New vaccine raises concerns about deepening inequity
The nation has a third weapon to wield against the coronavirus, and this one doesn’t need to be kept frozen or followed by a booster shot.
Those attributes of Johnson & Johnson’s coronavirus vaccine, which gained regulatory clearance Saturday, promise to help state and local officials quell the pandemic. First, however, they will need to determine its place in an expanding anti-virus arsenal, where it joins vaccines with sky-high efficacy rates that are still in short supply.
Decisions to send the shots to harder-to-reach communities make practical sense, because Johnson & Johnson’s single-shot vaccine is easier to store and use. But they could drive perceptions of a two-tiered vaccine system, riven along racial or class lines — with marginalized communities getting what they think is an inferior product.
The issue came up on a recent call between governors and Biden administration officials coordinating the country’s coronavirus response. Gov. Charlie Baker, a Massachusetts Republican and former health insurance executive, stressed the need for prominent health officials to communicate clearly about the benefits of the one-shot vaccine, according to three people who heard his remarks and spoke on the condition of anonymity.
The Johnson & Johnson vaccine proved safe and effective in a clinical trial, completely preventing hospitalization and death, including in South Africa against a more transmissible variant. When moderate cases were included, however, it was 66 percent protective, compared to efficacy of more than 90 percent reported for a vaccine jointly developed by U.S. pharmaceutical giant Pfizer and German biotech firm BioNTech and one from U.S. biotech company Moderna. Trials were conducted at different points during the pandemic, and in different countries with different transmission rates, which makes head-to-head comparisons impossible.
The apparent differences, Baker said, could nonetheless create uncomfortable questions for state and local leaders promoting the new vaccine to people who might ask, as one person paraphrased his comments, “Why didn’t you give us the good stuff ?”
A spokeswoman for Baker declined to make him available for an interview. But the apprehension he articulated is shared by governors, as well as state and local health officials, throughout the country, even as they celebrate the third vaccine and acknowledge that the United States faces an embarrassment of riches compared with many countries.
“J&J is going to be a challenge for all of us,” Washington Gov. Jay Inslee said in an interview.
In North Dakota, which has achieved one of the fastest rates of inoculation, Gov. Doug Burgum said the new product intensified concerns not just about “vaccine hesitancy, but the potential for brand hesitancy as well.” The problem has been on display in Germany, where some residents are shunning shots developed by AstraZeneca in favor of those made by Pfizer-BioNTech, because of the different levels of protection reported in clinical trials, according to officials there.
The challenge in the United States is especially acute in the context of the racial and economic disparities exacerbated by the pandemic, according to state and local officials. If a vaccine thought to be less effective — though still well above the threshold of 50 percent set forth last summer by federal regulators — is used overwhelmingly in communities of color, it could erode trust. The Biden administration signaled this week it was concerned about that possibility, as senior administration officials stressed that the new vaccine would be shared equally throughout the country.
“All vaccines will reach all communities,” Marcella Nunez-Smith, who heads the administration’s coronavirus equity task force, said during a Monday briefing.
Fulfilling that promise is critical, advocates said.
“If we end up with a hierarchy that says all rich white people get Pfizer, and all poor Black people get J&J, that would be a problem,” said Helene Gayle, president and chief executive of the Chicago Community Trust, one of the largest community foundations in the country.
To complicate matters further, these dilemmas are inseparable from characteristics of the new vaccine that simplify logistics. The easier storage and scheduling requirements position the Johnson & Johnson product to penetrate hard-toreach populations, such as those without housing, as well as transient groups, including people moving through the criminal justice system.
Because people of color are overrepresented in both populations, however, the racial undertones of a targeted approach to distribution could become pronounced.
“There is a risk of that,” acknowledged Mouhanad Hammami, director of the Wayne County Health Department, which serves Detroit as well as suburbs that include some of the richest ZIP codes in Michigan.
The risk, too, is that residents may try to be selective about which vaccine they’re getting. “We hold our clinics based on the vaccine made available to us, so we have a Pfizer clinic or a Moderna clinic,” he said. “And probably people will come — or choose not to come — based on the product being offered.”
That is unwise, specialists said. “The vaccine that’s available to you, get that vaccine,” Anthony Fauci, the nation’s leading infectious-disease expert, said during a briefing on the eve of Johnson & Johnson’s authorization.
But Inslee said his constituents naturally want options, and with more supply in the near future, that may be possible. In the meantime, his pitch for Johnson & Johnson is simply this: “It’s going to save your life, which we think is a pretty high value. It has a downside of slightly lower efficacy to prevent you from getting a headache — but you only have to have one shot instead of two.”