As the Johnson & Johnson COVID-19 vaccine rolls out this week, public health officials and J&J itself are working to dodge AstraZeneca's European fate.
Vaccination efforts in Europe are sputtering thanks to negative media coverage of the AZ vaccine, made worse by a patchwork of age-group approvals and conflicting government statements. The communications snafu serves as virtual roadmap—and warning—of what not to do as J&J stares down its own perception issues.
Numbers lie at the core of both vaccines' problems—mostly a fixation on top-line efficacy numbers, but also some misinterpretation. J&J and AZ's shots posted overall efficacy rates in the 65% range, and that appears to fall short of Pfizer and Moderna's well-over-90% efficacy rates. However, J&J argues that these are apples-to-oranges comparisons that don't account for trials done at different times and in different countries where coronavirus variants likely affected the results.
While AstraZeneca and partner Oxford University may be victims of the European Union's bumbling centralized rollout, the two bear responsibility for confusing data reports and a general lack of transparency, resulting now in a mishmash of authorizations around the world. And its approvals are still changing after more than a month on the EU market—just this week, France reversed its decision against the shot in people ages 65 and older, and Germany is poised to do the same.
An AZ spokesperson did not address specific questions about the European rollout, but in an email, pointed to its recent data "showing our vaccine is effective against all disease severities of COVID-19 and across all adult age groups, and in particular older adults."
"Our focus remains on ensuring broad and equitable access of our vaccine globally to help overcome the challenges of this pandemic as quickly as possible," the spokesperson said.
J&J's advantage for its vaccine—which, like AstraZeneca's, is adenovirus-based—is widespread and simple communications in U.S. media. CEO Alex Gorsky hit the TV circuit Monday morning to get the word out that the J&J vaccine is safe and effective.
Combating the 66% overall efficacy number, Gorsky repeatedly emphasized the vaccine’s 85% effectiveness rate against serious illness and 100% effectiveness at preventing death, noting at least once "and what's the objective here, keeping people out of the hospital and keeping people from dying."
The Biden administration is backing J&J, too, pointing out the apples-to-oranges math. There are no direct comparison studies of the vaccines, Anthony Fauci, M.D., chief medical adviser for the Biden COVID-19 response team, said during a White House press briefing Monday.
“I want to point out again a question we often get asked … What vaccine is better than the other vaccine? In order to be able to determine that, you would have to compare them head to head. This was not done,” he said, emphasizing all three are safe and urging people get whichever one is available to them.
Fauci also appeared on Sunday news shows and in a White House social media video answering J&J vaccine questions, parsing the data carefully and noting he would get the vaccine himself.
Still, Fauci’s facts aren’t countering all consumers’ feelings. Negative vaccine comparisons and preferences are propogating on social media, likely fueled further by anti-vaxxers known for online misinformation tactics.
The good news is U.S. consumers’ initial impression of J&J’s vaccine is positive. Sixty-four percent said they would be willing to take the J&J single-dose vaccine “despite reports it has a lower efficacy rate,” according to a survey from The Harris Poll run Feb. 26-28. Forty percent said the J&J vaccine is just as effective as the Pfizer and Moderna shots—19% said it’s less effective but 21% countered that they think it’s more effective.
Of course, that doesn't mean smooth sailing for J&J. On Wednesday, another hurdle sprang up in New Orleans, where its archbishop instructed Catholics to avoid the vaccine. The directive is based on J&J's use of cells with distant ties to abortion. The Catholic Church has previously balked at vaccine developers' use of cell lines originally derived in the 1970s from tissue from an aborted fetus, according to a report from Religious News Service.
Also affecting J&J's launch are longstanding healthcare inequities exacerbated by COVID-19. The pandemic's lopsided burden on marginalized communities and low-income groups has raised skepticism in already skeptical people.
State governors told the White House last weekend that they're worried the differences in overall efficacy will imply that some will get "better" vaccines than others, according to The Washington Post.
J&J's vaccine is more likely to be used in locations that lack the high-tech cold storage required for Pfizer and Moderna's shots—and those areas overlap with neighborhoods and rural regions where people are more likely to be poor or marginalized. Washington Gov. Jay Inslee even went so far to say. “J&J is going to be a challenge for all of us.”
However, the White House COVID team pushed back on any ideas of a two-tiered system of vaccine distribution.
“All of the authorized vaccines will be distributed across states and jurisdictions and across all of our federal vaccination channels,” Marcella Nunez-Smith, co-chair of Biden's COVID task force, said Monday. “That doesn’t mean that every vaccination site will have every vaccine, but it means that all vaccines will reach all communities—so all three authorized vaccines available in the suburbs, all three available in the cities, all three available on the coast and in the Heartland.”
Elyse Margolis, W2O President at WCG, said it’s important for J&J, and other vaccine makers, to remember that vaccine perceptions and questions are valid—even if inaccurate on their face—and should be answered.
“These perceptions and questions don’t come out of nowhere,” she said in an email. “They come out of a long history of health inequity and discrimination that, rightly so, demand us to ask questions—especially now that multiple vaccines are available."
She added, "The only way to address perception and speculation is with truth and science. And the truth is that the J&J vaccine has been studied and evaluated by independent experts with exactly the same amount of rigor as have the Moderna and Pfizer vaccines."