Joseph Raya-Ward was set. The Johnson & Johnson vaccine was for him. One dose and boom, done!
“I wanted the J&J vaccine,” said the southeastern San Fernando Valley resident. “At the time, I was concerned about variants, and J&J was the only American vaccine to be tested against them. I’m also awful with shots and the idea of only having to do things once really worked for me. Knowing what we know now, I’d probably opt for Pfizer or Moderna, but I’m just happy to have it over with.”
It’s not an uncommon conversation, from Orange County to L.A. to the I.E., in the thick of the Southern California scramble to get immunized against COVID-19, you can hear the questions: Do you go with Pfizer-BioNTech or Moderna — which each require two doses weeks apart — or do you go with the Johnson & Johnson — a one-dose deal?
Amid the diversity of preferences, public health officials and experts encourage people to get whatever vaccine they can get access to. Don’t wait for the one you “want,” they add — a particularly salient nudge now that demand for the vaccine is entering its most intense weeks as universal adult eligibility is just days away. (President Joe Biden on Tuesday moved up his deadline for universal eligibility for a vaccine to April 19 — and that aligns with Southern California’s schedule to distribute the vaccines.)
“I hear lots of people express a preference but there’s really no consistent pattern,” said Los Angeles County Public Health’s Chief Science Officer Paul Simon. “We’re really discouraging people from waiting for one particular brand of vaccine. We know not only from the vaccine trials but increasingly from what we’re learning with vaccinations being done … that all three vaccines work very, very well.”
The Centers for Disease Control and Prevention agrees.
One and done
On Thursday, thousands descended on Cal State Los Angeles’ mass vaccination site after word spread that COVID-19 Johnson & Johnson shots were available.
By midmorning, site managers were turning people away, citing a surge that gobbled up available doses of the one-shot vaccine.
Attracting many is the one-shot nature of the J&J doses. Once you’re jabbed, it takes about two weeks to gain full immunity. For many, the vaccine saves time, and logistically it has benefits, including its ability to be stored at higher temperatures, not the freezing conditions required by the other two. And while supplies remain scarce in Southern California, public health officials also like the fact that its one-dose nature and handling requirements are ideal for distribution in more remote and rural areas of Southern California. Company officials estimate that a vaccine can remain stable for up to two years with proper storage.
- The FDA’s analysis found that, in the U.S., the Johnson & Johnson COVID-19 vaccine was 72% effective at preventing all COVID-19 28 days after vaccination and 86% effective at preventing severe cases of the disease. In South Africa, where a variant was emerging, researchers in a similar trial found the Johnson & Johnson vaccine to be slightly less effective at preventing all illness there – 64% overall – but was still 82% effective at preventing severe disease.
While the efficacy numbers are lower than the Moderna and Pfizer serums, experts (and even Raya-Ward, at the beginning of this story) have pointed to the fact that it was tested in a time when the virus was surging and variants were emerging — suggesting a hardened success under real-world, changing conditions that better reflect the current moment.
Conversation has also revolved around the building blocks of the vaccines themselves, and how the Johnson & Johnson vaccine works, compared to Pfizer and Moderna.
- J&J is a viral vector vaccine. You’ll get jabbed with a harmless weakened cold virus that is not COVID-19 (it’s called an adenovirus), but which is carrying COVID’s genetic material. The adenovirus is grown using what’s called an immortalized cell line, and the virus then is pulled out and purified. The weakened virus can’t replicate or make you sick, or become part of your DNA. But what it does do is deliver the COVID-19 genetic material to your cells, prompting them to produce a protein (a “spike protein”) that is found specifically on the surface of COVID-19. With the instructions, your cells can now mass produce the protein. Once that protein is displayed on your cells, your immune system starts creating antibodies and white blood cells that will fight the actual virus if you’re infected.
That spike protein is still the key in the Pfizer and Moderna vaccines.
