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The Differences Between the Vaccines Matter
Yes, all of the COVID-19 vaccines are very good. No, they’re not all the same.
MARCH 7, 2021
Public-health officials are enthusiastic about the new, single-shot COVID-19 vaccine from Johnson & Johnson, despite its having a somewhat lower efficacy at preventing symptomatic illness than other available options. Although clinical-trial data peg that rate at 72 percent in the United States, compared with 94 and 95 percent for the Moderna and Pfizer-BioNTech vaccines, many experts say we shouldn’t fixate on those numbers. Much more germane, they say, is the fact that the Johnson & Johnson shot, like the other two, is essentially perfect when it comes to preventing the gravest outcomes. “I’m super-pumped about this,” Virginia’s vaccine coordinator told The New York Times last weekend. “A hundred percent efficacy against deaths and hospitalizations? That’s all I need to hear.”
The same glowing message—that the COVID-19 vaccines are all equivalent, at least where it really counts—has been getting public-health officials and pundits super-pumped for weeks now. Its potential value for promoting vaccination couldn’t be more clear: We’ll all be better off, and this nightmare will be over sooner, if people know that the best vaccine of all is whichever one they can get the soonest. With that in mind, Vox has urged its readers to attend to “the most important vaccine statistic”—the fact that “there have been zero cases of hospitalization or death in clinical trials for all of these vaccines.” The physician and CNN medical analyst Leana Wen also made a point of noting that “all of the vaccines are essentially a hundred percent” in this regard. And half a dozen former members of President Joe Biden’s COVID-19 Advisory Board wrote in USA Today, “Varying ‘effectiveness’ rates miss the most important point: The vaccines were all 100% effective in the vaccine trials in stopping hospitalizations and death.”
We’ve learned a little more from the ongoing public vaccination programs. Four important reports have come in the past two weeks. In one, researchers compared about 600,000 people who had had a full course of the Pfizer vaccine in Israel with 600,000 people matched in age and other demographics who had not been vaccinated. The shots’ effectiveness at preventing hospitalization was measured at 87 percent. (“This vaccine is fabulous in a real world setting,” Jha tweeted in response.) A preprint from Scotland reported an efficacy rate against hospitalization of about 80 percent among people 80 or older, almost all of whom had received only one dose of either the Pfizer or the AstraZeneca vaccine. Two reports from Public Health England estimated a reduction of hospitalization of about 50 percent and 43 percent for the same age group, again almost all after just one dose of the Pfizer vaccine. These are exciting outcomes—those vaccines really, really worked! But they oughtn’t lead anyone to think that the vaccines are all the same, and that protection will be perfect.
Efficacy is merely one layer, though. The Pfizer and Moderna vaccines have an edge at preventing symptomatic illness, but the Johnson & Johnson vaccine brings its own advantages. It has no demanding freezer requirements, which means it’s easier to distribute and more accessible to many communities. It’s more affordable than the other two—the company is providing it at cost around the world. Then there’s the fact that resources can be stretched a lot further when only a single dose has to be administered.
For individuals, too, the Johnson & Johnson vaccine has benefits. As a one-and-done injection, it’s more convenient. It also has a lower rate of adverse events than Moderna’s. You can’t compare results of these trials too precisely, but there are indications of a striking difference. About 2 percent of those who got the Johnson & Johnson vaccine recorded having reactions, such as fatigue, muscle aches, and fever, that were severe enough to interfere with daily activities. For those getting their second injection of Moderna, that rate was higher than 15 percent. People who are on the fence about getting vaccinated may find that this difference tips the scales in favor of getting a shot. Others who have doubts about the newness of the mRNA technology in the Pfizer and Moderna vaccines may appreciate the fact that Johnson & Johnson’s approach has already been deployed in the company’s Ebola vaccine, which got full drug approval in Europe last year.
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This pandemic has been devastating for certain communities.