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nwhikerThe Johnson & Johnson vaccine efficacy numbers are out and I have some thoughts. Because I always have some thoughts. That doesn't mean that any of these thoughts are good thoughts.
To recap:
-- One dose
-- Easy to meet storage requirements
-- 66% effective in preventing moderate to severe disease (72% in the US)
-- 85% effective at preventing hospitalization and death.
Some thoughts, that I've tried to divide up via broad topic.
The science and my concerns about this type of vaccine
First let me preface this by stating that I am not a doctor, not an immunologist, and not a virus expert. TBC.
I do remember, however, the late 90s and the first (?) gene therapy trial that killed a young man, as an adenovirus wreaked havoc with his immune system. My understanding is that the one used to deliver the DNA payload to the macrophage's nucleus is not supposed to be able to reproduce. As dh said, neither were the dinosaurs in Jurassic Park. Seriously, though, what happens when the vaccine adenovirus meets the simple common cold adenovirus? Will there be problems. My concern is that this vaccine mechanism was developed for Ebola, and while it was tested, it's kinda not the large scale deployment that we're going to see here.
The mRNA vaccines, I feel, are safe. This is different. I don't trust virus at all. :P
I'm willing to be convinced, but so far I'm not seeing a lot of discussion at the lay person level about potential risks. This concerns me as well.
Equitable distribution
This. Is. Going. To. Be. A. Mess.
Why?
Because J&J vaccine doesn't require a booster, and is thus probably going to be targetted at group who are either perceived as non-compliant or who are non-compliant. That percieved? Is going to be BIPOC. So unless we're careful, the least effective vaccine is going to be given to the most vulnerable. This is not acceptable.
Replace BIPOC with disabled people, poor people, prisoners (*). Replace lack of booster with need of -80C or -4C.
There is going to be pressure... well, not pressure... but it's going to be easier to target the mRNA vaccines to wealthier areas in bigger cities.
And I am not even going to touch on what that means for rich vs poor vs developing countries. Are we going to shunt all the J&J and maybe Astra Zeneca vaccine to them, and hoard the Pfizer and Moderna jabs for us... and again, not just 'us' but the wealthier segment of us.
And to be clear, this is just talking about equitable distribution in the context of a one-dose-vs-two-dose and shelf-stable-vs-freezer-needed context. There is a whole kettle of nasty goo bubbling about equitable vaccine distribution absent this split in effectiveness between the mRNA vaccines and J&J already. The large discrepancy on how good these vaccines are is going to complicate what was already complicated.
(*) This is one group where it might make sense to target them with the no booster shot: because if they are released during the waiting period, they don't get that second shot until their time comes up in their states priority list. So eh.
The implication of lower efficacy
OK, people. Time to talk about long term Covid. Which appears to be real, unlike chronic Lyme disease. :P It's hard to know what the down the road picture is going to look like (chickenpox and shingles, anyone?) but one thing is emerging: people who end up with long term Covid appear to be mostly people who've had a mild disease course. So while the numbers of the J&J vaccine look good for preventing hospitalization and death, what are their implication for long term Covid? Do we, as a side effect, create more long term cases? We don't know. We just don't know.
Corollary to this is just the fact that we don't know the long term effects of this damn virus, it's only just recently feted its first birthday. Ten years from now, are we going to have a spike in heart attacks from blood clots in heart veins? Or a sudden number of young people with failing kidneys? Or, I dunno, some weird ass lung complication? We. Just. Do. Not. Know. Which means avoiding catching it is critical (wear a mask, or two!) and that we need to be cognizant of the difference in vaccine efficacy which may lead to more, less, different, or no consequences down the road.
Bitching about MDs and other medical professionals on Twitter
1. The complete and utter cluelessness about medical people on Twitter saying "Take whichever vaccine you can get! 66% isn't bad!" when they've gotten the 95% effective shot is, well, tone deaf. At least acknowledge that for the unwashed masses looking at this data, an vaccine that is almost 1/3 less effective is a pretty big deal.
2. 66% only seems bad because of how awesome the mRNA vaccines are, usually followed by "And the flu shot is only 40-60% effective!" WTF? While I'd not be thrilled to get the flu after a flu shot, the implications of the flu for long term health issues are very different from Covid-19. I'm seeing a lot of disingenuous reactions.
