Why Johnson and Johnson COVID-19 (Coronavirus) Vaccine Should NOT Be Seen as a Second-Class to the Pfizer/BioNTech and Moderna mRNA Vaccines

Written By Humayra Ali
JnJ Vaccine

To quote Jimmy Fallon from an earlier segment of The Tonight Show, “Well guys, here is some big news from earlier today: Johnson and Johnson announced its single-shot COVID vaccine has completed its global trial and soon will be available. Yup, Johnson and Johnson said their vaccine is proved to be 66% effective. Way…way to go? 66%? Pretty much the D students of the vaccine world! Not failing, but we pretty much want to bump that average up to a C+ by next semester.”

Fallon’s jokes aside, he merely reflected the sentiment a lot of people currently hold regarding the efficacy outcome of the Johnson and Johnson (JNJ) vaccine. The public will naturally compare the JNJ vaccine’s 66.9% protectiveness with the Pfizer/BioNTech and Moderna Covid-19 vaccines’ 94% to 95% efficacy. However, these numbers are highly misleading. This article breaks down the reason why it will be a mistake to assume that the JNJ vaccine is 2nd-rated compared to the mRNA vaccines.

The JNJ vaccine was tested after the emergence of the more contagious coronavirus variants, including the one identified in South Africa 

Given so many choices, we tend to compare and contrast the different options for COVID-19 vaccines. Although, one much take caution that while some attributes of these vaccines can be analyzed side-by-side, others should not be directly compared unless the vaccine candidates are compared head-to-head in one single clinical study. Namely, safety and efficacy results should not be directly compared from different studies because the study parameters usually vary between the clinical trials. 

The JNJ vaccine was tested in different populations and at a different time, in comparison to the mRNA vaccines. It was evaluated in 44,000 people in the US, South Africa, and Latin America. Pfizer/BioNTech's vaccine was evaluated in 43,000 people in the United States, Germany, Turkey, South Africa, Brazil, and Argentina. Moderna's COVID-19 Vaccine was investigated in 30,000 people, but only in the US population.

The JNJ vaccine was tested after the advent of the troubling new coronavirus variants, such as the one seen in South Africa, called B.1.351. The South African variant appears to weaken the body's ability to recognize the virus, even in cases after vaccination. When the body can not recognize it, it can’t spike an immune response to fight off the intruder. Despite being highly contagious, the JNJ vaccine proved to be 57% efficacious in South Africa, where B.1.351 is the dominant variant. In comparison, the JNJ vaccine achieved 72% efficacy in the US, where B.1.351 coronavirus is far less common.

Experts are alarmed that another COVID-19 surge is imminent, as early as weeks away, driven by newer variants of the coronavirus. In particular, they are concerned about the highly contagious B.1.1.7 variant that was first identified in the UK. The Centers for Disease Control and Prevention (CDC) warned that this particular variant will be the predominant strain in the US by March of 2021. As we are faced with such a threat, it is kind of reassuring, to some extent, to have a vaccine that has already been tested in a global population that was exposed to the new coronavirus variants.

JNJ vaccine was 85% effective against severe disease and 100% effective at preventing death in the clinical study 

While the overall efficacy of the JNJ vaccine was 66.9% against moderate to severe illness, it was 85% effective against severe disease and 100% effective at preventing death, since those who got the vaccine in the clinical study did not die from Covid-19. The whole idea behind vaccinating is to reduce transmission, serious illnesses requiring hospitalization, and death, and the JNJ vaccine was able to demonstrate that.

In the world of vaccines, 66.9% protectiveness is considered superb in terms of preventing symptomatic infections

For perspective, the FDA had set its efficacy requirement at 50% for the COVID-19 vaccines, and last year’s flu vaccine was 29% effective according to the CDC. Nonetheless, even that 29% effectiveness was sufficient to prevent severe symptoms in most individuals and reduce the rate of transmission or the ability of the virus to spread among people. You do not need a highly effective vaccine (eg, 95% effective) to achieve that as much as you need most people vaccinated because herd immunity is at play when most people are protected by a vaccine.

Herd immunity is better understood as herd or community protection. Herd immunity occurs when enough people in the community are exposed to the virus, usually through vaccination, and thereby limits the ability of the virus to spread. When a high percentage of the population is vaccinated, the infection cannot spread as easily, mainly because there aren’t that many people left who are unexposed or unvaccinated and can succumb to the infection—therefore, the disease can potentially disappear. But, the key to making herd immunity work is by vaccinating most of the population. The percentage of the population who needs to be vaccinated to achieve herd immunity can vary by disease. In the case of measles, 19 out of 20 people (95%) need to be vaccinated to protect the remaining 1 out of 20 who are not vaccinated. 

We currently do not know the threshold level of herd immunity needed to curb the spread of the coronavirus pandemic. According to the Centers for Disease Control and Prevention (CDC), the herd immunity threshold for COVID-19 has yet to be established. However, the JNJ vaccine comes at a highly opportune time when the demand for COVID-19 vaccines far surpasses their supply. 

JNJ vaccine can change the course of coronavirus pandemic leveraging its added benefit of a single-shot dose and ideal storage and transportation conditions

COVID-19 vaccination has been a logistical nightmare so far, to say the least. It's been such a challenge to administer even a single dose as well as signing up for a second dose and making sure that a second dose is available at the right time. Logistical challenges proved to be a huge barrier for many Americans, let alone harder-to-reach rural America. To date, less than 50 million Americans have received at least their first dose of a Covid-19 vaccine per CDC data, and less than 25 million people have gotten both doses of the mRNA vaccines. So essentially, only less than 10% of Americans are vaccinated as of the end of February 2021. That statistic is way grimmer when we think about the global population, simply owing to the lack of availability of vaccines worldwide. With its single-shot vaccine and easy transportation and storage requirements, the JNJ vaccine can dramatically surge vaccine availability.

While JNJ vaccines’ 66.9% protectiveness is much lower than the Moderna and Pfizer vaccine efficacies, this vaccine could prove to be more valuable globally, leading the way for vaccine coverage in poorer countries where it is in dire need. Pfizer's and Moderna's vaccines use very similar mRNA technology, while JNJ uses a single-dose of the genetically modified viral vector (also known as Ad26.COV2.S that uses the same technology JNJ used for Ebola, Zika, HIV, and RSV vaccines). mRNA vaccines lend themselves to quick turnaround from a development standpoint, but mRNAs are fragile and unstable in nature, so they are encased in lipid (or fat) nanoparticles, kind of like buttery substances that can melt at room temperature. Hence the mRNA vaccines must be kept at cold temperatures, requiring special equipment to store and ship these vaccines. Pfizer's vaccine has to be kept at ultracold temperatures of -100°F (-70°C). Moderna’s vaccine, with a different formulation of the lipid nanoparticles, can be shipped at -20°C (-4°F) and can be kept stable for 30 days at 2 to 8°C (36 to 46°F), the temperature of a standard home refrigerator. On the other hand, viral vector vaccines are cheaper to produce, as in the case of the AstraZeneca and JNJ vaccines, and they can be kept stable for months at standard refrigerator temperatures, which is quite suitable for global distribution, particularly in poorer countries.

To sum it up, the JNJ vaccine should be looked at as another historic milestone that can help us get back to normalcy sooner than later.

VaxTherapy is NOT affiliated with any of the pharma/biotech companies working on COVID-19 vaccines. The purpose of this post is to provide education and awareness from a virologist’s independent perspective based on available facts and data

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Humayra Ali
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