Just how equitable is the J&J vaccine?
Goal is to make sure everyone is given an equal chance
Virginia localities are preparing to move into phase 1C as more vaccines become available to more of the population. One of the biggest ongoing concerns for health officials locally and statewide is making sure all citizens are treated equitably during the vaccination efforts.
As Riverside Health System vice president and chief pharmacy officer Cindy Williams said at the beginning of March, Johnson & Johnson’s one-and-done vaccine might be put to its best use on targeted groups such as members of the homeless population, who are harder to schedule second doses for, or people living in rural areas where transportation to and from vaccine appointments can be harder to obtain. But how does the efficacy of the vaccine affect those equity efforts?
If the end goal of those equitable vaccination efforts is to make sure everyone is given an equal chance at protection from COVID-19, how does the J&J vaccine — shown in clinical trials to be slightly less effective at preventing moderate illness than the Pfizer or Moderna options — play into equity issues?
First, it’s important to understand the differences between vaccine effectiveness and vaccine efficacy, and the context in which those different percentages appear.
Efficacy is the percentage of time a vaccine prevented illness in just a clinical trial, according
Dr. Kelly Goode, Pharm.D, professor in the Department of Pharmacotherapy and Outcomes Science at Virginia Commonwealth University School of Pharmacy, and co-chair of Virginia’s Vaccine Advisory Workgroup.
Effectiveness, on the other hand, is the percentage of time it prevented illness in real-world conditions — something everyone is still seeing the results of as more people are vaccinated.
J&J’s vaccine has a 67% efficacy when it comes to preventing moderate to severe COVID-19 14 days after vaccination, according to the FDA. That means that vaccine recipients in South Africa, South American countries, Mexico and the United States were less likely, by that percentage, to develop disease in the “much more controlled environment” that is created by clinical trial conditions, Goode explained in a phone call.
According to the CDC, “Based on evidence from clinical trials, the Pfizer-BioNTech vaccine was 95% effective at preventing laboratory-confirmed COVID19 illness in people without evidence of previous infection,” while “the Moderna vaccine was 94.1% effective” under those conditions.
That efficacy can vary slightly between vaccines by time period and country, depending on the variants that emerged in different places during those trials, and the level of COVID-19 case surges happening while the trial was conducted, Goode added.
“Johnson & Johnson was studied in South Africa, where they did have the emergence of that variant,” she said. In South Africa, the efficacy of the vaccine was 57%, while in the United States, it was 72%. “You also had more surges during that time of the trial (than there were during the trials for Pfizer and Moderna). So, all of that you have to take into account.”
When it comes to preventing “severe/critical COVID-19 occurring at least 14 days after vaccination,” according to the FDA, J&J’s vaccine has a 77% efficacy in clinical trials. The efficacy went up to 85% after 28 days.
Most importantly, nobody in the trials who received the J&J vaccine died of COVID19.
The J&J vaccine is “just as equally efficacious against that severe disease and death” as Pfizer and Moderna, Goode said.
All of those percentages, and especially the efficacy when it comes to preventing deaths, matter when it comes to vaccine equity, because the single-shot J&J vaccine has advantages for distribution to specific populations.
Irene Ferrainolo, public information officer for the Peninsula and Hampton health departments, said that the VDH had discussed such advantages, to try to plan different options once the Peninsula and Hampton health districts get their first shipments of J&J doses.
“There’s not an official prioritization” for which groups might best be served by the single-shot J&J vaccine, she said in a phone call, “but the populations that have been discussed have been discussed for a practical reason.”
Those populations include the homeless, those in rural areas, those in urban areas without their own vehicle to travel to farther-away vaccine clinics, incarcerated people who may be released before getting a second dose of vaccine, and housebound individuals who rely on home health care.
While the Peninsula and Hampton health districts and health systems in the area had not yet received any J&J vaccines at the time of the interview, Ferrainolo said once J&J becomes an option, “we would focus (use) on those special populations.”
The Peninsula and Hampton health departments had discussed the issue of the slightly higher risk of illness for those who receive the single shot J&J vaccine, Ferrainolo said, and the equity of that trade-off.
“Our thinking on that, and the first person I heard say this was Dr. Fauci, is that although it is less effective percentage wise, it is effective,” she said. “So it’s not as though we’re giving a vaccine that does not protect a person.”
She added that many individuals have reached out to her health districts to specifically request J&J vaccines, to avoid the extra needle and save themselves the second dose. Some were even willing to wait for the vaccine, since those doses are not yet available in those districts.
“We’ve had a surprising — for me, anyway, it was a surprising amount of people — requesting J&J,” she said. “People have different anxiety levels when it comes to any injection.”
Riverside has also had specific requests for J&J doses. Williams said in an email that “once we receive the Johnson & Johnson vaccine, we plan to utilize in situations where follow-up for 2nd dose may be difficult, such as inpatient admissions and skilled nursing facility admissions.”
She added that they will “consider clinics focused with that vaccine option, most likely through our medical group operations,” to accommodate those groups. The health system, which administered its 100,000th dose of COVID-19 vaccine March 22, will “continue to focus on equitable distribution of vaccine in the communities that we serve,” Williams said.
As of right now, according to Goode and Ferrainolo, the biggest obstacle to vaccine equity is still making sure that Virginians have the ability to access any vaccine, not whichever vaccine has a higher efficacy in clinical trials.
Goode called the equity of each variety of vaccine “a difficult question to answer,” but said that at the end of the day, with each vaccine equally preventing severe disease and deaths due to COVID19, “I think we want vaccine in arms, and it doesn’t really matter which one.”