17 million Americans received the Johnson & Johnson Covid vaccine, only to be told later that it was the least protective of the options available in the United States. New data shows that the vaccine is preventing infections, hospitalizations and deaths as well as the Pfizer-BioNTech and Moderna vaccines.
Some experts are not convinced that the vaccine has vindicated itself. The vaccine's deployment in parts of the world could be affected by the accumulating data.
Distribution of a single-dose vaccine that can be refrigerated for months is the most practical option in Africa.
The only plant that makes usable batches of the vaccine is temporarily shut down by Johnson. South Africa's Aspen pharmacare is going to be able to supply large quantities to the rest of Africa. Only 13 percent of Africans are fully vaccineed, and only 1 percent have received a booster dose.
Linda Gail-Bekker said that the single dose is very exciting because of the need to quickly get vaccines out.
The ease of delivery and mild side effects of the Johnson & Johnson vaccine made it an attractive option for communities with limited access to health care. It has had a difficult journey.
The single-dose vaccine seemed to produce a weaker initial immune response than the two-dose vaccine, and more people who got the vaccine had breakthrough infections.
The distribution of the J.&J. vaccine was stopped in the United States and South Africa in April as health officials looked into reports of a rare blood-clotting disorder in women. The vaccine's reputation was never fully recovered after both countries resumed the roll out.
The idea that the vaccine is inferior has grown out of date, according to experts.
Dr. Gail-Bekker said that J.J. has been kind of lowered in people's minds. It punches above its weight for a single-dose vaccine.
The data from the C.D.C. showed that the Moderna vaccine resulted in the lowest rates of breakthrough infections, with Pfizer-BioNTech in the middle.
The gaps between J.&J. and Pfizer began to narrow during the summer months. By now, all the vaccines seem to be performing well against coronaviruses; in fact, Johnson & Johnson appears to be holding up slightly better.
Unvaccinated people were more likely to become infections than people who received a single dose of the Johnson & Johnson vaccine, and more likely than people who received two doses of the Moderna vaccine. The Johnson vaccine appeared to be more protective against infections than the other two alternatives.
The vaccines all appeared to have the same effectiveness against infections among Americans who got booster doses. The data does not indicate who received which type of booster shot, but a booster shot did not add much to Johnson and Johnson's previous level of protection.
67 percent of the population was collected by the C.D.C.
The company said that the C.D.C. data adds to the growing body of evidence that the Covid-19 vaccine protects against breakthrough infections.
The findings show that the J.&J. vaccine should be looked at more closely.
He said that the vaccine platform may have some surprising characteristics. The data is interesting and we should spend more time understanding it.
The results jive with his experience in H.I.V. research with the adenoviruses that forms the backbone of the Johnson & Johnson vaccine.
The vaccine's profile is improving with time.
In the first few weeks after immunization, the levels of antibodies go up, but then go down quickly. Some research suggests that the J.&J. vaccine may be able to slow down the decline of antibodies. The biological phenomenon of affinity maturation may lead to the development of more sophisticated antibodies.
The vaccine may have offered a more robust defense against the Omicron variant, which may have caused the huge increase in infections over the past few months. Studies show that the vaccine trains other parts of the immune system as well as the other two vaccines.
Some people are not convinced that the Johnson vaccine is catching up. Natalie Dean said that it may only appear to be effective now because many recipients got breakthrough infections early on.
The rate of infections is lower among people who did not get a booster for the vaccine. The death rate is slightly higher among those who got the Pfizer-BioNTech and Moderna vaccines.
The differences are small and disappear among those who got booster shots. The C.D.C.'s statistics on deaths only last through January, and the Johnson & Johnson vaccine's edge may only become apparent in data from February or March.
Deaths tend to lag infections because many deaths are after long hospital stays.
Dr. Dean would like to see data with information on individual factors, like prior infections and other high-risk conditions, rather than the age-adjusted overall numbers provided by the C.D.C.
She said that it was a shame that we didn't have more direct study of outcomes among people who received J. She said that fewer people got the vaccine because we were relying on other countries to generate data.
The information came from South Africa. In one trial, Dr. Gail-Bekker and her colleagues evaluated one dose of the Johnson & Johnson vaccine in half a million health care workers and 240,000 individuals.
The researchers matched the recipients with a control group based on age, sex, risk factors and prior Covid infections. When the Delta variant was the most popular in the country, they found that the vaccine had an effectiveness of about 67 percent against hospitalization and about 81 percent against death. The protection against the Beta variant was the same.
Dr. Gail-Bekker said that the single dose worked well for severe disease and death.
The researchers offered a booster of the vaccine to the participants when the Omicron variant began to circulate in South Africa. Only half of them agreed.
Dr. Gail-Bekker said it was extraordinary. She recalled that there was a feeling that Pfizer-bioNTech and Moderna vaccines were superior.
The Omicron variant of the J.&J. vaccine had an effectiveness of about 75 percent against hospitalization, which is comparable to the protection from the Pfizer-BioNTech vaccine. The findings were presented last month at the Conference on Retroviruses and Opportunistic Infections.
The trial only looked at people who got two doses of the Johnson & Johnson vaccine, but it suggests that the vaccine may be an excellent booster for people who initially got two doses of the vaccine.
In December, the C.D.C. recommended the vaccine over Johnson and Johnson because of the risk of rare side effects. The agency found that women ages 30 to 39 had the highest incidence of blood clot, at 11 per million.
The side effects of the vaccines have been rare. They are thought to cause about 11 cases of myocarditis for every 100,000 males who have been vaccined.
Dr. Dean said that more data on different combinations of vaccines may clarify which is the most effective in the long term. Some vaccines may have an edge over others because of the arrival of new variant.
She said that she keeps an open mind about what could be the best vaccine regimen for the future.
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