Using the New Johnson & Johnson Covid-19 Vaccine to Create Equity and Trust

The Food and Drug Administration’s recent approval of Johnson & Johnson’s Covid-19 vaccine for emergency use in the United States is wonderful and welcome news. Its addition dramatically increases the likelihood that all adults will have a chance to be vaccinated before this summer — but only if people are willing to accept any of the three available vaccines.

That will happen only if people trust that the different vaccines are being distributed fairly.

To recap: The FDA has granted emergency use authorization to three Covid-19 vaccines. The first was for a vaccine developed by a partnership between Pfizer and BioNTech, soon followed by one developed by Moderna. The Johnson & Johnson vaccine makes three. The Pfizer/BioNTech and Moderna mRNA vaccines, both of which require two doses spaced a few weeks apart, initially needed to be stored at ultra-cold temperatures, though this has recently been eased. The Johnson & Johnson vaccine, which isn’t mRNA-based, requires just a single dose and has long-term stability at refrigerator temperatures.The features of the newly authorized vaccine will increase the efficiency of immunization programs. From an equity perspective, these same features could also help address many vaccine roadblocks, such as resource constraints in the health care system and geographic barriers to health care access, that have been identified in indices such as the Covid-19 Vaccine Coverage Index.

Before the ink was dry on the FDA authorization, news reports about differences between the Johnson & Johnson vaccine and the vaccines developed by Pfizer/BioNTech and Moderna began to circulate, fueling concerns that the Johnson & Johnson vaccine might be inferior. Although the J&J vaccine offered complete protection against hospitalization and death in the U.S. trial, rivaling that of the Moderna and Pfizer/BioNTech vaccines, it showed somewhat lower protection against less-severe disease.

While these differences are difficult to interpret because of differences in timing and in definition of outcomes between the trials conducted to test each of the vaccines, they have been enough to cause concern among some people.

People of color, as well as low-income and rural Americans, live in communities where roadblocks to vaccination are most prevalent. Using only one type of vaccine when three are available may create suspicion in these communities, especially when that vaccine is wrongly perceived as second-class.

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