By Jacob Derin
Dr. Anthony Fauci has a consistent response whenever he’s asked the question, “Which of the COVID-19 vaccines is best?” He says that he’d take whichever vaccine was offered to him. You might notice, however, that this doesn’t actually answer the question.
Dr. Fauci has been in a very difficult position since the start of the pandemic, having worked under an overtly hostile administration and being caught between the roles of scientist and public communicator. He knows that his every word is scrutinized by political actors and the public at large. At a time when so many are suffering from the very public health disaster he’s spent his entire life working to avoid, he must be excruciatingly aware of the damage he could do with an incautious statement.
However, Dr. Fauci’s failure to level with people on this front might be doing more harm than good. It hasn’t been lost on anyone that the clinical trials from the new Johnson and Johnson vaccine returned significantly lower efficacy numbers than the Pfizer and Moderna versions. Even though all of the vaccines are essentially perfectly effective at preventing hospitalizations and deaths, the clinical data does not support the assertion that they’re equally effective in all respects; critically, it doesn’t imply that they are all equally effective at preventing infection.
Undoubtedly, some of this has to do with the fact that the Johnson and Johnson vaccine was tested in an environment where the new mutations of SARS-COV2 are spreading. However, the gap between the Pfizer/Moderna and Johnson and Johnson numbers is big enough to throw doubt on the claim that all of it can be explained by this fact. In fact, it would be surprising to learn that they were all equally effective, given that they don’t even work the same way in the human body.
From a public messaging standpoint, Dr. Fauci is right to encourage people to take whichever vaccine they can get their hands on. We need as many people vaccinated as quickly as possible. The death rate is still unacceptably high.
However, there are practical and ethical implications to the fact that the vaccines aren’t equally effective. The Johnson and Johnson vaccine only requires one dose, making it a natural choice for homeless people, immigrants and others who might be difficult to track down for a second dose. But, if it turns out that the Johnson and Johnson vaccine is less effective than the others, we would be placing the homeless and immigrant populations at higher risk of contracting and spreading the virus.
This isn’t only an ethical problem but a serious practical issue. Much has been made of the concept of “herd immunity” against COVID-19. Dr. Fauci has said that as much as 85 percent of the population needs to be vaccinated to reach herd immunity. However, that number may well be even higher as more infectious variants of SARS-COV2 continue to emerge and spread.
With an already large number of people skeptical about the vaccine, it was always a big question whether that was an attainable goal. If the Johnson and Johnson vaccine is significantly less effective than the Pfizer and Moderna versions and all the vaccines are less effective against the new mutations, we may not reach herd immunity even with 100 percent vaccination.
There are solutions to all of these problems, including booster shots to deal with new mutations or, possibly, a second dose of the Johnson and Johnson vaccine. But, to reach those solutions, we have to understand the problem properly.
Dr. Fauci needs to trust the public enough to tell them the truth. I would much rather he tell people that the vaccines are not all equally effective but that you should still accept whichever one you can get. People may misinterpret his words or purposefully twist them, but that’s an occupational hazard as a public communicator of science.
Jacob Derin is a third-year English and Philosophy major at UC Davis.
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As I recall, there was an earlier controversy in regard to masks. In that some knew they were effective, but didn’t want to share that information with the public at that time because it would create shortages for front-line workers. And therefore downplayed their effectiveness.
And yet, I’ve rarely seen this discussed, except for a brief period of time afterward.
This type of thing does not foster trust.
Maybe officials should just tell us the truth, the whole truth, and nothing but the truth (as they understand it) – and let the toilet paper shortages commence (which they do, anyway). 😉
Jacob,
Thanks for another really interesting perspective. I agree with many of your points, but disagree with your conclusion that Dr. Fauci is not telling the “truth”. This implies that there is a single, one size fits all answer to the question of which vaccine is best.
I would suggest that this is inaccurate. As a clinician, I am all too aware that the answer to the question “which intervention is best” is frequently, it depends. Often the answer boils down to the “best” intervention being the one the patient both can and will do. There are going to be a small subset of people who will not return for a second shot ( needle phobia or fear of second shot symptoms) as well as logistics may play a role. For them, J&J may be “the best” vaccine whereas for the majority Pfizer or Moderna may be more desirable. Like with masks, people are seeking absolutes in a situation of constant change. Understandable, but not consistent with our current situation.
I appreciate what you’re saying, and I did say in this piece that if you’re offered the J and J shot that you should take it. However, the data do suggest that it is less effective against mild disease:
https://www.ucsf.edu/news/2021/03/420071/how-effective-johnson-johnson-covid-19-vaccine-heres-what-you-should-know
We still don’t know how well the vaccines prevent transmission, and if those mild cases still include transmitting people, reaching herd immunity may be harder with the J and J shot. In addition, as I noted, there are ethical issues with giving certain populations a less effective vaccine. Also, without herd immunity the immunocompromised and others who can’t take the vaccine will still be at risk.
