There was some good news about a week ago about COVID-19 vaccines when the Johnson & Johnson vaccine was granted emergency use authorization (EUA) by the FDA. So now we have three effective vaccines from three different companies against COVID-19. The news got better two days ago, when news stories reported that Merck will team up with J&J to manufacture the new COVID-19 vaccine. I say this is all good news, because anything that makes available a larger supply of safe and effective COVID-19 vaccines is a good thing and important for helping to end the pandemic.
Unfortunately, with the rollout of the J&J vaccine, to add to the Moderna and Pfizer/BioNTech vaccines already being distributed under EUA has also come the rollout of unhelpful messages not coming from antivaccine activists. It’s bad enough to have to combat antivaccine disinformation in a pandemic, just as safe and effective vaccines are finding their way into more and more arms, but when messaging that is—shall we say?—unhelpful is coming from sources viewed as authorities (albeit not medical authorities) that makes it harder to combat.
Detroit Mayor Mike Duggan’s “only the best for Detroiters” message is not just unhelpful, but could fuel suspicion of the J&J vaccine
Much of the unhelpful messaging is based on differences between the J&J vaccine and the COVID-19 vaccines by Moderna and Pfizer/BioNTech. Sadly, an example came from my hometown (and city where I still work), Detroit, specifically the Mayor of Detroit, Mike Duggan:
From the news story from a local TV station, WXYZ:
Detroit Mayor Mike Duggan is saying no to the new Johnson & Johnson COVID-19 vaccine, for now.
The city turned down more than 6,000 doses of the single-dose shot this week, which is slightly less effective at preventing COVID-19 in the U.S. at 72%, compared to the double-dose Pfizer and Moderna shots, each around 95%.
Those doses that were turned down were provided to other health departments in the state struggling to get shots in the arms of seniors so they didn’t go to waste.
Duggan said for right now, he wants the city to have the best options, and he said that’s Pfizer and Moderna.
“Johnson & Johnson is a very good vaccine. Moderna and Pfizer are the best, and I’m going to do everything I can to make sure residents of the city of Detroit get the best,” Duggan said.
Duggan turned down 6,200 doses of the vaccine, made in Grand Rapids. The doses were sent to Detroit this week, on top of its allocated Pfizer and Moderna doses.
“The day may come when we have more Detroiters asking for vaccines than we have Moderna, Pfizer. In which case, we will set up a Johnson & Johnson site,” Duggan added.
I actually like Mayor Duggan. I’ve generally supported Mayor Duggan. I don’t live in the City of Detroit itself, but I was quite literally born in the city, and I do still work here—and have for 13 years now. I also think Duggan has generally done an excellent job as Mayor of Detroit, but, damn, this was some seriously awful public messaging, irresponsible in the extreme. Basically, Mayor Duggan has given a message to southeast Michigan that the J&J vaccine is somehow inferior to the Moderna and Pfizer/BioNTech vaccines, that it’s second rate. Even the statement that the city will eventually accept the J&J vaccine and set up separate vaccination sites if the day comes when “we have more Detroiters asking for vaccines than we have” of the other vaccines sends a message that he’ll only take the J&J vaccine if there isn’t enough of the other vaccines to go around. The unmistakable implication is that he views the J&J vaccine as somehow second-rate compared to them, in the context of a statement that he wants Detroiters to “get the best.”
In a city whose population is over 80% Black, this message, apparently unintentionally, feeds into the long history of mistrust of the medical profession among Blacks, an all-too-understandable mistrust based on the long history of racism in the medical profession that led to centuries of different treatment, inferior care, dismissal of symptoms, and even the Tuskegee syphilis experiment. I don’t think any of this messaging was intentional, just tone-deaf. Adding to that is the simple fact that communities of color have been hit the hardest by COVID-19, and the very communities that would most benefit from a “one shot and done” vaccine that doesn’t have rigorous storage requirements tend to be the communities whose population is disproportionately non-white—such as the City of Detroit, where such advantages would be very real indeed. Indeed, the Mayor seemed to realize that he had gone too fairly quickly, as the City seemed to be already backing off, but then he appears to have decided to double down:
When asked whether the move to receive Johnson & Johnson vaccines was a change in direction from Duggan’s comments a day earlier, Roach said, “there is no change in direction.”
