and, in the trial, all hospitalizations and deaths occurred among people who got the placebo. None of the vaccinated people diagnosed with Covid-19 got sick enough to need hospital care.

“If it comes to getting my family members vaccinated, and all that’s available is J&J or Novavax, I’d tell them to take it,” said Robert Hancock, president of the Texas College of Emergency Physicians.

Novavax is another vaccine maker that, on Thursday reported that its vaccine was 90% effective in one trial in the United Kingdom, but 49% effective in another trial in South Africa, likely because of the B.1.351 variant circulating in that country, which appears to evade some aspects of the immune response. The company has not said when it might apply to the FDA for authorization.

The differing efficacy levels among vaccines could also complicate the logistical advantages J&J’s shot provides. If states started allocating J&J’s shot only to rural areas, “there may be concerns that that’s inequitable,” said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “People in rural areas might feel like they’re getting short shrift.”

Julie Swann, the head of the department of industrial and systems engineering at North Carolina State University, who advised the CDC during the H1N1 pandemic, agreed. She said providers should start surveying their communities to see whether people have a preference for which vaccines they receive. “It would be a real mistake to distribute J&J solely based on infrastructure,” she said.

Eventually, as more vaccines get authorized, health officials could recommend that certain people, based on age or other risk factors for more severe Covid-19, are prioritized for certain shots. Perhaps the mRNA vaccines could be reserved for people who are most vulnerable to the coronavirus, suggested Swann, while the J&J vaccine could be deployed to more general populations.

For now, federal health officials haven’t issued guidelines for who should get which vaccines.

Another question looms for the vaccine drive: the variants. It appears that B.1.351 has some impact on at least some of the vaccines, though experts note that immunizations don’t work like light switches that are either on or off. Rather, people vaccinated may be less defended from getting infected against B.1.351 than other forms of the coronavirus, but the vaccines could still protect them from getting severe Covid-19.

For now, health authorities and companies say the emergence of B.1.351 and other variants serves as a signal they need to be ready to adapt vaccine designs if and when a form of the virus emerges that could significantly “escape” the immune protection conferred by vaccines. Some vaccine makers have started studying booster shots engineered specifically against B.1.351, and federal health authorities said Friday they are reviewing contingency plans to tweak the vaccines if needed.

“We will continue to see the evolution of mutants,” Fauci said. “We, as a government, the companies, all of us that are in this together will have to be nimble to be able to adjust readily to make versions of the vaccine … specifically directed towards whichever mutation is actually prevalent at any given time.”

The variants add pressure to the 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 earlier forms of the virus, which means a higher proportion of the population will need to be vaccinated to drag down the U.S. epidemic. If more people get vaccinated and cases decrease, that lowers the chance of even more nefarious variants popping up.

“The sooner we can get people immunized, the better chance we have that this will not keep happening with more and more variants emerging because there’s such a large population of viruses,” Francis Collins, the director of the National Institutes of Health, told reporters Friday.

Rachel Cohrs and Matthew Herper contributed reporting. 

  • Where does this leave me, I recently has a foot operation and I am 78 years, I need to have someone come to my home or a drive through near by. Plus, I do not have anyone to take me to these large locations. I am left out in the cold. All the locations in my area are not taking anyone. What an I to do? Thank you, Cynthia

  • Dr. Michael Osterholm is predicting a new epidemic worse than the first, based on his projection the UK variant will quickly rise to become predominant. Based on this, he is recommending as many people as possible get at least one shot ASAP, and the scheduled 2nd shot be delayed.

    The claim that the vaccines work against the South African variant seem to based on very thin evidence. Moderna and Pfizer apparently said their vaccines should work – but this was based on purely test tube experiments with surrogates for everything as best I can tell – and we have Moderna saying they are going to create a “booster” – Why, if the vaccine you have works fine? I am glad they are doing it, but obviously they do not feel confident what they have will work.

    I see no reports either is claiming efficacy against the Brazilian P.1 variant. The one which is causing the huge outbreak in Manaus. A news report, vague about which variant, claims the variant from Brazil is now being found in samples from the San Francisco Bay Area. Are we on the brink of TWO new epidemics? The UK variant infecting a large number of people who do not have immunity to the Wuhan variant, and then the Brazil variant infecting everyone, because neither vaccine nor part infection by Wuhan or UK confers immunity to Brazil ? THREE NEW EPIDEMICS?
    Because people will be able to get Wuhan or UK variant if not vaccinated, or previously infected with Wuhan, AND the South African variant, vaccinated or previously infected or not, AND the Brazilian variant, no matter what their immune systems have already seen?

    It seems most likely we are in for another year of epidemic, with 4 variants being epidemic at once, the Wuhan variant dying out without another surge, UK only being quelled after a bad surge, and, if we are LUCKY – immunity to South Africa conferring immunity to Brazil and vice versa . And then you have to wonder if immunity to South Africa/Brazil will give you immunity to Wuhan/UK, but it appears quite possibly it will not.

    I am pretty upset Trump and CDC did not put in real travel restrictions to keep these variants out of the country. I do not let CDC off the hook, I feel, if Trump would not do what was necessary, they needed to go public and raise the alarm, beg Congress for authority if needed, etc, etc. Our procedures by the way are STILL INADEQUATE. But I guess it does not matter any more.

    • Plz see my comments above. Osterholm is a fearmongering opportunist here in Minnesota now selling hoodies on his University of Minnesota sponsored website. Also, I am sure you know he is also subsidized by 3M (masks) and Gilead.

