Detroit mayor: Johnson & Johnson is a good vaccine -- but I want our residents to have only the best

There are two issues here, one simple and one complicated.

The complicated one is the fact that the mayor, Mike Duggan, turned down a shipment of 6,200 doses of Johnson & Johnson. “Johnson & Johnson is a very good vaccine. Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the City of Detroit get the best,” he said afterward about his decision. But that wasn’t the only reason he turned down J&J. According to Duggan, Detroit has enough doses of Pfizer and Moderna on hand to meet expected demand in the city over the next several weeks. By rejecting J&J, he’s freeing up those doses to go elsewhere (specifically to “other health departments that had lower coverage rates for those age 65 years or older,” according to Duggan’s spokesman) at a moment when they’d otherwise sit on shelves in Detroit.

“The day may come in March or April when every single Moderna and Pfizer is committed, and we still have people who need a vaccine. And at that point we will set up a Johnson & Johnson center. I don’t see that in the next couple of weeks,” Duggan explained. Which is … defensible, no? If the goal is to vaccinate the entire U.S. population as quickly as possible, we don’t want any jurisdiction hoarding doses. Redirect that shipment of J&J to some rural area where it can be put to use, saving lives immediately.

On the other hand, isn’t it the feds’ problem to make sure doses are efficiently allocated? If Duggan wants the very best for his city’s residents, logically he should want every dose available to him since it’s possible that he’s underestimating demand over the next few weeks. Imagine being a local trying to make an appointment to get your shot and finding out that they’re all out because the mayor didn’t anticipate a surge — even though various polls show that interest in getting vaccinated is rising among Americans, particularly Democrats. There’s plenty of room for improvement in Detroit in the pace of daily vaccinations too:

However, the city still lags surrounding counties and the state as a whole when it comes to total percent of adults immunized. Of Detroit adults, 11 percent have been vaccinated so far. For Macomb County, the figure is 16.5 percent; 19.1 percent for Oakland County; 18.6 percent for outer Wayne County, and 18.5 percent for Michigan as a whole…

The state on Wednesday announced it is expanding eligibility to people 50 years old and up with disabilities or pre-existing medical conditions and caregivers of children with special health care needs starting March 8. Detroit is doing the same.

So not only is Detroit behind on vaccinations, it’s actually about to expand eligibility and encounter an uncertain new source of demand. Why take the chance of running short on supply?

I don’t see a clear answer to the dilemma of what to do if you sincerely believe you have enough supply at a given moment to give shots to everyone who wants one. Certainly Duggan’s decision to refuse the J&J shipment is justifiable on grounds that it’ll be put to better use elsewhere like rural communities, since J&J’s shot is a single dose and can be stored at normal refrigeration temperatures. A two-dose vaccine is a minor inconvenience for city-dwellers, who may live 10-20 minutes away from the nearest vaccination center. It’s a major inconvenience for someone who lives one to two hours away from one. If the J&J doses end up going to Michiganders who can’t easily access the vaccine, whether because of where they live (in the sticks) or how they live (homeless), then maybe this is for the best.

That’s the complicated part. The simple part is Duggan’s messaging, as it’s indefensible for him to frame his decision as wanting only the “best” vaccine for his residents and making clear that Johnson & Johnson isn’t it. That’s a poisonous talking point in that it’s destined to make some vaccine fencesitters shun J&J even if it’s the only shot available locally. (CNN’s headline of Duggan’s announcement today was “Detroit mayor declines Johnson & Johnson allotment, saying the other vaccines are better.”) A slower pace of vaccinations means more infections, which means more deaths. And it’s plausible that demand in Detroit might surge in the near future to the point where there aren’t enough doses of Pfizer and Moderna to cover everyone, forcing Detroit to start dosing out J&J. How’s Duggan going to convince his residents to go for that now that he’s told them it’s a second-tier product?

Let’s review the facts about J&J. It *might* be less effective than Pfizer or Moderna in preventing infections of coronavirus, but it’s hard to say definitively since Johnson & Johnson was tested at a later stage of the pandemic, when vaccine-resistant variants were more prevalent. It’s *as* effective as Pfizer or Moderna in preventing hospitalizations and deaths, as there wasn’t a single person who needed to go to the ER or ended up dying of COVID after 28 days in the clinical trials for all three vaccines. In other words, even if J&J doesn’t snuff out infections as completely as the competition does, it seems to successfully turn COVID into “just the flu,” which all of us can live with.

On top of all that, there’s evidence that immunity from the J&J shot continues to increase over time. It may not be 95 percent effective at preventing infections after two weeks but what about after two months? This graph is, uh, provocative:

The bottom line with J&J, Pfizer, Moderna, and every other vaccine that ends up on the market is that they get us closer to herd immunity by shutting down (most) vectors of transmission for the virus, and herd immunity is the best protection against infection. You have a 72 percent chance of avoiding illness with J&J if you’re exposed to the virus but a much higher chance of avoiding it if everyone’s been vaccinated since the virus just won’t be able to travel much from host to host anymore in those circumstances. A politician with half a brain should want to press that point at every opportunity to make people less hesitant about the shot. Instead Duggan’s out there encouraging them not to settle for anything except Pfizer or Moderna unless they’re forced to.

And as the mayor of a major city, those comments will have legs. They’ve already been picked up by national news sources, as noted above. Some people in places where J&J is the only game in town are destined to hold out for an mRNA vaccine now, extending their risk of infection. As I say: Indefensible.

If anything, Duggan should be hyping Johnson & Johnson based on the fact that it’s a single dose. Detroit is a majority-black city and African-Americans are consistently more reluctant to get vaccinated in opinion polling than whites are. One way to help sell them on taking the plunge is to emphasize the no-fuss nature of J&J’s product. Just one shot, one time, you’re in and out and then you’re done. For some people, that’s a winning pitch:

At Black churches across the Mid-Atlantic region this winter, Darrell J. Gaskin, a professor of health policy at Johns Hopkins University and a pastor, and Rupali Limaye, a scientist at the university who studies vaccine hesitancy, have counseled and reassured hundreds of pastors and congregation members of African Methodist Episcopal Zion churches in virtual presentations, emphasizing the Johnson & Johnson vaccine’s safety and prevention of severe Covid-19 and death, including among the Black volunteers in the company’s trial.

Dr. Gaskin said it was crucial for officials to emphasize the benefits of the vaccine at the beginning of its distribution, so people “don’t feel like there’s a luxury vaccine and then the non-luxury vaccine.”

“We’re facing disparities related to Covid,” Dr. Limaye said. “How do we reduce disparities? We get a product out that’s one dose and that’s stable.”

“This one is more appealing to me,” said one of Gaskin’s congregants to the NYT. “Who likes to get stuck more than once?” The J&J shot also seems to have fewer side effects than Pfizer or Moderna, another potential selling point. Why Duggan would choose to undermine all of that by presenting Johnson & Johnson as inferior to the mRNA vaccines escapes me, unless there’s some sort of reverse psychology at work in which he thinks that presenting Pfizer and Moderna as superior will goose demand for those vaccines within the city. But even if he does, it’s shortsighted. Eventually Detroit will need J&J to get everyone vaccinated as rapidly as possible. What will he say then?