For public health experts across Virginia, the Johnson & Johnson vaccine was a more-than-welcome addition to the state’s weekly allocation.
The one-dose shot boosted Virginia’s shipments by 69,000 this week, spurring a slew of new mass vaccination events. It doesn’t have the same cold storage requirements, making it easier to ship and redistribute. And at the national level, it’s prompting a new wave of optimism, with President Joe Biden promising a vaccine “for every adult in America by the end of May.”
But state health officials also worry the Johnson & Johnson vaccine has an image problem. When trial data was released, many reports honed in on the numbers: 72 percent effective against COVID-19 infections in the United States, 66 percent effective in South America and 57 percent effective in South Africa. Pfizer’s, by contrast, showed 95 percent effectiveness at preventing symptomatic COVID-19 after two doses. Moderna’s showed 94.1 percent.
Those numbers don’t tell the full story. Dr. Costi Sifri, the director of hospital epidemiology at UVA, said that the Pfizer and Moderna vaccines were studied before the discovery of more infectious new coronavirus variants, making the results hard to compare with Johnson & Johnson’s.
“The bar went higher for this vaccine,” he said. And the Johnson & Johnson vaccine, like Pfizer and Moderna’s, is virtually 100 percent effective against severe disease causing hospitalizations and deaths.
“Even if we’re saying it’s less efficacious than Pfizer or Moderna, it’s still better than most of the other freaking vaccines we’ve ever had,” said Dr. Robert Winn, director of the VCU Massey Cancer Center (flu vaccines, for example, generally range from 40 percent to 60 percent effectiveness).
“And I get why people are confused,” he said. “But while it may not be the Bentley, it’s still the very good Ford that gets you from Point A to Point B.”
Concern over optics, though, has played a heavy role in how Virginia is distributing the Johnson & Johnson vaccine in the first several weeks of its rollout. Of particular concern is that the vaccine will be viewed with suspicion in many low-income communities and communities of color, where discrimination — and unethical research — has contributed to mistrust of the medical system.
Winn said it’s compounded by the fact that some communities are already distrustful of vaccines in general, especially given how quickly it was developed (the “Operation Warp Speed” moniker from the federal government did nothing to assuage concerns, he said).
Coupled with the disproportionate burden of disease among Black and Latino Virginians and frequent public discussions on the risk of underlying conditions, he said there’s real concern that — without clear messaging — some communities might feel they’re being offered an inferior vaccine, even though that’s not the case.
“There’s a lot from a communications standpoint that we really have to be thoughtful about,” Winn said last month at a meeting of the state’s Vaccine Advisory Workgroup. “Because there are some communities that are saying, ‘Well, if we’re so at-risk, how come you aren’t making exceptions for us?'”
Gaylene Kanoyton, president of the Hampton NAACP, added that there could be “a major backlash” because health disparities “have always been in the Black and brown and underserved communities as it is.”
That’s led to careful consideration over how the Johnson & Johnson vaccine will be deployed. Dr. Danny Avula, the state’s vaccine coordinator, said Wednesday that Virginia’s first 69,000 doses were directed to local health departments and hospital systems that could get the shots out as quickly as possible through mass vaccination events. Cat Long, a spokesperson for the Richmond-Henrico Health District, said those types of events made it easier to find a “medium ground” that offered people a choice to accept or decline the vaccine.
“One important slice of the pie is, how do we offer vaccines in a way so they’re accessible to folks both culturally and physically?” she said. Like other health departments across the state, Richmond-Henrico (which received 5,000 doses of the Johnson & Johnson vaccine) is offering them to registered seniors through three large-scale clinics over the next week. Events using the Johnson & Johnson vaccine will be clearly marked in the district’s scheduling system, giving people the opportunity to wait for another event.
“It’s sort of a yes or no,” Long said. “We’ll say ‘This is a vaccine that will be offered,’ and then they have the choice to sign up for the event.” Residents who choose to wait won’t lose their spot on the district’s pre-registration system. But as the Johnson & Johnson vaccine becomes more prevalent, she said it might be a longer wait for clinics exclusively using shots from Pfizer or Moderna.
Right now, the district isn’t redistributing the vaccine to any of its community partners, such as pharmacies and low-cost health clinics. Long said they’re also not using it at pop-up events, which officials stage at prisons and congregate care facilities and in collaboration with faith leaders in certain underserved areas.
“The logistics of getting 10,000 vaccines into arms a week is a lot,” she said. “So adding that layer of asking every single individual which of the three vaccines they want when it really doesn’t make a difference — it’s too much. But at the same time, if we were to do it on-site at those type of events, then people wouldn’t have a choice.”
The same basic strategy is being deployed in many other areas, including the Blue Ridge Health District, which is also staging events for residents 65 and older. New River Valley in Southwest Virginia is holding a clinic for essential workers, but redistributing half its doses to pharmacies and other community partners for seniors.
The district’s director, Dr. Noelle Bissell, said a portion of the shots are also being held for residents in Phase 1b who specifically requested the Johnson & Johnson vaccine.
“We actually have a list of people who waited for it,” she said in a press briefing on Wednesday. “Some people didn’t want the hassle of coming back for a second shot. Some people who suffer from different muscle aches and pains — well, the vaccine goes into your muscle. And they only wanted to do that once.”
The single-dose schedule is just one of the major advantages of the Johnson & Johnson vaccine. It can also be kept at normal refrigerator temperatures for months, unlike the doses from Pfizer and Moderna, which use a different type of technology — requiring them to be stored at very cold temperatures. Sifri said that can create logistical problems even within large hospitals, and makes it more challenging to transfer doses to other settings.
Some rural health clinics also lack the necessary cold storage equipment, which makes the Johnson & Johnson vaccine more deployable to areas where shots otherwise wouldn’t be accessible. Avula said those perks — especially the single-dose effectiveness — mean the vaccine could be especially beneficial for certain populations, including homeless and transient residents who might not always be able to wait for a second shot.
“Take inpatients in hospitals,” he said at a press briefing on Wednesday. “If you are in the hospital, you have kind of a unique window of opportunity. A one-dose vaccine is much easier to give than to try to coordinate a second dose after you’ve been discharged.”
Right now, the prospect of giving out any vaccine on an individual basis is still far in the future. Avula said that Virginia received 69,000 Johnson & Johnson doses for the next two weeks, not including another 22,000 distributed directly to pharmacies through a separate federal partnership. But officials won’t be able to order any more until March 12.
The state still receives roughly 160,000 Pfizer and Moderna doses a week, in addition to doses allocated to pharmacies through the federal partnership.
The state’s share of Johnson & Johnson vaccine is expected to decline over the next several weeks, based largely on production at the national level. But by the end of March, Avula said it should rapidly begin to increase.
“It won’t be until the last week of March that we see supplies tick back up,” he said. “But at that point, they should do so in a very significant way. We are anticipating it will be somewhere around 100,000 doses, and then that number will continue to increase as we go through the month of April.”
By spring, he estimated that between 20 to 30 percent of the state’s total supply would be Johnson & Johnson vaccine. And health officials are hoping that growing availability will also lead to growing confidence.
“People will start to know people who got that vaccine, and I think they’ll just grow more familiar,” Long said. Both she and Bissell also emphasized that it’s not just communities of color with concerns. Over the past few weeks, health departments say they’ve fielded multiple questions on whether Virginians will be able to choose the vaccine they ultimately receive.
For Bissell, that’s missing the point.
“From a public health standpoint, we’re not going to get to COVID-zero,” she said. “It’s going to be circulating. So from a public health standpoint, vaccine success is preventing hospitalization and death. And all three vaccines are very effective at that.”