- But instead of injecting a COVID-19 genetic material into a weakened vector that delivers instructions, those vaccines use genetically engineered messenger RNA (mRNA) that deliver the instructions to make the spike protein. Once you’re injected, they too start making the proteins displayed on cell surfaces, which generates the antibodies.
That whole process takes about two weeks following each dose of vaccine for the body to produce antibodies that protect against infection.
The Pfizer vaccine (two shots, 21 days apart) has about 95% efficacy in preventing COVID-19 in those without prior infection. Moderna’s (two shots, 28 days apart) stands at 94.1% efficacy.
Are their differences in side effects?
They are similar.
No matter what vaccine, there might be some pain, redness, and swelling on the arm where the shot was given. And don’t be surprise in the immediate couple of days afterward, you feel some tiredness, headache, muscle pain, chills, fever and nausea. And then there will be some with some people with no side effects.
Where the difference lies, experts say, is on the second-dose shots; the effects may be more intense than on the first.
Any differences in how long immunity lasts, once you get the shot?
The verdict is still out, but if vaccine immunity is anything like natural immunity — brought on by actually becoming infected — there are some encouraging signs. And in that case, it might not matter which vaccine you get.
Also, remember, researchers note that this is a coronavirus, not like the measles, where one shot lasts a lifetime. Coronavirus — and COVID-19 in particular — mutate, so the shots have to change along with it.
To understand how long immunity could last, The National Institutes of Health point to a study, also published in January in Science, by researchers at the La Jolla Institute for Immunology that analyzed immune cells and antibodies from almost 200 people who had been infected with COVID-19 and receovered.
Remember the spike protein?
“The researchers found durable immune responses in the majority of people studied. Antibodies against the spike protein of SARS-CoV-2, which the virus uses to get inside cells, were found in 98% of participants one month after symptom onset. As seen in previous studies, the number of antibodies ranged widely between individuals. But, promisingly, their levels remained fairly stable over time, declining only modestly at six to eight months after infection.
Also, those all-important cells that fight infection and remember the body’s immune responses remained high.
As the eligibility pool widens, and word spread about experiences people have with the various disease, it’s clear that the one-dose vaccine can help in communities where it might be more diffiictult for people to come back for a second dose.
“For people who have a hard time getting to a site and live very dispersed, obviously one shot and you’re done works better for everyone in those situations. So again a good use of a vaccine that’s highly effective and easier on everybody,” said L.A. County Public Health Director Barbara Ferrer.
Even with many physicians and doctors discouraging waiting for the vaccine you want, some local entities make it clear what you’re getting. In that sense, you still have a choice.
For instance, San Bernardino County’s registration website denotes when and what brand of vaccine is being distributed at each of its vaccination hubs. Orange County sites also list the brands distributed at its vaccination centers. In L.A. County, you can also find out what’s being offered where in the county’s mammoth network of clinics, pharmacies and hospitals sites.
There’s always the chance your preference will change over time, too.
At first, Kevin Sammons and his partner Karen, of Crestline, were keen on the Moderna vaccine.
“We just thought it was great to know Dolly Parton donated a million dollars for its development and, later, came to absolutely love one of the vaccine developers, Kizzmekia Corbett, through her Twitter account,” Sammons said
(Parton, by the way, recently received the second dose of the vaccine she helped fund).
“As time passed and we began to hear feedback from those that received both shots, we began to lean much more toward Pfizer,” Sammons said. “While we would have both taken Moderna if that’s the fastest we could get, it seems those that took Pfizer the second time had lesser reaction and lost less work time.”
Sammons and his partner Karen jumped on a Pfizer appointment slot at Loma Linda University Health and were geared up for their second dose next week.
“It remains to be seen how we will react,” Sammons said. “All I know is, however sick we get, it should be long passed once we hit the two-week milestone on April 27. While we will still wear masks and continue the other precautions until health professionals say we can stop, it’s going to be one heck of a big relief. Just getting the first shot felt like a huge weight was lifted off our shoulders.”
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