If you get the choice, which COVID-19 vaccine should you choose?
For now, experts are clear: The best vaccine is the one about to go into your arm. But as the vaccine supply grows, Americans eventually might find someone asking, “Which vaccine do you want?”
The answer for most people will still be “Whatever’s available.” But there are differences that could play a role, though doctors are unanimous that all three authorized vaccines work extremely well to protect against severe disease, hospitalization and death.
A shot now is better than waiting for a different shot, said Dr. Kathryn Edwards, scientific director of the Vaccine Research Program at Vanderbilt University’s School of Medicine. It likely benefits the individual and society alike by lowering the overall spread of the disease.
Beyond that, there are small trade-offs when it comes to the current vaccines. In general, Pfizer-BioNTech and Moderna vaccines require two doses and are somewhat more effective. Johnson & Johnson requires one dose and is somewhat less likely to cause side effects.
J&J’s “one and done” aspect is a selling point for many.
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Pedro Betancourt works at the airport in Miami and “can’t take chances,” he said. His choice would be “Johnson & Johnson due to a convenient one shot.” But he said he wasn’t picky because he and his wife had gotten COVID-19, which he described as “mild but scary.”
Right now, “I hope everyone takes the vaccinations seriously so that we can begin moving forward to normalcy,” he said.
People in that group might choose the Pfizer-BioNTech or Moderna vaccines.
For someone who doesn’t have anyone at home at high risk, and isn’t at high risk themselves, that slightly better effectiveness wouldn’t matter as much. The ease of the one-shot J&J vaccine could be more important.
“They might think, ‘As long as I’m doing my bit for the community, if it’s enough for that, then that would be enough for me,’” Bastian said.
Immunity: How fast does it work?
How quickly the vaccines’ protection kicks in and how long it lasts are still being worked out. No long-term data is available because none of the vaccines are more than a year old.
The vaccines don’t give immediate protection because there are biological limitations at work, said Dr. Otto Yang, a professor of medicine and
“It takes time for antibodies and T cells to build to adequate levels. Antibodies in particular also require ‘maturation.’” he said.
It might seem the one-shot J&J vaccine, would be faster but that’s not necessarily the case.
From published data on symptomatic infections, it appears the Moderna and Pfizer vaccines likely reach maximum protection from 14 to 28 days after both shots, said Akiko Iwasaki, a professor of immunobiology at Yale University.
The endpoint protection from symptomatic infection was measured two weeks after the second shot for Moderna, and one week after the second shot for Pfizer during the Phase 3 trials. That would be at 42 days for Moderna and 28 days for Pfizer.
That’s not so different from J&J. After 28 days, its protection from severe disease was 85% and after 49 days it was 100%, said Iwasaki.
She did acknowledge there’s no good head-to-head data.
“It is comparing apples and oranges though since the efficacy was measured differently, Moderna and Pfizer-BioNTech as symptomatic infections, Johnson & Johnson as moderate to severe disease,” she said.
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How well the vaccines work against newly emerging COVID-19 variants is another factor.
Scientists say it’s difficult to really know whether any of the three work better against the variants as the vaccines were tested at different times when different variants were circulating.
Even so, some Americans prefer J&J.
“If I could choose, I would go with Johnson & Johnson. The reason why is because this vaccine protects people from the variants. Pfizer-BioNTech and Moderna came out before the variants showed up,” said James Bock of Rockford, Illinois.