True are written… Fauci, and many others, have not claimed that… the claim is that they are equally effective in minimizing severe symptoms requiring hospitalizations, and/or leading to death… none claim you won’t get Covid, but it will be manageable/survivable… that is huge progress… Fauci and others have no problem getting ill… they just want to avoid hospitalizations and deaths…
No magic wands claiming you won’t get ill…
Not sure your comment is that accurate.
For example: “ Based on evidence from clinical trials, the Moderna vaccine was 94.1% effective at preventing laboratory-confirmed COVID-19 illness in people who received two doses who had no evidence of being previously infected.”
Granted that’s not 100 percent, but 94% effective is fairly strong. Not sure what other vaccines promise.
From the CDC website. The bolding of the words “between 40% and 60%” was added by me.
You conflate the difference between getting ill, and becoming seriously ill, and/or dying… big diff…
Before ANY vaccines were out, our son tested positive, twice, spent 14 days in isolation, had fairly mild/moderate cold/flu symptoms, later tested negative… and he is tested regularly (once every 2 weeks)…
Re-read Robb Davis’ post… it’s his field…
I’d say that is a pretty accurate assessment of where we are… better to get a shot that is reported as as being 65% effective, than no shot at all (basic logic, good biology, good math)… a second shot of a 65% effective vaccine, brings you up ~ 88% effective… where the best 2-shot regime, is 94% effective… nota big diff given what we know of all the variables… simple math and statistics…
And there is insufficient data to know how long ANY vaccine is effective, particularly with emerging mutations/variants… anyone not choosing to get vaccinated until the vaccine offered to them is 94% on a one shot regime, they are fools, and a danger to all of ‘the herd’…
They can always get a second shot…
I think there is broad agreement on the first phrase here. The second, however, has no basis (so far) in any evidence. The writer is simply in no position to make the statement.
Keep in mind that ALL the vaccines currently approved for use in the US are so approved under emergency authorization. This means that they are still being evaluated concerning many factors, not the least of which is their efficacy against emerging variants, as well as the duration of their protection.
The science around the virus and the vaccines has moved forward at speeds that are astonishing by any historical standard. But our understanding of these things as well as how to best protect people from the virus’ spread is STILL proceeding by the tools of science which is about the assembling of evidence in a systematic way and, thereby, being cautious about being overly precise about what needs to be done.
Those who would denigrate the response—and especially communication around recommended practices—have used this reality about the assembly of evidence to cast aspersions on the entire process. I am not suggesting that communication about the virus has been without problem nor that public health practitioners—of which I am one—have not bungled the message at times. We have.
But we are still learning about this virus, we are still learning about the vaccines, and as evidence emerges we will use it to promote public health and safety to the best of our ability.
Just two final points: 1) early recommendations concerning masks had more to do with our understanding of their efficacy and THAT is what drove the early recommendations. While it is true that there was concern about PPE for health care workers, it was not immediately clear how homemade face coverings could play a role in stemming the spread. When that was understood, Fauci and others immediately began to promote their use. 2) my wife of nearly 40 years, with a pre-existing condition, received the J&J vaccine one week ago. We were thankful and had zero concern that it was “less effective” or in some way inferior. It could very well save her life and it may (though I have no basis for suggesting it will), provide longer lasting protection than the Pfizer vaccine for which I will receive my second dose this week.
Seems to me (based upon recollection) that they understood pretty-early on that the disease was spread through air. (I think there’s an early video of Trump acknowledging that.)
The reason that they did not immediately assume that asymptomatic people may be spreading the disease is unclear, to me. Nor is it clear to me why front-line workers would need masks, if there was little risk.
A Google search (“did Fauci lie about masks”) turns up quite a few results, mostly defending him. But I don’t think that comments like this helped confirm credibility:
Of course, this all got wrapped-up into politics/conflicts with the Trump administration, as well. Which also muddled the message.
https://www.businessinsider.com/fauci-doesnt-regret-advising-against-masks-early-in-pandemic-2020-7
The J&J numbers in the US study were about 72% efficacy at preventing infection. I’m open to the possibility that the entire gap between that and the 94-95% efficacy numbers from Pfizer/Moderna is due to the new mutations. However it seems unlikely.
As I noted, the vaccines have different biological mechanisms of action, and the J&J shot only requires one dose. It would be surprising to learn that they were equally efficacious.
Also, when the trials were conducted, the new variants probably hadn’t spread far enough in the US to make the difference. As of March 3, we’ve confirmed about 2,500 cases of the UK variant and 65 cases of the South African variant. The J and J trial concluded in late February.
Nothing in science is certain. Perhaps we’re undercounting the variants, or ignoring other factors. But the evidence seems, to me, to point to a lower efficacy of the J and J vaccine.
Ok Jacob, do the math… if J&J is @ 72% @ one dose, should be ~96% @ 2 doses (Pfizer/Moderna is @ 94-95%?))… simple math… they (CDC/FDA) are considering precisely that…
But 72% efficacy is still much better than no shot… you seem not to acknowledge that… if 100% of folk go a single shot of J&J, that would be real close to the 80% ‘immunity’ sought…
You are comparing a two-shot regime to a one shot… how can you compare the two as to efficacy? A one-shot regime for Pfizer/Moderna would be the right comparison to a 1 shot J&J…
Don’t know where that fits with English and Philosophy… but it is certainly not science nor math…
It’s an open question whether or not a second dose of J and J confers greater immunity. You can’t simply assume the effects would be cumulative without seeing clinical results. If you read my article carefully I suggested a 2 dose regimen of J and J as a possible solution and linked to an article examining that possibility. I also said
I would much rather he tell people that the vaccines are not all equally effective but that you should still accept whichever one you can get.
