Multiple Covid-19 Vaccine Protections Pose Messaging Challenge

Varying protection levels in forthcoming Covid-19 vaccines could pose a messaging challenge for public health leaders racing to achieve high vaccination levels.

Johnson & Johnson Inc. released interim results Friday showing its vaccine was 66% effective in preventing severe and moderate cases of Covid-19, with a 72% protection level in the U.S. That’s lower than the 90%-plus efficacy rates of the Pfizer/BioNTech and Moderna vaccines currently in circulation.

“A 70% or 75% effective rate is still really wonderful. It is on par even above some of the other vaccines that we use all the time,” Katharine J. Head, an associate professor at Indiana University whose research focuses on health communications in vaccines and cancer screenings, said in an interview. The seasonal flu shot is about 40% to 60% effective at reducing the risk of illness.

Top U.S. infectious disease expert Anthony Fauci said the early J&J findings offer “value added” to the vaccines that are currently available. Pfizer and Moderna’s vaccines offer a higher level of protection, but they also require two doses and have special storage and administration requirements. J&J’s vaccine requires just one shot. It’s inexpensive and can be scaled up quickly.

“This could be a messaging challenge because if you look at it just superficially and you say ’72% versus 94, 95%,’ you’ve got to make sure that people understand the implications,” Fauci said Friday. The J&J vaccine worked particularly well against severe cases of Covid-19, preventing 85% of severe infections and 100% of hospitalizations and deaths. The company’s introduction to the mix of already available vaccines can keep people out of the hospital and stop them from getting severely ill.

“If you can prevent severe disease in a high percentage of individuals, that will alleviate so much of the stress and human suffering and deaths in this epidemic that we’re seeing,” Fauci said.

Back to Normal?

Curbing the spread of the SARS-CoV-2 virus to the point where masks and social distancing will be less necessary requires lots and lots of people to get shots, whichever one is available. “I totally understand the idea that people want to get the best vaccine. We all want that,” Head said. “But the most important thing is to remember just getting any vaccine is important right now, and having high population coverage is really what’s going to help us get back to normal.”

J&J’s vaccine could be particularly beneficial in places where it’s harder to meet Pfizer’s cold chain requirements, where access is an issue, and people can’t return to get their second shot.

The high protection level shown in Moderna and Pfizer’s clinical trials far exceeded any expectations of federal health leaders. The Food and Drug Administration set the bar for Covid-19 vaccines at 50%. Fauci and Peter Marks, who heads the FDA’s vaccine center, said this past summer they would like to see 70% efficacy when clinical trials were still underway.

The rush to create a Covid-19 vaccine has created an unusual situation because, at most, there are usually two vaccines on the market for a disease, Head said. “In our lifetimes, we really haven’t had to face picking one among many vaccines to try to prevent ourselves from disease.”

What’s also different about this vaccine rollout is that people are unlikely to get shots where they usually go for health care. In Los Angeles, some 7,000 people got shots at Dodger Stadium, for example. That’s the opposite of what Head’s research shows—that a strong recommendation from a trusted health-care provider heavily influences vaccine uptake.

“It’s really hard to have conversations with trusted health-care providers because we may not know the people giving us the vaccine,” Head said. If people have questions, they should still call a trusted provider or find reliable sources of information.

More Analysis, Verification

The J&J data still needs to be verified by the FDA, and subsequent analysis could show subsets of the population where the level of protection is higher, Marks said Friday at an American Medical Association webinar. It’s important to deploy the vaccines thoughtfully by finding the populations that will benefit most from each one.

“We have to be very cautious for vaccine confidence not to let anyone think that they are getting an inferior vaccine for some reason just because they are who they are,” he said.

The public health messaging around vaccine efficacy will need to clearly state that efficacy is a moving target as the emerging variants appear to diminish the effectiveness of the vaccines, although they still fall within the cushion of protection.

With a constantly evolving situation and as new mutations may continue to emerge, it’s important to emphasize that getting vaccinated soon is more important than getting the vaccine with the highest efficacy rate, said Lu Tang, an associate professor of health communication at Texas A&M University, in an email Friday. “I believe the best solution is to be transparent.”

Coronaviruses mutate all the time, but the rapid rate of infection gives the SARS-Cov-2 more opportunities to replicate, increasing the chances that it will mutate. That’s why mass vaccination is the best weapon against variants.

“If you prevent the virus from robustly replicating as it otherwise would, then in effect, you’re going to slow down the evolution of the mutants,” Fauci said in an interview with Bloomberg Law. He is the director of the National Institute of Allergy and Infectious Diseases as well as President Joe Biden‘s chief medical adviser for Covid-19.