A year after doctors identified an outbreak of coronavirus in the Seattle area, a third vaccine is expected to arrive soon to bolster the arsenal against the virus, now responsible for more than 500,000 deaths in the United States.
The new vaccine, which was developed by Johnson & Johnson, could be authorized for emergency use as soon as this weekend and ship nationwide next week. The vaccine could hasten a rollout that has lagged public expectations and has been hampered by supply and distribution problems.
And the Johnson & Johnson vaccine’s key characteristics — that it requires only one dose and remains stable in a refrigerator for long periods of time — could help health officials get it to hard-to-reach groups, such as those experiencing homelessness or maritime workers heading out to sea.
The two vaccines that have received emergency approval in the United States — from Pfizer and Moderna — require two doses.
If the federal Food and Drug Administration greenlights the Johnson & Johnson vaccine for emergency use, Washington state expects to receive next week some 60,900 doses, said Michele Roberts, the Washington state Department of Health’s acting assistant secretary in charge of vaccine rollout.
The federal government also plans to make more doses available directly to community health centers and pharmacies.
How the state will use the new supply of Johnson & Johnson vaccine remains an open question.
“We’re waiting for final guidance before we finalize plans,” Roberts said in a Thursday news briefing.
That guidance will trickle out this weekend and early next week, as independent advisers to the federal government assess data from the vaccine’s clinical trials and debate how best to put it to work.
First, an advisory committee to the FDA will meet Friday and vote on whether the vaccine is safe and effective. A separate committee advising the Centers for Disease Control and Prevention (CDC) will outline a general strategy for use of the vaccine, which state leaders can adopt at their discretion.
Data released by FDA officials Wednesday provides some insight.
Overall, the vaccine had a 72% efficacy rate during its clinical trial in the United States and evidence suggests the vaccine is safe and causes only mild side effects.
In South Africa, where a highly contagious coronavirus variant is driving cases, the efficacy was 64%. Health officials earlier this week announced that the same concerning variant had been discovered in Washington state.
While the Johnson & Johnson vaccine’s overall efficacy is lower than the Moderna and Pfizer mRNA vaccines, which both tout efficacy figures near 95%, the most important metric is how well it prevents severe disease and death, said Lisa Jackson, of Kaiser Permanente Washington Health Research Institute.
On that score, the Johnson & Johnson vaccine’s performance was an impressive 85% and there were no deaths among trial participants who got the shot.
“You want to prevent people winding up in the hospital,” Jackson said. “You might have more mild cases, but that is less consequential for the individual and for society.”
With new variants spreading at an unknown rate in the U.S., the pandemic is at a critical and uncertain point, said Janet Baseman, a professor in the department of epidemiology at the University of Washington.
The best way to bring it under control is to vaccinate as many people as quickly as possible.
“The more coverage we have and the less spread we have, it minimizes the impact of the variants,” Baseman said. Making it harder for the virus to spread and infect new people will also make it harder for new variants to develop, she added.
“We need multiple vaccines in our tool kit because of these variants,” she said. So far, the Johnson & Johnson vaccine is the only one shown to also be highly effective against the variant dominant in South Africa, Baseman pointed out.
Vaccine has unique attributes
For vaccine providers, the Johnson & Johnson vaccine is attractive because it’s a one-shot regimen and its vials, which store five doses, can be stored easily in the refrigerator for several months, if necessary.
Perhaps most important, for health organizations that have seen orders denied for lack of supply, it will boost the number of doses available.
“Our biggest challenge is getting vaccine,” said Dr. Meena Mital, chief medical officer of Neighborcare Health, which serves low-income and uninsured people, sharing a sentiment common among community health centers.
Nationwide, the federal government expects to ship more than 2 million doses next week, and capacity should open up later this spring. Johnson & Johnson is slated to deliver 100 million doses by the end of June.
Alix Van Hollebeke, the nursing director for Downtown Emergency Services Center (DESC), one of Seattle’s biggest homeless shelters and supportive housing providers, said she was “thrilled” to hear Johnson & Johnson’s vaccine could soon be available, saying it was difficult to reach people experiencing homelessness not only once, but twice, for vaccination.