“The mayor made clear that he intended to maximize the availability of Moderna and Pfizer vaccines, which we have done successfully. The 29,000 Moderna/Pfizer vaccines over the next week administered directly by a health department is an extraordinary number,” Roach said.
“The mayor would have strongly resisted any attempt to reduce Detroit’s allocation of Moderna and Pfizer going forward by substituting J and J in whole or in part.
“We now have clear assurance from the state that Detroit’s full allocation of Moderna/Pfizer will continue and that J and J vaccines will be additional. Based on that assurance, the city is proceeding to set up a separate J and J vaccination site and will offer it to Detroiters as an additional option.”
And even more grudgingly:
“The day may come in March or April when every single Moderna and Pfizer (vaccine) is committed and we still have people who need a vaccine, and at that point, we’ll set up a Johnson & Johnson center. I don’t see that in the next couple weeks,” he said.
No, Mr. Mayor. The “best” vaccine in a pandemic is a safe and effective vaccine that you can go into arms now. I agree with blog bud Skeptical Raptor when he says: Get whichever vaccine is available to you because it probably doesn’t matter in the long run because all three vaccines prevent severe disease from SARS-CoV-2. As for that bit about “reducing” the size of the shipments of Moderna and Pfizer vaccines and filling in the gap with the J&J vaccine, well, that’s just nonsense. The Michigan Department of Health and Human Services pointed out that the consignment of doses of the J&J vaccine would be in addition to the doses of the other vaccines that the city was already slated to receive.
It’s also a fallacy to try to make a head-to-head comparison between the results of the clinical trials for the Moderna, Pfizer/BioNTech, and J&J COVID-19 vaccines. First, what are we talking about? As we know, both the Moderna and Pfizer/BioNTech vaccines, which are based on mRNA technology, demonstrated roughly 95% efficacy in preventing COVID-19 in their phase 3 clinical trials, but required two doses to achieve that. (In addition, both vaccines required ultracold storage conditions, which not all clinics and sites have available.) The J&J vaccine, in contrast, is based on adenovirus technology, in which a weakened version of the adenovirus (the virus responsible for cold-like illness) does the same thing as RNA, namely making a viral protein that triggers an immune response, specifically the spike protein responsible for getting into the cell and starting an infection. It also doesn’t require storage requirements as stringent as the other vaccine and requires only one dose, both of which are advantages. However, in its clinical trials, the J&J vaccine was slightly less effective. As the Raptor reported, its vaccine efficacy against severe/critical COVID-19 was 73.1% at 14 days after vaccination and increased to 81.7% at 28 days after vaccination. The Raptor also noted:
Although the effectiveness of this vaccine may appear lower than the 95% reported for the mRNA vaccines, they are still within the statistical range of them. For example, individuals without comorbidities exhibited vaccine effectiveness of nearly 90%. In fact, the only group that showed very low effectiveness were those ≥60 years old with comorbidities.
Again, as has been pointed out in several places, you can’t really make a direct comparison between the results of the clinical trials for the J&J vaccine and the COVID-19 vaccines made by Moderna and Pfizer/BioNTech. The simple version was well (and pithily stated) on Twitter:
What he means is that the clinical trials for the Moderna and Pfizer/BioNTech vaccines were done earlier in the pandemic, while the J&J vaccine trial was carried out later in the pandemic, when the prevalence of the virus was higher and more transmissible, more virulent variants of SARS-CoV-2 were circulating. Does that mean that the Moderna and Pfizer/BioNTech vaccines would have performed less impressively if they had been tested under such conditions? There’s no way of knowing. What we do know is that all three vaccines were 100% effective in preventing death from COVID-19 and that all three were very effective in preventing severe disease and hospitalization. It’s just that the J&J vaccine was somewhat less effective in preventing moderate-to-severe COVID-19. As our friend noted, the one group that showed the lowest efficacy was those over 60 with medical comorbidities, which dragged down the average efficacy. In individuals without comorbidities vaccine effectiveness was nearly 90%.