I think that you should take the J and J vaccine if it’s offered, but that its lower efficacy matters.
Your recollection ain’t so good… people wiping down/sterilizing every doorknob, every pushcart, etc., every time anyone touched anything, was de rigeur for months… some stores/businesses still do that out of an abundance of caution… or fear of liability suits…
Folk were warned not to touch face with hands, do “elbow-bumps”… Fauci correctly pointed out that masks do not protect YOU from others… they protect others from you…
In the first month or two, when No One knew how it was transmitted, it was considered a primary mode of transmission… to the extent masks were proposed, it was considered protecting you from others…
The RIGHT answer is to self-isolate if you have a temp, particularly if you are sneezing or coughing, washing hands, wear masks to protect others from you, and wiping down commonly used surfaces from time to time (at least daily)… and, since you brought up Trump, don’t go the Mira-Lago Resort for at least 21 days… after they have time to ‘sanitize’… and better screen guests and workers…
And, since you brought up Trump, look at his, his campaign’s record as to no masks, no distancing, at rallies (into October), press conferences, Mira Lago resort practices, and how many later tested positive, after attending those venues… even he felt ill in August/Sept, and while at Walter Reed, he ‘toured’ his fan base with no mask, so no protection for his masked drivers… so ‘the Donald’ KNEW at those points… no change in behavior, up to last week…
The Donald, and his minions, knew/should have known that this was not good… but they persisted, because it was all false science, false news (“knews”?)
Seems to me that you’re the one with the “faulty memory”. Listen to the first few seconds of this, as that’s all it takes – in reference to February of last year.
This didn’t take long to find.
If Trump knew, it’s reasonable to assume that Fauci and others did, as well. Who do you think advised Trump?
https://www.youtube.com/watch?v=gBwwgMj-ewI
Seems to me that this is actually a pretty easy question to answer (in light of the information already known), which I believe is the point of the article.
Clearly, the two-shot regimens provide more protection. Is he afraid to say that?
Seems to me that this (once again) demonstrates a lack of faith in the public. (Whether or not that belief is misplaced is a different issue.)
All I can tell you is that I’m going to keep a permanent stockpile of toilet paper on hand, for the rest of my life. 🙂
Each of these statements is speculation on your part and say nothing to the long-term effectiveness of any of the vaccines—against emerging variants or simply in protectiveness over time. Tests are still ongoing to determine the effect of a second J&J dose or a booster. Also, we need to see what happens after several months. J&J was tested in South Africa when the B.1.351 was circulating widely there according to highly regarded science writer Helen Branswell. The US has lagged South Africa and other countries in testing for variants (just as the US has lagged in testing overall).
Branswell wrote in February and, I believe it is still the case:
As you rightly recommend, people should get the J&J if offered. I just wish we could all be a bit more patient to allow a fuller picture of the effectiveness (real world not an RCT setting) of these vaccines.
One final note, you called out, in particular, homeless individuals in your piece. I can say from direct experience with this population that having a one-dose vaccine for these folks—who are more mobile and more difficult to reach for a variety of reasons than housed individuals—is a real advantage. I am more concerned about them getting nothing at all or not getting a second dose of a two-dose vaccine.
I wouldn’t say that those are speculative statements; they’re based on evidence. As I noted above
I don’t phrase them as absolute statements because in science nothing is certain, not even our best models of the universe. But that evidence does seem to support the assertion that the J and J vaccine is less effective at preventing mild to moderate disease:
https://www.ucsf.edu/news/2021/03/420071/how-effective-johnson-johnson-covid-19
I don’t disagree with you about homeless people getting the vaccine. The J and J shot is a better alternative to no shot. But, if the Pfizer and Moderna vaccines are better alternatives this needs to be acknowledged so that we can factor it in to our considerations.
It’s perfectly reasonable to say that the J and J shot is a good choice for the homeless even though it’s less effective because it might be hard to deliver a second dose. But it’s not reasonable to say that it’s a good choice because there are no differences between the vaccines.
As for a second J and J shot, the trials are ongoing. That’s why I said we should consider it as a possibility not absolutely commit to it.
The asymptomatic infection and transmission question is a big one. There is evidence from Israel tending towards the assertion that the Pfizer and Moderna vaccines precent transmission, but we don’t know for sure. It matters a lot for herd immunity calculations, as does the efficacy of the J and J shot against mild to moderate illness.
I have read that the J&J vaccine may have come up as less effective in trials because it was tested during a big surge where as Pfizer and Moderna were not. That would mean that individuals receiving the J&J during trial would have had more instances of exposure to C-19 than would have occurred at other times.
It’s certainly possible, but the Pfizer/Moderna numbers seem to have scaled well in Israel where a large majority of the population is now vaccinated.