“People move around as encampments are cleared or people go to a shelter for extreme weather. We just can’t guarantee that we can find them again,” Van Hollebeke said.
Teresita Batayola, the president and CEO of International Community Health Services (ICHS), said some patients vaccinated at the community health clinic have not returned for second doses.
Batayola said ICHS is not focusing on mass vaccinations, instead working to ensure people of color, refugees and immigrants have low-barrier access to vaccines. The organization calls and texts patients directly to inform them of vaccination opportunities or remind them of second dose appointments.
A single shot would simplify that process, Batayola said, and free up time to vaccinate others.
Dr. Jennifer Kreidler-Moss, CEO of Peninsula Community Health Services, which serves Kitsap and Mason counties, said the relatively straightforward handling and storage requirements for Johnson & Johnson’s vaccine could allow more mobile clinics or pop-up vaccination events in hard-to-reach communities.
And as restrictions ease, Kreidler-Moss sees opportunity for vaccine providers trying to reach people who won’t go out of their way for a shot.
“Being able to go out and go to a soccer tournament and put out a sandwich board that says: ‘Free shot J&J,’ — that would be a good way to reach a population,” Kreidler-Moss said.
State officials in the Thursday media briefing said they had preliminary discussions about groups that could benefit from the Johnson & Johnson vaccine.
State epidemiologist Dr. Scott Lindquist called it “an ideal vaccine” for members of the maritime or fishing industries, where people live in tight quarters and where receiving a second dose can take complicated logistics.
“We have to send the second dose onward to what is their next port of call,” Lindquist said.
Lindquist added that seasonal farmworkers could benefit from the one-shot regimen, too. These workers often live in group housing near the farms where they work. Many of these workers will arrive this spring.
Because hospitals are best equipped to handle the vaccines with more complicated cold-storage requirements, they do not expect to receive much Johnson & Johnson vaccine, according to Cassie Sauer, of the Washington State Hospital Association.
Equity of vaccine rollout
Nationwide, communities of color have been disproportionately impacted by the coronavirus. Washington officials, since they began planning for vaccination, have wanted equity to be at the center of the state’s rollout.
The first stages of the vaccine rollout prioritized health workers and Washington residents over 65, who are predominantly white.
The disparities are less stark when accounting for age, but gaps have opened, showing that vaccination lags in Black and Hispanic communities. At times, getting vaccinated has come down to who has access to transportation, technology and language to navigate a confusing system.
Now, a new vaccine with different characteristics, and public perception, adds an additional layer of complexity for state officials to consider.
For example, farmworkers and people experiencing homelessness, who might be well-served by the speed and handling ease of Johnson & Johnson’s shot, are more racially diverse.
Perspectives differ among vaccine providers and groups serving diverse communities over the differences between vaccines and how much they matter.
Van Hollebeke said DESC can’t store Pfizer, and if it were available next week, she’d consider ordering Johnson & Johnson over Moderna.
But for Mital, of Neighborcare, which has had success getting people to return for second doses, the choice was more complex.
“The single shot is not the end of the story, Mital said. “Getting COVID, for our patient populations, means they can’t work, which has a devastating impact on people. Many of our patients are front-line, essential workers.”
For Batayola, the bottom line was that Johnson & Johnson offered strong protection against severe disease and death.
“Communities of color, immigrants and refugees — our populations have taken disproportionate impact from COVID-19. We want them protected sooner rather than later,” Batayola said.
Jiquanda Nelson, the vice president of the African American Health Board, an organization working on COVID-19 vaccine outreach and coordinating community events, said her organization’s first mission was to provide enough information for people to make an informed choice. Preferring one vaccine over another was less of a concern.
Louis Shackelford, a member of the board who also works at the COVID-19 Prevention Network, said he knew some might view the vaccine’s efficacy numbers as less desirable, but that focus should remain on the vaccine’s effectiveness at preventing severe disease COVID-19 and death.
“The Johnson & Johnson vaccine — it’s another opportunity for us to save the lives of those most impacted,” Schackleford said. “I echo — [presidential health adviser] Dr. Fauci’s recommendation — you should get the vaccine that’s available.”