Equity, Efficacy Concerns a Potential Challenge for New Vaccine Rollout

Public officials and providers are looking to get ahead of concerns that the new Johnson & Johnson coronavirus vaccine may be a subpar option doled out to underserved communities.

A NEW VACCINE SHIPPED out this week looks to be a valuable tool as the U.S. aims for herd immunity against COVID-19, but providers may be challenged by questions of equity and a perception that the shot is less effective than its counterparts.
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Johnson & Johnson’s COVID-19 vaccine received federal emergency-use approval late last week, joining candidates from Moderna and Pfizer to become the third coronavirus vaccine publicly available in the U.S. But unlike Moderna’s and Pfizer’s vaccines, which are given in two doses, Johnson & Johnson’s requires just one dose. It also can be refrigerated for three months, in contrast to its counterparts’ more stringent freezer requirements.
Photos: COVID-19 Vaccinations
TOPSHOT — Health professional Raimunda Nonata, 70, is inoculated with the Sinovac Biotech’s CoronaVac vaccine against COVID-19 inside her house becoming the first Quilombola (traditional Afro-descendent community member) to be vaccinated at the community Quilombo Marajupena, city of Cachoeira do Piria, Para state, Brazil, on January 19, 2021. — The community of Quilombo Marajupena, 260km far-away from Belem, capital of Para, doesn’t have access to electricity. (Photo by TARSO SARRAF / AFP) (Photo by TARSO SARRAF/AFP via Getty Images)
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Yet experts and officials have expressed concern that the efficacy of the J&J vaccine may be called into question, leading people to regard it as inferior to Pfizer’s or Moderna’s.
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[ READ: Biden Promises Enough Vaccines for Every Adult By End of May ]
“We have to make sure this does not get labeled as a second-class product and for low-income communities,” says Dr. Georges Benjamin, executive director of the American Public Health Association.
Dr. Marcella Nunez-Smith, head of the White House’s COVID-19 Health Equity Task Force, this week acknowledged the advantages of Johnson & Johnson’s vaccine, but pushed back against the idea that it should be the primary option for marginalized communities
“There are clinical benefits to J&J that we talked about briefly — in terms of the cold-storage capacity, the single dose — that might make it very useful for health care providers in their toolkit, as they’re thinking about things like some pop-ups,” Smith said. But she added that distribution “should be even across communities.”
That may require a careful calculus: Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, noted that the new vaccine could help “fully vaccinate people who may have difficulty, or who are not interested, in returning for a second dose” — a point echoed by other experts who’ve said the single-dose shot could aid efforts to vaccinate homeless people and those without transportation or internet access. Walensky said the easier storage requirements might allow for vaccinations in community settings and mobile sites.
Still, Nunez-Smith noted that federal officials can provide “technical assistance” to help states “pivot and intervene and correct” on vaccine distribution if needed.
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Overall across eight countries, clinical trial data showed J&J’s vaccine was found to be 66% effective at preventing moderate to severe disease; in the U.S. alone, it was found to be 72% effective. The vaccine also was 85% effective overall against severe disease, preventing deaths completely and hospitalizations after a period of at least 28 days.
By contrast, the Moderna and Pfizer vaccines have 94% and 95% efficacy rates against symptomatic COVID-19, respectively. But as White House adviser Dr. Anthony Fauci noted, vaccines have not been compared head to head. And pitting Johnson & Johnson’s offering against the other two would be a difficult task, as STAT News reports, given factors such as testing design differences.
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What’s more, the J&J vaccine was being studied in countries like South Africa amid the circulation of new coronavirus variants. The spread of variants has raised red flags for the CDC, particularly as a weekslong decline in U.S. cases of COVID-19 has stalled. And though the CDC says there is no evidence to suggest a South African virus variant has an effect on disease severity, the Johnson & Johnson vaccine proved 64% effective against moderate to severe/critical disease in the country and 82% effective against severe/critical COVID-19 alone.
Fauci also underscored the lack of hospitalizations and deaths within the Johnson & Johnson studies. “We have three highly efficacious vaccines that also … (have) a very good safety profile,” Fauci said.
