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!