While a case can be made that the J&J vaccine should perhaps be primarily used in people under 60 without comorbidities, the bottom line, again, is that in the middle of a pandemic in which getting as many people vaccinated as quickly as possible is critical to achieving herd immunity before SARS-CoV-2 variants evolve to escape susceptibility to existing vaccines, the best vaccine is the safe and effective one you can get now. Also, there are a lot of people eager to receive the J&J vaccine because it is effective and is “one and done,” while availability of a vaccine that can be stored in refrigerators rather than requiring ultracold freezers allows for easier setup of vaccination clinics at nonmedical sites, like sports stadiums.
Unfortunately, politicians are not the only ones sending unhelpful messages about this vaccine.
Mixed messages about the J&J vaccine from the Roman Catholic Church in the US
Over the last few days, I’ve been seeing news stories like this one about the Catholic Church sending mixed messages about how the J&J vaccine is “morally compromised” because it uses a cell line derived many decades ago from an aborted fetus. Yes, it’s the same old, same old:
Roman Catholic leaders in St. Louis and New Orleans are advising Catholics that the COVID-19 vaccinefrom Johnson & Johnson, newly approved for use in the U.S., is “morally compromised” because it is produced using a cell line derived from an aborted fetus. The New Orleans Archdiocese says the decision to receive a vaccine is one of individual conscience.
In its statement late last week, it stopped short of advising Catholics not to take the Johnson & Johnson vaccine, but adds that Catholics should choose coronavirus vaccines made by Moderna or Pfizer — if they are available.
The Archdiocese of St. Louis on Tuesday encouraged Catholics to seek out the Pfizer or Moderna vaccines and avoid the Johnson & Johnson version if possible. Like the New Orleans Archdiocese statement, the St. Louis statement called the Johnson & Johnson vaccine “morally compromised.” However, the St. Louis statement stressed that Catholics can get that vaccine “in good conscience if no other alternative is available.”
Later Tuesday, a statement issued by chairmen of the United States Conference of Catholic Bishops’ committees on doctrine and abortion issues issued a statement reiterating the moral concerns. It said the Pfizer or Moderna vaccines are preferable “if one has the ability to choose a vaccine.”
I realize the message from the Archdiocese of St. Louis and the US Conference of Catholic Bishops about the J&J vaccine are the same sort of message that the Roman Catholic Church has been sending about vaccines ever since 2003, with the New Orleans Archdiocese merely being a more extreme version. That was when the Pontificia Academia Pro Vita, at the time led by Cardinal Joseph Ratzinger (who later became Pope Benedict XVI, issued a statement that the use of vaccines whose manufacture involves the use of such cell lines derived in the distant past from an aborted fetus is morally acceptable, albeit less than ideally so, because the extreme good of preventing the diseases targeted by vaccines outweighs the distant “evil” of the abortion. Even then, the Church tried to thread the proverbial eye of the moral needle by saying that vaccines not using such cell lines should be encouraged, even though vaccines developed and manufactured using them have prevented billions of cases of disease and prevented millions upon millions of deaths, and characterized the use of such vaccines thusly:
…the lawfulness of the use of these vaccines should not be misinterpreted as a declaration of the lawfulness of their production, marketing and use, but is to be understood as being a passive material cooperation and, in its mildest and remotest sense, also active, morally justified as an extrema ratio due to the necessity to provide for the good of one’s children and of the people who come in contact with the children (
In other words, again, the extreme good of vaccination outweighs the distant “evil” and “passive material cooperation” with it. Moreover, before COVID-19 vaccines had even been developed, the Vatican weighed in:
The Vatican concluded that “it is morally acceptable to receive COVID-19 vaccines that have used cell lines from aborted fetuses” in the research and production process when “ethically irreproachable” vaccines aren’t available to the public. But it stressed that the “licit” uses of such vaccines “does not and should not in any way imply that there is a moral endorsement of the use of cell lines proceeding from aborted fetuses.”
