Where does that leave us for making decisions? As Anthony Fauci told The New York Times last weekend, “Now you have three highly effective vaccines. Period.” Again, you will get a lot of benefit from any of them, and your risk will shrink even more as those around you get vaccinated too. Whichever one you start with, a booster may be coming in the not-so-distant future, of the same vaccine or perhaps a different one. By taking the first vaccine you can get, you’ll also avoid the risk of finding yourself without protection if infection rates surge where you live.
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.
Given these concerns, there’s some danger in the message—however well intentioned—that the COVID-19 vaccines are all the same by any measure, or that they’re perfect wards against severe disease. Vaccination is a public-health imperative, and going full tilt to promote uptake supports the common good. But it’s a personal health decision too. People want to protect themselves and those close to them, and they are likely to care about outcomes other than hospitalization and death, no matter what anyone says now.
Still, raising these concerns in public can be fraught. In response to an inquiry about her data table, Gandhi affirmed the importance of looking at severe-disease outcomes and noted that “careful, collegial and collaborative scientific discourse on the vaccines is imperative moving forward to help us get through the pandemic.” Topol pointed out that he has emphasized the vaccines’ measured efficacy against symptomatic disease many times before, so any isolated reference to his table “takes that particular post out of context.” Jha wrote in an email that he stands by the message of his original tweet, and notes that COVID-19 hospitalizations and deaths are so rare among the people vaccinated in these trials, to quibble over differences is akin to “counting how many angels are dancing on the head of the pin.”