Does the J&J vaccine require 2nd booster?
Some doctors, health departments absolutely support another dose
Drug giants Pfizer and Moderna — makers of the country's most widely used vaccines in the fight against COVID-19 — are now seeking approval for a second booster shot as immunity wanes and more contagious variants come ashore. Good news for some.
But now many of the nearly 17 million Americans like Brian King who got the Johnson & Johnson jab are wondering, “What about us?”
“I understand that we're a minority share of vaccinated people,” said King of Redwood City, who had the J&J shot and a Moderna booster. “But seeing stories that only discuss the effectiveness of the more common vaccines leaves me with less information than I'd like about such an important public health issue.”
In the early rush to develop vaccines to combat the deadly coronavirus, Johnson & Johnson's one-shot contribution was roundly heralded. It promised protection two weeks after a single shot, didn't use the new messenger-rna technology of the other brands or need special cold storage, making it attractive for people without easy access to pharmacies and health care facilities.
But in April 2021, a rare but serious blood clot issue was reported, production problems further delayed its rollout and finally, regulators largely recommended the other available vaccines. The vaccine never regained its footing.
More than a year later, most Americans considered “up to date” on their COVID-19 vaccines have been given three shots — an initial two and then a booster by Pfizer or Moderna. Those who started with Johnson & Johnson's single dose have been told to get just one more. King said he understands health officials are doing their best but wishes
for more information and direction.
Other countries like Germany and France have called for J&J'S shot to be followed by two other doses. The city of San Francisco has made third shots available, too, citing studies suggesting a J&J shot and single booster isn't good enough, and many doctors have urged a third dose. But federal health authorities have been silent on whether J&J plus a booster is as good as three Pfizer or Moderna shots, let alone four.
Asked whether the J&J shot and one booster is enough, the Centers for Disease Control and Prevention simply referred to its current guidance of one Pfizer or Moderna booster, and two only for those with compromised immunity.
“I think it's a dereliction of duty by the CDC to not address the situation,” said Dr. Michael Lin, an associate professor of neurobiology and bioengineering at Stanford University who strongly recommends a third dose for Johnson & Johnson vaccine recipients. “The data are very clear. … You need a third dose.”
Evidence of waning immunity and the emergence of more contagious virus variants like delta and omicron spurred approval for
booster doses last fall for all three authorized vaccines in the U.S. — initially with no brand preference. Those vaccinated with Pfizer or Moderna were urged to get a booster five months after their second shot, and those who had J&J were told to get a booster after two months.
Then, in December, the CDC recommended the Pfizer and Moderna vaccines over J&J for primary and booster shots, citing safety concerns.
Still, 16.8 million Americans received J&J'S shot as their primary COVID-19 vaccine, about 8% of the U.S. total. In California, they include Gov. Gavin Newsom and Health and Human Services Secretary Dr. Mark Ghaly. Nearly 1.5 million got a J&J booster.
Assessing the efficacy of vaccines and boosters is challenging because it's unclear how long their protection lasts as the virus mutates into new variants. Trials and studies based on the original strain or last summer's delta are obsolete now with omicron and its more contagious sub-variant BA.2.
Unlike Pfizer and Moderna, Johnson & Johnson hasn't sought approval for a second booster. Instead, the company points to
studies it says demonstrate the durability of protection from its vaccine. A March 17 study found J&J protection against the delta variant in the U.S. remained stable for six months.
An earlier Jan. 6 study found that while all three U.S. vaccines maintained protection against intensive-care hospitalizations, there was no increase in hospitalizations and only “modest waning” of protection against breakthrough infections six months after the J&J shot.
And a Dec. 30 study found the J&J booster was 85% effective in preventing hospitalization in South Africa when the omicron variant was prevalent.
But Dr. Bob Wachter, who chairs the medical department at UC San Francisco, said back in December that a J&J shot and Pfizer or Moderna booster offered only about the same protection as two primary Pfizer or Moderna shots.
Stanford's Dr. Lin points also
to other studies he says show a J&J shot and booster are inferior to three Pfizer or Moderna shots. And San Francisco pointed to five studies in its Jan. 13 announcement that it would offer second boosters to J&J recipients who live or were vaccinated in the city.
Some who had the J&J shot haven't waited for the government's guidance.
Aneela Mirchandani of San Francisco got a Pfizer booster in July after her April J&J shot, and another in December before she and her husband planned to travel.
“I was hearing from doctors I know that despite the CDC, they were telling patients to boost it with a Pfizer or Moderna even though J&J was supposed to be a single shot,” Mirchandani said. “We were seeing delta shoot the numbers up, so we just got the second Pfizer and didn't worry about it too much.”
Nearly a year after that first J&J shot, they remain COVID-FREE.