Why You Shouldn't Count Out the Johnson & Johnson Vaccine

Meghan Fitzgerald, RN, MPH, DrPH, is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor. She has decades of experience working in the healthcare field, ranging from frontline patient care to advising prominent healthcare firms. Here, she offers her perspective on why the Johnson & Johnson vaccine is still an important and viable player in the fight against COVID-19.

Data on the waning protection of vaccines and the increased threat of the highly-infectious Delta variant led the Centers for Disease Control and Prevention (CDC) to make a U-turn last week, recommending COVID-19 booster shots despite advising against them the month before.

The CDC booster guidance is subject to an independent review by the Food and Drug Administration (FDA) to determine the safety and effectiveness of a third dose of the two-dose Pfizer and Moderna mRNA vaccines.

Notably absent from the booster conversation is the one-dose Johnson & Johnson (J&J) vaccine. But here's why you shouldn't count out J&J just yet.

A J&J Booster Is Pending

While at this time, it may sound like there's no recommended booster for J&J, there's just no recommended booster yet. Because the U.S. didn't begin administering the J&J vaccine until March of 2021, under current guidance, boosters wouldn't be needed until November at the earliest. To issue this guidance, officials evaluate vaccine efficacy, safety, and immunity data as it rolls in. Pfizer and Moderna have already provided eight months of data.

According to Johnson & Johnson, its booster is both in the works and quite promising. On August 25, the company said clinical trial data shows people who received a booster six to eight months after their initial J&J shot saw antibodies increase nine-fold compared to 28 days after the first shot.

Mixed Vaccine Booster Plans are Underway in Some Locations

We don’t have final data yet on whether it's safe and effective to offer a J&J shot after receiving an mRNA vaccine like Pfizer or Moderna. But some U.S. experts support it in at-risk populations.

In Germany and Britain—where available vaccines include Pfizer, Moderna, J&J, and AstraZeneca—healthcare professionals have been administering mixed regimens with no issues reported to date. 

Texas Tech University just announced it will offer an extra dose of the Pfizer vaccine to those who are immunocompromised and previously received any of the three available vaccines in the U.S.

J&J Vaccine Remains Highly Effective

Nearly 14 million people in the U.S. have received the single-dose J&J vaccine. It's important to remind this group that recent research shows this vaccine remains very effective at protecting against the most concerning outcomes: hospitalization and death. A study released this month followed nearly 500,000 healthcare workers in South Africa, showing that the J&J vaccine was 71% effective against hospitalization and 95% effective against death from the Delta variant, specifically.

The World Depends on the J&J Vaccine

While boosters are top of mind in the U.S., the bigger story is the need for J&J as a first dose in other countries. Its one-shot dosing schedule, simpler handling conditions (no frozen storage), and global buying group orders make this vaccine a realistic option for billions in remote and poorer locations.

Last week, Canada donated 10 million unused J&J shots to other countries in need of vaccines, and India authorized the J&J vaccine for emergency use. This sharing of vaccines and science is essential at this stage of the pandemic.

Unfortunately, reputation damage is real. Johnson & Johnson recipients account for less than 10% of fully-vaccinated people in the United States. Additionally, manufacturing challenges have led to supply issues for states. These constraints will provide less of a study pool of J&J recipients for researchers to evaluate. This matters to millions outside of the U.S. who depend on this vaccine.

Reminder: Boosters Will Not Solve Our COVID Problem

My husband got the J&J vaccine and I have zero worry about his protection and safety. I have advised him to not seek a booster at this juncture. He is healthy—not in a high-risk group—and has no issue wearing a mask in crowded indoor settings

If we could convert a few of our unvaccinated friends to get their first shot, that effort would go further to protecting us and our community than a booster.

As a public health leader, I agree with my peers forcing action to vaccinate the poorest countries now while continuing to target mainly those at highest risk with boosters. As we have seen with the Delta variant, time and logistics are not on our side. It is paramount we continue to study and include the J&J vaccine in our global war against COVID-19. The pace of vaccination in poor countries has exposed global inequity that can’t be ignored. The U.S. does not get out of the pandemic unless the world does.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.