The J.&J. Conundrum – The New York Times

The J.&J. Conundrum – The New York Times

Friends, family members, and dozens of readers have asked: Should people who received the single-shot Johnson & Johnson Covid vaccine get a booster shot?

Karen, a Morning reader from Michigan, emailed us, saying, “Since receiving mine in March, I’ve been wondering what the facts are.” I’m terrified.” “Information about J.&J. is not communicated at all!” wrote Leah in California. Lauren from Nashville inquired, “What is the advice for us?”

Today’s newsletter is dedicated to them. We’ll do our best to lay out the facts so you can make your own decision.

Booster shots for the other two vaccines used in the United States — the double-shot vaccines from Moderna and Pfizer, both of which are based on genetic technology known as mRNA — have received more attention. Many experts believe that a third shot will benefit at least immunocompromised people and older adults.

The situation is more complicated with J&J’s single-shot vaccine, which employs more traditional virus-based technology. J.&J. has received less attention because only 8% of vaccinated Americans have received the vaccine. However, 14 million people are still covered, and many of them require assistance.

J.&J., how effective are they?

J&J has always appeared to be less effective than the other two US vaccines. According to the most recent C.D.C. data, the gap may be widening over time, owing in part to the Delta variant. “All of the evidence we have shows that J&J is less effective in preventing both infections and hospitalizations,” Stanford University’s Dr. Michael Lin told us.

According to the state, approximately one out of every 20,000 J&J recipients in Colorado was hospitalized with Covid at some point during the previous week. Pfizer’s share was one in 27,000, while Moderna’s was one in 32,000.

True, any of those possibilities remains extremely remote. “We believe this vaccine is doing what it was designed to do, which was to stop people going to hospital and ending up in I.C.U.s and dying,” said Dr. Linda-Gail Bekker of the University of Cape Town, who co-led a recent study of J.&J. and the Delta variant.

Nonetheless, giving people even more protection against a severe case of Covid is extremely valuable. Given Delta’s contagiousness, the possibility that a J.&J. recipient would become infected with a less severe case — and infect others — appears real enough to warrant consideration.

What about another J.&J. shot?

Multiple shots are the norm for many vaccines, not just Covid.

The fact that the Food and Drug Administration approved J.&J. as a one-shot vaccine was never meant to imply that a second shot would provide additional protection. It happened because data showed that the J.&J. vaccine was quite effective after one shot, and scientists and regulators felt compelled to get Covid vaccines into people’s hands as soon as possible.

Experts have long assumed that the government would eventually recommend a second round of ammunition. J.&J. announced internal research last month indicating that second shots boost immune responses. President Biden’s surgeon general, Dr. Vivek Murthy, has indicated that regulators are likely to approve a second shot in the coming months.

Why not try a different booster shot?

However, many J&J recipients prefer a follow-up shot with either the Moderna or Pfizer vaccine to a second J&J shot. They are aware that J.&J. appears to be less effective than other vaccines, and some J.&J. recipients have expressed concern about reports of a very rare but serious blood clot.

Notably, many doctors and prominent experts who received the J&J vaccine have opted for a follow-up Moderna or Pfizer vaccine. Bill Enright, a biotechnology CEO, Zo McLaren, a health economist, and Angela Rasmussen, a prominent virologist, are among those on the list. About a month ago, the city of San Francisco began offering a Moderna or Pfizer booster shot to J&J recipients.

The fact that there is little data on these vaccine combinations is probably the most important reason to be cautious. However, there is information on another relevant combination.

The AstraZeneca vaccine, which is used in many countries but not in the United States, is similar in design to the J&J vaccine. Many people in Europe and Canada received AstraZeneca for their first injection and Pfizer for their second, and they appear to be doing well.

This method is sometimes referred to as “mix and match,” and it makes intuitive sense. People are benefiting from the immunity benefits of two types of vaccines.

“I believe I did the right thing in protecting myself from the Delta variant and thus protecting others who only have one shot,” Rasmussen wrote in June. “Sometimes, public health necessitates making difficult decisions in the absence of a complete data set.”

Dr. Leana Wen of George Washington University told us, “I strongly believe that the federal government should permit boosters for J&J recipients.”

Dr. Rochelle Walensky, the director of the C.D.C., declined to discourage J.&J. recipients from seeking out a Moderna or Pfizer shot during a podcast interview this summer. She stated that there was insufficient data to be certain about the benefits and risks. When podcast host and former Biden adviser Andy Slavitt asked if she thought it was a “huge mistake,” Walensky replied, “Not from what I’ve seen so far.”

That was a remarkable and telling statement coming from the head of a notoriously cautious agency.

Can you, however, get a booster shot?

That is a difficult question to answer. Even if you want a follow-up shot, the US government has not approved it, and doctors have generally declined requests from patients.

Many people are understandably frustrated by the situation: some experts, citing scientific evidence, are urging a follow-up shot. And some doctors have discovered a way to obtain a second shot for themselves.

However, if you walk into a doctor’s office and request one, you will most likely be denied. There may appear to be two sets of rules for people with medical connections and another set for everyone else.

What should I do? You have a couple of options for a follow-up shot. You can go to different drugstores or clinics, hoping to find one that will give a Pfizer or Moderna shot to a J.&J. recipient — or one that will not ask you questions about your medical history. You can also choose to be less than completely honest. You will not be alone.

Allison, a New Hampshire reader, wrote to us, “I got J.&J. Do I act as if I didn’t and get Pfizer or Moderna as well?”

In conclusion

The following is a brief justification for getting a Pfizer or Moderna shot as a follow-up to a J.&J. shot: The evidence suggests that you will benefit. So far, there have been no reports of concerning side effects. The Delta variant of the coronavirus is an even greater threat to human life than previous versions of the coronavirus. You may be allowing bureaucratic caution to get in the way of your own health by waiting.

Here’s a brief argument against a follow-up shot: A single J.&J. vaccine shot still provides adequate protection, and the government may soon allow a second J.&J. shot. There is currently insufficient rigorous data on the benefits and risks of the mix-and-match approach with J.&J. And you might have to be a little sneaky to get another shot.

We can see why so many people are perplexed.

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The J.&J. Conundrum - The New York Times