Breakthrough cases keep rising
J&J vaccine: Study says officials should consider mandating booster shot
The Johnson & Johnson vaccine may be less effective against the delta variant of the coronavirus than the Pfizer and Moderna vaccines, and health officials should at least consider urging that people who received J&J’s single dose get a booster shot, authors of a small study said Tuesday.
The study, published this week and not yet peerreviewed, analyzed the levels of neutralizing antibodies, or titers, produced by 36 people — 12 who got the J&J vaccine, 12 who got Moderna and 12 who got Pfizer. It found that people who received the J&J shot produced
titers at levels that were about fivefold lower compared to people who received the Pfizer or Moderna shots.
But that may still be enough to ward off the delta variant.
“The takeaway is that all of the vaccines work very well,” said lead author Nathaniel Landau, a professor of microbiology at the NYU Grossman School of Medicine, “but that we believe it should be considered or thought about for the J&J, which is a single shot, whether it would be even better if there was a second shot to go with it.”
The J&J shot produced higher titers against the alpha variant, which was first found in the U.K., but lower against the delta and lambda variants, which were first detected in India and Peru, respectively. The findings for the delta variant are particularly important because the delta variant is now spreading quickly in the U.S., representing more than 80% of new cases.
These findings appear in line with previous studies that have found that the AstraZeneca vaccine, which is similar to the J&J vaccine because both are adenovirus vaccines, is less effective against the delta variant than the Pfizer and Moderna vaccines.
Johnson & Johnson, in a statement to The Chronicle, stated that while Landau’s study offered insight “into a single aspect of immune response” from vaccines, “the data do not speak to the full nature of immune protection” that has been seen in published interim studies. The “dual protection mechanisms” of J&J’s single shot, “both neutralizing and nonneutralizing binding antibodies and multiple kinds of Tcells, play a cooperative role” against the virus, it said.
“Additional Company data also demonstrated the Johnson & Johnson singleshot COVID19 vaccine generated strong, persistent activity against the rapidly spreading Delta variant and other highly prevalent SARSCoV2 viral variants,” the company said.
The small study posted this week did not look at Tcell response to the vaccines, an important component of the immune system that is harder to measure than antibodies.
The findings do not mean that the J&J doesn’t work well, Landau said.
“We don’t want to give the idea that the J&J shot is no good, or people shouldn’t get it,” he said. “The decrease in protection will be a small decrease in protection.”
But public health agencies should consider whether to recommend that J&J recipients get a booster shot, he said.
“We suggest that the public health agencies should consider that possibility,” he said.
J&J said this month that its singledose vaccine works well against the delta variant, offering protection for at least eight months. The company is testing a twodose regimen.
Health officials initially hoped the “one and done” J&J shot would make it faster and easier to vaccinate hardtoreach populations like homeless people and others who may find it difficult to come back for a second dose. But the J&J shot ran into early hurdles — most notably, the Food and Drug Administration suspended its use to investigate rare reports of blood clots mostly in young women — and it never really took off in the U.S.
In California, J&J shots make up just 3.7% of total doses given — about 1.5 million Californians have received it — and account for 7.5% of people who have been fully vaccinated, according to data from the California Department of Health and Human Services.
J&J recipients include Gov. Gavin Newsom, California Health and Human Services Secretary Dr. Mark Ghaly and San Francisco Mayor London Breed, who received the shot publicly to try to convey that it was safe and effective.
J&J was the vaccine given to the vast majority of residents of a Santa Rosa homeless shelter that experienced a large outbreak this month. That outbreak drew widespread attention in part because 45 of the 88 cases were among vaccinated people. Just over half of the 153 residents were fully vaccinated.
One case from that outbreak has been identified as delta, said Kate Pack, the lead epidemiologist for Sonoma County. Other cases are still being analyzed.
It’s premature to conclude there were so many cases among vaccinated people because they mostly got J&J, said Dr. Sundari Mase, the Sonoma County health officer. She said the caseload among vaccinated people did not immediately concern her, and noted that many of those people were asymptomatic and would not have been tested at all if they weren’t part of an outbreak situation.
Nine people from that outbreak have been hospitalized, including six who were fully vaccinated, Pack said. All of those hospitalized were older adults who had multiple underlying health problems.
The outbreak, Mase said, is further evidence of how important it is to vaccinate everyone, especially in situations where vulnerable people are at risk.
“If 95% of people were vaccinated at that shelter, we wouldn’t see spread of the virus, because it would be such a smaller group that could get it and spread it,” Mase said. “The takeaway is always what it’s been: Get vaccinated, get vaccinated, get vaccinated. Keep yourself and your family and your community safe.”