While the messaging from the New Orleans Archdiocese is clearly more dangerous in a pandemic, messaging from the Vatican and the US Catholic Church is very problematic in the middle of a pandemic because it will inevitably lead some Catholics to view the J&J vaccine as inferior to the others in a different way than Mayor Duggan’s statement.
Indeed, the mixed messaging from the Catholic Church has the potential to be even worse, because it basically says, “Sure, use these vaccines if you have to if nothing else is available, but they are products of killing babies.” Also, the US religious wingnuts being US religious wingnuts, some Catholic leaders in the US have beyond even the mixed messaging of the Catholic Church into messages that are anything but “mixed”:
That was followed by much more unequivocal guidance from the Diocese of Bismarck, N.D., which issued an unsigned statement that said the Johnson & Johnson vaccine “is morally compromised and therefore unacceptable for any Catholic physician or health care worker to dispense and for any Catholic to receive due to its direct connection to the intrinsically evil act of abortion.”
I wonder: How is it different to be using these cells to manufacture the J&J vaccine, compared to the Moderna and Pfizer/BioNTech vaccines, for which these cells were apparently used during vaccine development to test their ability to make spike protein. I mean, how close does the aborted cell line have to be to the vaccine to make the vaccine evil? Is it like homeopathy, where, as homeopaths claim that water has a “memory” of all the homeopathic remedy that’s been diluted away to nothingness, in which ever having been in contact with one of these fetal cell lines, no matter how remote the contact was, permanently contaminates the vaccine?
It gets worse:
I note that the J&J vaccine had not yet been approved under an EUA in January. Only the Pfizer and Moderna vaccines were available then. One also must wonder if the Bishop also opposes vaccinating children against, for example, measles, given that the manufacture of the MMR vaccine also uses such cells.
In a pandemic, politics and religion can kill
We’ve already seen how ideology can hamper public health messaging. When the pandemic hit, we had arguably the worst possible President to be in charge of a time when disciplined and nuanced messaging were needed, and he contributed to resistance to masks and public health interventions of all sorts other than vaccines. The only reason he didn’t oppose vaccines is because he viewed vaccines, inappropriately, as as magic bullet that would end the pandemic and save his reelection bid.
I’m sure that politics is what motivated Mayor Duggan, possibly combined with a misguided belief that by portraying the J&J vaccine as “not the best” he’s doing the best for the people of Detroit. While I’m sure he didn’t intend it, Mayor Duggan’s statement will likely lead Detroiters to view the J&J vaccine as “inferior” in a way that could feed into the preexisting distrust among Detroiters of the medical system. That’s plenty bad, as persuading some Detroiters to take the J&J vaccine when Mayor Duggan finally does bow to reality will be more difficult because of his previous political posturing about providing “only the best for Detroiters.” Worse, Mayor Duggan really should know better, given his long tenure as the President and CEO of the Detroit Medical Center before he went into politics. I can’t help but wonder if this “only the best” message will end up killing more people than any difference in efficacy between the J&J vaccine and the others COVID-19 vaccines ever could, even in a worst case scenario.
Religion, though, has the potential to do even more harm. Although I’ve touted the Catholic Church’s messaging that it is morally (grudgingly) acceptable to use vaccines that were manufactured using fetal cell lines, I’ve always been hesitant about the mixed messaging. In normal times, the mixed messaging was less harmful, as the stakes, although by no means low, were much lower than they are in a pandemic. Unfortunately, in the middle of a deadly pandemic that’s already killed over a half a million in just the US alone, the stakes are much, much higher, and one wonders how many Catholic might die because the Catholic Church on the one hand proclaimed that the J&J vaccine is (grudgingly) morally acceptable, while on the other hand decry it as the evil product of abortion. In doing so, the US Catholic Church prioritizes the”evil” of an abortion happened over 50 years ago and cells that are so far distant from the abortion that likely nothing remains of the originals after many replications over the lives of living, breathing Catholics now.