COVID vaccine

Pfizer, Moderna, Johnson & Johnson: Which COVID Vaccine is Best?

With a third coronavirus vaccine now approved in the U.S., what is the difference between the vaccines and should you opt for one over the other?

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UPDATE: The U.S. is recommending a “pause” in administration of the single-dose Johnson & Johnson COVID-19 vaccine to investigate reports of potentially dangerous blood clots.

In a joint statement Tuesday, the Centers for Disease Control and Prevention and the Food and Drug Administration said they were investigating unusual clots in six women that occurred 6 to 13 days after vaccination. All six cases were in women between the ages of 18 and 48. More than 6.8 million doses of the J&J vaccine have been administered in the U.S., the vast majority with no or mild side effects. Read more here
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As more Johnson & Johnson doses become available in Illinois, marking a third coronavirus vaccine option for residents, can you choose and should you?

According to medical experts, the three vaccines currently available in the U.S., which include the newly-approved Johnson & Johnson vaccine, each offer some level of protection.

Already, Pfizer and Moderna COVID vaccines have been circulating across the U.S., both requiring two shots for full protection.

But according to an analysis by U.S. regulators, Johnson & Johnson’s single-dose vaccine also offers strong protection against severe COVID-19.

Here's a breakdown:

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How effective is each vaccine?

The FDA said J&J’s vaccine offers strong protection against what matters most: serious illness, hospitalizations and death. One dose was 85% protective against the most severe COVID-19 illness, in a massive study that spanned three continents — protection that remained strong even in countries such as South Africa, where the variants of most concern are spreading.

Published results from a mass vaccination campaign in Israel showed Pfizer's vaccine was 92% effective at preventing severe disease after two shots and 62% after one. Its estimated effectiveness for preventing death was 72% two to three weeks after the first shot, a rate that may improve as immunity builds over time. Meanwhile, the Moderna vaccine provides a similar level of protection, 94.1%, and requires two shots, 28 days apart.

It is not known if any of the three vaccines prevent the spread of the virus by people who are asymptomatic.

While the overall effectiveness data may suggest the J&J candidate isn't quite as strong as the two-dose Pfizer and Moderna options, all of the world’s COVID-19 vaccines have been tested differently, making comparisons nearly impossible, CNBC reported.

"If you kind of do a comparison for influenza vaccines, which we do annually, influenza's efficacy can range anywhere from 40% to 60% - and that's a good year," Monica Hendrickson, public health administrator for the Peoria County Health Department said Wednesday. "So again, something that's high public health was, you know, we were hoping for something above 40%. To get to 95%, even 65%, that's a homerun."

Hendrickson noted that the vaccines each hold a high effectiveness against death and severe illness for coronavirus.

"So, really, you're looking at a distinction that from a clinical standpoint, or from, you know, an epidemiological standpoint is very minor compared to what we really are hoping for, which is decreases in death and decreases in severe illness, where they all match up between the three vaccines," Hendrickson said. "Most important thing though is that when these vaccines come on the market, if you have an option to any of these, get one of them."

Hendrickson's message echoes one made by Dr. Marina Del Rios, emergency medicine specialist at the University of Illinois-Chicago, during NBC 5's "Vaccinated State" panel last month.

“Part of my messaging in the community has been that the vaccines on the market are equally efficacious and equally safe," Del Rios said. "The best vaccine you can get is the one that you can get a hold of first, and getting vaccinated earlier, sooner rather than later, protects us from getting sick ourselves and also our community, which has been so terribly devastated by this virus.”

Dr. Arnold Monto of the University of Michigan, who chaired an FDA advisory panel that unanimously voted that the Johnson & Johnson vaccine’s benefits outweigh its risks, said the evidence shows no reason to favor one vaccine over another.

“What people I think are mostly interested in is, is it going to keep me from getting really sick?” Collins said. “Will it keep me from dying from this terrible disease? The good news is all of these say yes to that.”