So there. My current musings.
To recap:
-- One dose
-- Easy to meet storage requirements
-- 66% effective in preventing moderate to severe disease (72% in the US)
-- 85% effective at preventing hospitalization and death.
Some thoughts, that I've tried to divide up via broad topic.
The science and my concerns about this type of vaccine
First let me preface this by stating that I am not a doctor, not an immunologist, and not a virus expert. TBC.
I do remember, however, the late 90s and the first (?) gene therapy trial that killed a young man, as an adenovirus wreaked havoc with his immune system. My understanding is that the one used to deliver the DNA payload to the macrophage's nucleus is not supposed to be able to reproduce. As dh said, neither were the dinosaurs in Jurassic Park. Seriously, though, what happens when the vaccine adenovirus meets the simple common cold adenovirus? Will there be problems. My concern is that this vaccine mechanism was developed for Ebola, and while it was tested, it's kinda not the large scale deployment that we're going to see here.
The mRNA vaccines, I feel, are safe. This is different. I don't trust virus at all. :P
I'm willing to be convinced, but so far I'm not seeing a lot of discussion at the lay person level about potential risks. This concerns me as well.
Equitable distribution
This. Is. Going. To. Be. A. Mess.
Why?
Because J&J vaccine doesn't require a booster, and is thus probably going to be targetted at group who are either perceived as non-compliant or who are non-compliant. That percieved? Is going to be BIPOC. So unless we're careful, the least effective vaccine is going to be given to the most vulnerable. This is not acceptable.
Replace BIPOC with disabled people, poor people, prisoners (*). Replace lack of booster with need of -80C or -4C.
There is going to be pressure... well, not pressure... but it's going to be easier to target the mRNA vaccines to wealthier areas in bigger cities.
And I am not even going to touch on what that means for rich vs poor vs developing countries. Are we going to shunt all the J&J and maybe Astra Zeneca vaccine to them, and hoard the Pfizer and Moderna jabs for us... and again, not just 'us' but the wealthier segment of us.
And to be clear, this is just talking about equitable distribution in the context of a one-dose-vs-two-dose and shelf-stable-vs-freezer-needed context. There is a whole kettle of nasty goo bubbling about equitable vaccine distribution absent this split in effectiveness between the mRNA vaccines and J&J already. The large discrepancy on how good these vaccines are is going to complicate what was already complicated.
(*) This is one group where it might make sense to target them with the no booster shot: because if they are released during the waiting period, they don't get that second shot until their time comes up in their states priority list. So eh.
The implication of lower efficacy
OK, people. Time to talk about long term Covid. Which appears to be real, unlike chronic Lyme disease. :P It's hard to know what the down the road picture is going to look like (chickenpox and shingles, anyone?) but one thing is emerging: people who end up with long term Covid appear to be mostly people who've had a mild disease course. So while the numbers of the J&J vaccine look good for preventing hospitalization and death, what are their implication for long term Covid? Do we, as a side effect, create more long term cases? We don't know. We just don't know.
Corollary to this is just the fact that we don't know the long term effects of this damn virus, it's only just recently feted its first birthday. Ten years from now, are we going to have a spike in heart attacks from blood clots in heart veins? Or a sudden number of young people with failing kidneys? Or, I dunno, some weird ass lung complication? We. Just. Do. Not. Know. Which means avoiding catching it is critical (wear a mask, or two!) and that we need to be cognizant of the difference in vaccine efficacy which may lead to more, less, different, or no consequences down the road.
Bitching about MDs and other medical professionals on Twitter
1. The complete and utter cluelessness about medical people on Twitter saying "Take whichever vaccine you can get! 66% isn't bad!" when they've gotten the 95% effective shot is, well, tone deaf. At least acknowledge that for the unwashed masses looking at this data, an vaccine that is almost 1/3 less effective is a pretty big deal.
2. 66% only seems bad because of how awesome the mRNA vaccines are, usually followed by "And the flu shot is only 40-60% effective!" WTF? While I'd not be thrilled to get the flu after a flu shot, the implications of the flu for long term health issues are very different from Covid-19. I'm seeing a lot of disingenuous reactions.
So there. My current musings.
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