      Still upset at Trump? These “variants” are just another cold virus with a spike protein engineered into them that are easily neutralized. Try to catch up and get off the fear bandwagon. Also learn how to compound ivermectin drops and carrageenan nasal spray. And take off that silly mask — you are not protecting anyone including yourself.

    • That would be good news, EXCEPT, the clinical trial was in South Africa, but at the time the “South African” strain was not the only strain down there – there were a bunch of people with the “original” Wuhan variant in the study – so the efficacy against what the politically incorrect are calling “the South African variant” is far less than 60%, that 60% is an average between the efficacy against Wuhan and UK – which is reported as 72% – and efficacy against the South African strain, taking into account their relative abundance in South Africa at the time. IF they were each about 50% of all cases in South Africa, then I guess the efficacy against South African variant was about 48%, for example, (60% is midway between 48% and 72%)
      That does not sound anywhere near as good when you are worried about exponential spread and a small reduction in the exponent makes a huge difference in total case over a fairly short period of time, but it may be worse, or better, in the US, because it may spread more easily or less easily here. There is not much reason, so far, to hope that vaccine will stop the SA variant epidemic here.

    • My mistake, my comment was addressing the initial reports of the South African trials of the J&J vaccine, which did not include the prevalence of the South African variant in the study participants, but now I see Novovax reports very high prevalence of the variant in their study participants -but still the efficacy is under 60% for the variant.

  • There are (at least) two ways to look at getting a Covid-19 shot- from the population perspective and from the individual perspective.
    From a population perspective, go at the first opportunity and get shot(s) du jour.
    From an individual perspective, do your homework and get the best shot(s) (hopefully while not letting scarcity of a particular vaccine make it more attractive).
    Under the individual perspective there is also the paralysis-by-analysis option and the refuse due to fill-in-the-blank option.

  • I’m terribly allergic to all shellfish: I have read recently of cases that have had severe/or less severe reactions to the vaccine because of their shellfish allergies. Which of the vaccines available have any shell fish components in their formulae? I am not been able to track down any relevant response to my question and would appreciate yours.

  • Good article. But please observe journalists should separate reporting facts in the news section from opinion in the op/Ed section. This quote didn’t belong in a news article:
    “ Polling data, for example, have shown that people of color, who have faced historic and ongoing mistreatment by medical providers, are less likely to get Covid-19 vaccines as quickly as other people. ”

    • What about this sentence you object to isn’t factual? Seems like very relevant context to an article about the implications of having multiple vaccines available.

    • DA is correct, ‘historic and ongoing mistreatment by medical providers’ indicates the author must have empirical data to back this up, and not just be opinion. Such an inflammatory claim should include a footnote or reference to backup data.

    • Yes, journalists are obliged to provide evidence to justify such a derogatory accusation – mistreatment by medical providers. I find this particularly offensive given the bravery of so many doctors who have lost their health and lives to Covid by treating patients.
      So much easier to blame a group….when you work remotely at a desk.

    • Did the poll(s) being referenced ask people of color WHY they were less likely to get Covid-19 vaccines, or only whether they were hesitant to get Covid-19 vaccines?
      If the poll did not ask why, then the phrase “who have faced historic and ongoing mistreatment by medical providers” may not have a reason to be included other than that was as good a place as any to get in the obligatory systemic racism wording and its always safe to assume systemic racism is the cause for anything bad.
      If the poll did ask why POC why they are Covid-19 vaccine hesitant, then I would be interested in 1) the reason(s), 2) the % of POC who were vaccine hesitant and 3) if that hesitancy correlated with anything that could be addressable, including systemic racism.

    • I think it would be a mistake to not mention such information in an article addressing vaccine distribution etc. There is empirical evidence (not opinion) on this and YES many studies ask about why. This article isn’t the place to break that down and prove the point but the information is easily available with a quick google search. No one is blaming a whole group of doctors, but it is the responsibility of those in public health to understand and respect the nuanced perspectives regarding the vaccine including fear because of medical treatment. To name a few quick items, black women are more likely to die in childbirth, there are rigorous studies that show a significantly lower percent of black patients receive standard of care treatment, there are measured discrepancies in health outcomes based on race all accounting for diseases that may have a greater burden on certain people groups & other things being equal, and things like the egregious Tuskegee Syphilis Study. To invalidate these people and their positions is not only disrespectful to them and their legitimate concerns, but does a disservice to public health since we need to reach a certain level of immunization to end this thing. Sure, it is hard when you just want life to be normal, and you believe it to only be possible through vaccines, but it is essential. It is disappointing that people who claim to be MDs do not recognize this and concerns me about patients of color, particularly those who hesitate to take the vaccine, are treated

  • The article states, “Johnson & Johnson, which on Friday reported its vaccine was 66% effective in preventing moderate to severe disease and 85% effective in preventing severe Covid-19 in clinical trials.” Is it 66% effective in preventing severe disease, or 85% effective in preventing severe disease?

  • Is it feasible to vaccinate as many people as possible using all of the current vaccine candidates and then, when manufacturing capabilities catch up, let people choose whether they want to get mRNA vaccines if they received a less efficacious one earlier?

    • A great question! We get a different flu vaccine each year. Is there anything about the mRNA vaccines or any others under development that would preclude one from being vaccinated again? The idea of developing boosters seems to suggest that the answer is “no” to being precluded. But this is far from an area where I can claim any expertise whatsoever.

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