There’s a cliche in photography: “The best camera is the one you have with you.” The saying is meant to encourage photographers to take their cameras around with them every day, because even if you have the latest, greatest model, you won’t get good pictures if your camera is just sitting on the shelf at home.
I’d like to suggest a pandemic-themed variation: the best vaccine is the one that’s in your arm.
When Moderna and Pfizer-BioNTech revealed late last year that their mRNA-based COVID-19 vaccines were both almost totally effective against severe symptoms, they set a remarkably high bar. So when Johnson & Johnson announced Friday that its COVID-19 vaccine, which uses a more traditional design, is “only” 66% effective at preventing disease, many took that as disappointing news. Over the weekend, I saw a disturbing number of people on social media say they only want the Moderna or Pfizer shots, and would reject the J&J vaccine if it was the only option available to them.
That would be a mistake. Yes, the J&J shot is less effective in preventing all COVID-19 symptoms—but those include such benign ailments as a nagging cough. It’s still 85% effective in preventing severe symptoms, meaning people who get the J&J shot and later contract the virus could suffer the equivalent of a bad cold, rather than maybe needing to go to the hospital, or worse. And yes, people who get the J&J vaccine and are later exposed to the virus have a slightly higher chance of serious COVID-19 symptoms compared to those who get the Moderna or Pfizer shots. But the difference is almost negligible.
Meanwhile, those with the J&J shot are much, much better protected than those without any vaccine at all. Furthermore, every person who gets any vaccine brings us all one step closer to herd immunity and the end of the pandemic. So if the J&J vaccine is the only one available to you, don’t hesitate to roll up your sleeve. (J&J’s shot hasn’t been cleared for use in the U.S. yet, but that authorization is expected in the coming weeks—the U.S. Food and Drug Administration (FDA) is looking for 50-60% efficacy for authorization, a bar the J&J vaccine clears easily, my colleague Alice Park reports.)
Still, decision-makers need to be smart about how the J&J vaccine is distributed. Because it requires only a single dose and is easier to store and transport than the other vaccines, it will be a more logistically practical option for underserved communities with less pre-existing access to high-end healthcare technology, which in the U.S. are often Black and brown neighborhoods. But disadvantaged communities, already justifiably suspicious of the health care system, may become more so if they have access to the J&J vaccines but not the other, slightly more effective shots. It’s yet another reminder that having a more just and equitable health care system would have made the COVID-19 pandemic easier to handle all the way around.
In a perfect world, we might set up a system where people with the lowest risk for developing severe COVID-19—like me, a young-ish, healthy white person who can work from home and has access to good healthcare—would get the J&J vaccine, while the slightly more powerful Moderna and Pfizer shots would be reserved for those at highest risk, like the elderly, front-line workers, and Black and brown people. Unfortunately, at least here in the U.S. where our vaccine rollout has been plagued by enough logistical troubles as it is, this isn’t a practical option. But state leaders making distribution choices need to be mindful of this potential pitfall—especially as early data show a distressing vaccination gap is already developing.