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Yet as J&J’s vaccine makes its way to states, some public health officials are trying to quickly get ahead of any fears and assumptions that it is less effective or less valuable. During a Monday meeting of the CDC’s Advisory Committee on Immunization Practices, Arkansas Secretary of Health José Romero said the vaccine’s effectiveness in preventing hospitalizations and deaths must be stressed, something he said he plans to do with his constituents.
Sandra Quinn, a professor of family science at the University of Maryland and senior associate director for the Maryland Center for Health Equity, says conversations around the J&J vaccine must be a dialogue between patients and their providers, who can reiterate the vaccine’s success against severe disease.
“I think for local and state health departments, local community health centers and others, it will be time to listen to what the concerns are,” she says, adding they must particularly listen to marginalized communities — including Black, Latino and rural communities — that have been hit hard by the virus.
One group preparing to have that dialogue is HealthLinc, a community health center with multiple facilities in northwest Indiana. The federally funded center is not only prepared to receive the Johnson & Johnson vaccines and begin getting them into arms, but took part in clinical trials testing the shot.
HealthLinc CEO Beth Wrobel says Johnson & Johnson used the organization’s Valparaiso, Indiana, location late last year to study the vaccine. Patients, providers, community members and even Wrobel and her son signed up.
The community health center, with 11 freestanding clinics that serve 40,000 patients, has a long history of community engagement, she says. Now, as a COVID-19 vaccine provider, it’s administered 11,000 doses, mostly of Moderna’s vaccine. Close to 30% of the shots were second doses, Wrobel says.
The center expects its next vaccine shipments to begin to include Johnson & Johnson doses.
“Our hope is we can get all Johnson & Johnson next week,” Wrobel says. “That’s how confident we are because this is a population that has barriers to getting to the clinic.” She adds that J&J might be an attractive option for the homeless population served by the center, as well as for seniors who don’t want to wait for a second dose.
“Eighty-year-olds want to see their grandkids,” she says. When the center gave seniors their second Moderna doses, she says, “they were crying because they got to hug their grandkids.”
With the Johnson & Johnson doses arriving soon, Wrobel says she’s been holding meetings with her employees to get everyone up to speed on the facts of the vaccine, and they’re still having discussions on how to best approach speaking with patients about it.
Wrobel says the center wants to begin with education, emphasizing that it’s impossible to compare the J&J vaccine to the Pfizer and Moderna offerings, but that it’s proved effective.
The center’s patient registration system also has a feature that can help with that. In December, Healthlinc added a survey to gauge interest and thoughts on COVID-19 vaccination, as well as a list of questions patients can take to their providers on the topic. The survey includes educational materials and links to the CDC built into it. Wrobel believes including this has given some patients who were on the fence the needed nudge to come in for a vaccine, regardless of the manufacturer.
“We were ahead of the curve before,” she says. “I think because they trust us, they trust their provider. It has really made a difference.”
[ MORE: States’ Progress on Administering the COVID-19 Vaccines ]
Indeed, providing transparency and answering patient questions is key, says the APHA’s Benjamin. He, like Wrobel, notes that the J&J vaccine might be an attractive option to a lot of people and urges providers and officials to shy away from any messaging that J&J’s vaccine is only for certain, underresourced populations.
It also might not be worth getting attached to one specific vaccine, Benjamin says, because people may end up getting multiple doses over time. “It is increasingly looking like this is not going to be a lifetime choice,” Benjamin says, adding that it’s possible that COVID-19 vaccines could be needed on a more periodic basis.
Benjamin additionally notes that even if the Johnson & Johnson vaccine goes to underresourced communities, that doesn’t change fundamental issues with access and equity that have been highlighted throughout the vaccine rollout, Benjamin says.
For example, the Los Angeles Times recently reported that more affluent community members were using codes meant largely for underserved Black and Latino communities to score vaccines.
“We should fix the fundamental issues with access and recognize that the J&J product is helpful, but that doesn’t mean we shouldn’t fix the appointment systems and the transportation systems, and make sure that it can be equitable,” Benjamin says.
Updated on March 3, 2021: This story has been updated to remove language about vaccine hesitancy and efforts to reach disproportionately affected communities.
Tags: vaccines, Johnson & Johnson, coronavirus, public health, inequality