Detroit Mayor Mike Duggan has done many remarkable things to revitalize his city. Last week Mayor Duggan made news for another reason, when he reportedly refused a shipment of 6,200 doses of the newly approved Johnson and Johnson COVID-19 vaccine. This appeared to be related to the lesser efficacy of this vaccine in preventing infections with the SARS-CoV-2 virus.
He clarified his comments a few days later suggesting Detroit simply lacked a need for the vaccine after pressure from national and state public health officials including Dr. Joneigh Khaldun, Michigan’s chief medical executive.
But would Mayor Duggan have been appropriate in rejecting based on the difference in efficacy? This is a complex issue with political, medical and social implications not addressed by the national news.
First some history. Detroit like many cities has for years had gaps in medical infrastructure that are just recently being addressed. Along with New York and New Orleans, the city was hit with one of the worst early outbreaks of COVID-19 infection last March. The outbreak overwhelmed local hospitals and disproportionally affected the African American and elderly communities in the city.
The very good news is that the vaccines that have been developed against COVID-19 appeared to work well for individuals of all races and ages. This generates optimism for the city as it moves forward beyond the pandemic.
Despite this hope, Detroit has faced challenges with its vaccine campaign. According to Bridge magazine only 34% of seniors over the age of 65 in the city have been vaccinated. The lack of transportation, limited internet access, and misinformation about the vaccine safety have all been issues in getting individuals to vaccination sites.
The city has been very innovative in developing programs that promote immunization, including one that provides vaccines for anyone who brings a senior in for a vaccine. However, the many challenges in Detroit have limited its vaccination rate.
Would it be valuable to restrict the Johnson and Johnson vaccine from places that have trouble vaccinating their residents? Medically, the biggest difference between the approved vaccines is that COVID-19 infections continue to occur with the Johnson and Johnson vaccine at a higher rate than with the mRNA vaccines from Pfizer and Moderna. In cities like Detroit, where density and infrastructure may lead to clusters of COVID-19 infection, one might perceive that totally stopping infections with a vaccine would be better in preventing outbreaks even if these infections are milder than in individuals who have not been vaccinated.
Additionally, in Mayor Duggan’s revised remarks on Friday he commented, “The only reason we chose to not accept the first shipment of Johnson & Johnson was that we had enough capacity with Moderna and Pfizer to handle the 29,000 first and second dose appointments scheduled for the coming week, which already put us very close to our capacity at our current locations.” Duggan also said the city will open a new vaccination site for J&J shots when demand from eligible residents exceeds its supply of Moderna and Pfizer’s doses. Therefore, without a need for additional vaccine doses the Johnson and Johnson vaccine is viewed as a burden to the city’s challenged distribution system.
However, this perspective overlooks some of the main advantages for the Johnson and Johnson vaccine. The fact that this vaccine can be simply refrigerated or kept in coolers could allow it to be more effectively distributed. Rather than focusing on large distribution centers this vaccine could be taken to churches, community centers and the other sites where people congregate on a daily basis. Vaccine could even be distributed door to door in the community. Importantly, since it is a single dose vaccine one only has to interact with the resident a single time to assure protection. A single shot is also a preference for many concerned vaccinees.
It is important to remember that the aspect where the Johnson and Johnson vaccine is equivalent to the Moderna and Pfizer vaccines is that it prevents serious illness and hospitalizations. This is very important to every community as local hospitals bear the major burden of care for patients with COVID-19.
Therefore, it might be important to think of the Johnson and Johnson vaccine as a paradigm change for immunizing difficult to reach populations even if other options are available. It is incredibly important to achieve high levels of immunization in all communities to protect their citizens and health systems from additional waves of infection as social distancing rules are eased.