Which COVID-19 vaccine should you get?

We will soon be faced with more decisions about the COVID-19 vaccines. Yesterday’s announcement that the Johnson and Johnson single dose vaccine was effective, albeit with 66% overall reduction in infections, strongly suggests that the FDA will soon approve this vaccine. Already people are beginning to debate which COVID-19 vaccine would be most appropriate for people to receive. This is both an easy and complex question.

The easy answer is to take whatever vaccine you can get as soon as you can get it. Regardless of efficacy, all three of these vaccines essentially eliminate the likelihood of a severe COVID-19 infection that will lead to death. Therefore, compared to having no vaccine at all, any of the three vaccines provide substantial benefit. 

The more complex issue is what benefit an individual might get from the more efficient RNA (BioNTech and Moderna) coronavirus vaccines as compared to the Johnson and Johnson vaccine. We could hypothesize that individuals with immune system problems, cancer treatments or immunosuppressive drugs would respond better to a two-shot vaccine and have better immunity. This would seem to be the most obvious group that would benefit from RNA vaccines.

There is also a potential benefit that would come more with risk to those around a vaccinated individual. 

If someone is living in the nursing facility with other patients who can’t get the vaccine or might not make an effective immune response to the vaccine, then reducing symptomatic infections entirely with the RNA vaccines would be better. This benefit might be less of an issue for the vaccinated individual as compared to the other residents. It also would hold for workers in nursing holms or similar settings. 

While the data on reducing asymptomatic infections is not entirely clear, these also would seem to be reduced to a greater degree with the RNA vaccines. Again, because of this individuals who would be at risk for spreading illness among debilitated patients might provide greater safety to their patients after an RNA vaccine.  

Finally, some individuals may not respond completely to the Johnson and Johnson adenovirus-based vaccine due to prior immunity to that virus. We currently have no way to check this, but if there was a sub optimal response after vaccination, this would not preclude getting a “booster” shot from Moderna later on, especially is a fully vaccine resistant variant virus emerges. 

To summarize, if you are in good health with an intact immune system and do not work in a nursing home, any COVID-19 vaccine is just fine. Let’s hope that having three available improves access!

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

5 thoughts on “Which COVID-19 vaccine should you get?

      1. Thank you Dr. Baker! I am not in the group that is eligible right now. Those of us in our 50’s should be soon. Initially thought the Johnson and Johnson vaccine would be better for someone with allergies and auto immune issues. I have Hashimoto’s, Raynaud’s and am being tested for RA. Its good to know that I have a few other options. Thank you again!

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      2. Good Morning Dr. Baker, I am struggling to make a determination as to what to do with regard to a covid vaccine for my family, either mRNA or traditional viral vector. I appreciate your previous response. There are other physicians out there who believe that the vaccine has been rushed for a few reasons, a few of which are: skipping the animal testing stage and only testing on healthy adults (excluding children, pregnant women and sick individuals). Dr. Mercola has written multiple articles on the covid 19 vaccines themselves as well as serious side effects. He is anti vaxx so I need someone to verify that what he is saying is either correct or wrong! I have attached a few of this articles in case you are unfamiliar with his work. The other group out there that is quite vocal is America’s Frontline docs led by Dr. Simone Gold. In my opinion, she is much more trustworthy as she has been on the “frontline” in CA treating patients in the ER. She says she was fired for treating patients with HCQ. Now of course it is being touted as an appropriate treatment for early stage covid 19. This is quite worry some, the about face in “opinion” as to whether or not this drug works. Many, many ER docs across the US have used it successfully. Both Mercola and Gold call the covid 19 vaccines experimental. I would greatly appreciate your thoughts on this matter. Trying to understand how those that have sworn to first do no harm can have such varying opinions on this topic. As a person who enjoys studying medicine but not in the medical field myself, I am trying to find out what I am missing so I can provide my family with guidance and best practice. I have many friends that are physicians all with different specialties. What I find interesting is that all of my ER doc friends have used HCQ successfully. Please know that greatly appreciate your time and thoughts on this matter.

        Kelly Monahan

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      3. First, get whatever vaccine you can; they all provide protection. They are also safe and the more people immunized the better the results. I have no idea about the HCQ use you cite, but the large, controlled trials showed no benefit.

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