How are they different?

The Pfizer-BioNTech and Moderna vaccines differ from traditional vaccines in their use of mRNA. Instead of introducing a weakened or an inactivated germ into your body, this vaccine injects mRNA, the genetic material that our cells read to make proteins, into your upper arm muscle. It teaches your body how to make the protein that triggers antibody production so if the real virus later enters your body, your immune system will recognize it, according to the federal Centers for Disease Control and Prevention. 

Unlike the Pfizer and Moderna shots, the J&J and AstraZeneca vaccines use a cold virus, called an adenovirus, to carry the spike gene into the body. J&J uses a human adenovirus to create its vaccine while AstraZeneca uses a chimpanzee version.

J&J’s shot uses a cold virus like a Trojan horse to carry the spike gene into the body, where cells make harmless copies of the protein to prime the immune system in case the real virus comes along. It’s the same technology the company used in making an Ebola vaccine.

The Pfizer and Moderna vaccines must also be kept frozen, while the J&J shot can last three months in the refrigerator, making it easier to handle. AstraZeneca's vaccine, widely used in Europe, Britain and Israel, is made similarly and also requires refrigeration but takes two doses.

What are the side effects for each vaccine?

Like Pfizer and Moderna's COVID-19 vaccines, the main side effects of the J&J shot are pain at the injection site and flu-like fever, fatigue and headache. No study participant experienced the severe allergic reaction, called anaphylaxis, that is a rare risk of some other COVID-19 shots, although one experienced a less serious reaction.

The FDA said there were no serious side effects linked to the vaccine so far, although it recommended further monitoring for blood clots. In the study, those were reported in about 15 vaccine recipients and 10 placebo recipients, not enough of a difference to tell if the vaccine played any role.

Where can you get them in Illinois?

Doses of the Johnson & Johnson vaccine have been shipped to both Illinois and Chicago since its approval.

A new mass vaccination site in suburban Des Plaines became the first large-scale facility to administer the Johnson & Johnson vaccine in Illinois.

Chicago Department of Public Health Commissioner Dr. Allison Arwady said Tuesday that while the city did receive doses following the Johnson & Johnson approval, no shipments have been sent this week and none are expected next week either.

"When you're planning, it can be tricky to sort of know. We're hoping there will be some the week after but there hasn't been," Arwady said. "Our Moderna vaccine has been flat, flat, flat for six weeks right? We've been getting 26,050 first doses of Moderna vaccine to stretch across the entire city every week - first doses. And then our Pfizer has been going up like a little bit."

A new program for homebound residents in Chicago also has paramedics bringing doses of the Johnson & Johnson vaccine to people's homes.

Are there other options?

Additional vaccines from AstraZeneca and Novavax could also be potentially approved in the U.S.

"In addition to the three that have been approved or have been authorized here in the U.S., we're keeping our eye on AstraZeneca," Chicago Department of Public Health Commissioner Dr. Allison Arwady said Thursday. "That is of active use, right? It's already in use in Europe and some other countries and it's been, you know, it's been having its studies here... we'll see. They weren't done yet, but there's been some speculation that, you know, possibly in April we could see that vaccine."

Arwady noted the AstraZeneca vaccine "has performed well broadly," but there was concerns it may not be as effective against the variant that emerged in South Africa.

"There's been some extra attention sort of looking at looking at the vaccine in that context, but it has generally also been a very good vaccine," Arwady said. "And I wouldn't be surprised if we see that one potentially going, you know, getting put before the FDA in April."

Novavax, which is the lesser known of the remaining vaccines, Arwady said, is another one she's monitoring.

"Hundreds of companies have been sort of looking at vaccines, but I'd say Novavax is the other one here in the U.S. and I'm kind of keeping my eye on going further behind in the trials, but their initial data looked good," she said. "Could that be sort of a may for another vaccine? I think possibly."

NBC Chicago/Associated Press
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