Which coronavirus vaccine you should get

On the face of it, the results reported Friday, after long anticipation for Johnson & Johnson’s coronavirus vaccine trial, may have been disappointing. Its effectiveness – its ability to prevent moderate and severe disease – was 72 percent in the United States, 66 percent in Latin American countries, and 57 percent in South Africa.

Those numbers are much lower than those established by Pfizer-BioNTech and Moderna, the first two vaccines to be licensed for emergency use in the United States, which reported efficacy between 94 and 95 percent.

Anthony Fauci, the foremost infectious disease expert and who is now President Joe Biden’s chief medical advisor on coronavirus pandemic issues, acknowledged the notable difference at a news conference Friday. “If you woke up and said, ‘Well, if I go to the left door I get 94 or 95 percent, if I go to the right door I get 72 percent.” Which door would you choose? ”He asked.

But Fauci said the most crucial indicator was the ability to prevent serious illness., which translates into keeping people out of the hospital and avoiding deaths. And in that regard, the Johnson & Johnson vaccine reported 85 percent in all countries where it was tested, including South Africa, where a fast-spreading variant of the virus has shown some ability to escape vaccines.

More important than preventing “some aches and pains,” Fauci explains, is defense against serious illness, especially in people with underlying conditions and older adults, who are more likely to become seriously ill and die from COVID-19 .

“If you can prevent serious illness in a high percentage of people, it will greatly alleviate the stress of human suffering and death from this pandemic that we are seeing, especially at this time,” added Fauci. “As we all know, our healthcare system has been affected in recent weeks by the number of people needing both hospitalization and intensive care.”

Francis Collins, director of the National Institutes of Health, compared the ability to prevent serious illness with the effects of flu vaccines, which do not always prevent flu completely, but do make it less severe. “The same seems to be happening here, in a situation where this variant of the virus is clearly making it a bit more difficult to get the strongest response you would like to get,” Collins said. “But still, faced with a serious illness, he looks very good.”

Moderna’s vaccine also showed high efficacy, 100 percent, against serious diseases. The Pfizer-BioNTech also reported similar numbers, but the total number of serious cases in the study was too small to be definitive.

But the researchers caution that comparing efficacy between new and previous studies could be misleading, because the virus is developing rapidly and tests have studied different pathogens to some extent.

“You have to recognize that Pfizer and Moderna have an edge,” said William Schaffner, an infectious disease expert at Vanderbilt University. “They did their clinical tests before the variants of the strain became apparent. Johnson & Johnson not only tested their vaccine against the standard strain, but they also had the variants. “

The best way to stop the spread of mutations and prevent new ones from forming is to vaccinate as many people as possible as soon as possible, Fauci and other researchers explain. Viruses cannot mutate unless they replicate, and they cannot replicate unless they can enter cells. Keeping them out by immunizing humans can stop the process.

In addition to the Pfizer-BioNTech and Moderna vaccines already in use in the United States, three more will be available soon: those made by Novavax, Johnson & Johnson and AstraZeneca. The use of the AstraZeneca vaccine has already been approved in the UK and other countries.

The Johnson & Johnson vaccine is expected to play an important role around the world, but especially in low- and middle-income countries, as it works with just one dose, is more or less cheap, and easier to store and distribute than the vaccines made by Pfizer-BioNTech and Moderna because they don’t share their strict freezing and refrigeration requirements.

People waiting to be vaccinated may wonder if they will have a choice between vaccines and whether they should stick with it and wait for the vaccine that is best for them to become available.

Paul Offit, a vaccine expert at Children’s Hospital in Philadelphia, told CNN that if there were an abundant supply of Pfizer-BioNtech and Moderna vaccines, it would be his first choice because of their overall higher efficacy.

But for now, there aren’t enough of those vaccines.

If you can’t get the Pfizer-BioNTech or Moderna vaccine, you’d choose the Johnson & Johnson shot, Offit said.as long as the data the company will provide to the Food and Drug Administration is as good as what it reported Friday.

Offit said Johnson & Johnson’s report on reducing serious illness was a powerful benefit. “That’s what you’re looking for,” Offit added. “You want to be away from the hospital, away from the morgue.”

The doctor noted that the company was also studying a two-injection treatment, which could increase the effectiveness of the vaccine.

People opting for the Johnson & Johnson vaccine should be able to safely get a Pfizer-BioNTech or Moderna vaccine later if a booster shot is needed, he added.

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