Could the J&J vaccine truly be a "one and done"?

AP Photo/Marta Lavandier

That was the promise, wasn’t it — at least before the CDC and FDA frightened Americans away from the Johnson & Johnson vaccine against COVID-19? The two mRNA vaccines looked slightly more effective and the new technology a bit more sexy, but the two-shot regime had a drawback among the needle-hesitant and more mobile populations. The J&J single-dose vaccine (also known as the Janssen vaccine) needed less special handling and could therefore travel farther, and get us rapidly in position for herd immunity.

The hysterical reaction to anecdotal reports of side effects more or less derailed that strategy in the US. That had a secondary effect of leading researchers to focus on the two mRNA vaccines from Pfizer and Moderna in terms of effectiveness over time. The decision by the FDA and CDC to recommend boosters for both vaccines have J&J recipients wondering: do we need a second shot?

The Associated Press asks that question this morning, and the answer so far appears to be … no, at least for now:

U.S. Surgeon General Vivek Murthy said boosters “will likely be needed” for the J&J vaccine. Authorities expect more data to decide in the coming weeks.

That’s in part because the J&J rollout didn’t start until March, several months after Pfizer and Moderna vaccinations began. The J&J shot is made differently. And there’s more data about how the Pfizer and Moderna vaccines fare against delta because they’re more widely used in countries where the variant struck before its U.S. surge.

There is some real-world data showing J&J’s shot holds up against the delta variant. A huge study of health workers in South Africa showed the vaccine remains highly effective against hospitalizations and death from the variant. And the vast majority of so-called “breakthrough” infections in vaccinated people were mild.

J&J has also presented lab data on virus-fighting antibodies that indicates its vaccine protects against the delta variant for eight months and counting. Another small lab study has raised questions about whether a two-dose approach would work better, an option J&J is studying.

CNN reported a couple of days ago that the question can’t really be answered yet:

“Our J&J patients have not been overlooked or neglected. It’s just the way the data are coming in,” said Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center.

For J&J vaccine patients who are calling and emailing about boosters, he is telling them to wait. “You can’t make good recommendations without the data,” he said.

Last month, J&J researchers reported the vaccine provides immunity that lasts at least eight months and possibly longer.

The J&J vaccine also appears to provide adequate protection against the Delta variant, the predominant strain of the virus making people sick in the United States today. J&J said in July that a second or booster dose of its vaccine would not be necessary at that time.

What has always been puzzling to me, as a J&J/Janssen recipient, is the relative lack of interest in tracking this vaccine’s performance. It’s true that it has a far smaller footprint in the US, but that’s a relative measure. The CDC reports that slightly over 14 million Americans have received the J&J/Janssen vaccine, and with another 7 million or so in inventory at the moment, the potential sample size for a robust real-world study is plenty large enough for scientific interest.

Instead, the only sustained interest in this vaccine’s performance comes from its manufacturer. J&J has done peer-reviewed research that shows impact from the vaccine remaining strong eight months or more, which seems to differentiate it from the two mRNA vaccines and their drop-off of effectiveness against mild acute infection. But because this research has been funded mainly by its manufacturer, most of the media attention has fallen on lab-based research that is not just too narrowly focused only on antibodies, but which contradicts the real-world performance of the J&J/Janssen vaccine. (That’s also true to some extent with lab research on Pfizer and Moderna, too.)

Ironically, that is a finding against interests for J&J in one sense — they could stand to make a lot of money from booster shots if the data demonstrates a need for them. That is, in fact, a suspicion among the vaccine-hesitant about the new guidance for Pfizer and Moderna. The data from Israel strongly suggests that a booster is necessary to lift immune response in light of the Delta variant, and that it is proving effective especially in vulnerable populations. Hence the initial change to allow booster mRNA shots to the immune compromised, especially organ transplant recipients. (Side note: my wife is a multiple transplant recipient, and she got her booster Moderna this week.)

I have largely assumed since receiving my vaccination in early March that I would eventually need a booster shot. We do this for other vaccines, especially those that deal with viral infections. We need boosters for the flu thanks to its variants, but we just call those “annual flu shots.” Pneumonia shots typically need boosters on a five- or ten-year basis, as do other vaccines. Until the newer shingles vaccine came out a couple of years ago, that needed a booster every ten years.

However, before I get a booster shot, I want to see data showing its necessity. I’m not resistant or even skeptical, but I don’t feel like going off on a flyer based solely on sensationalized coverage either. If reliable data shows that a second shot works after a certain period of time to make me more resistant to COVID-19, I’ll be the first in line to get it. If reliable data shows that the adenovirus-based J&J/Janssen holds up for months or years more than the mRNA-based vaccines, then I’d prefer to let someone else have my shot and get more people resistant to the virus in the population. Let’s let the science guide us here, but let’s get the science going, too. It shouldn’t just be Johnson & Johnson doing the research on the vaccine’s impact on 14 million Americans.

Addendum: If anyone at J&J or any other research group wants to include me in a study, e-mail me at ed-at-hotair-dot-com.