Can You Choose Which COVID-19 Vaccine You Get?

Ever since the Moderna and Pfizer vaccines were approved in December, it feels like each day brings more good news about the coronavirus shots.

The messenger RNA (mRNA) vaccines appear to be just as effective in the real world as they were in trials, and it’s looking more and more like people who contract the coronavirus are much less contagious after being vaccinated. Now a third effective vaccine option — the Johnson & Johnson shot — has been approved for emergency use by the Food and Drug Administration.

While this is incredible, game-changing news, some people are skeptical about the J&J shot, and if given a choice, would rather wait for the Pfizer or Moderna ones to become available. But in a race to vaccinate as many people as possible and build herd immunity to beat the pandemic, holding out for an mRNA vaccine not only puts your health at risk in the short term but it also impacts how soon we’ll achieve herd immunity and when we’ll be able to safely open up society.

If you’re offered the J&J shot, or any FDA-approved shot for that matter, you should get it. All of these shots are excellent at protecting people who are exposed to the coronavirus against hospitalization and death, and that’s the most meaningful outcome. Truth be told, most of us aren’t going to have the option to choose what shot we get on appointment day since supply is still so limited, but ultimately, it doesn’t really matter.

The main numbers people are getting hung up on are 95% (the overall efficacy of the mRNA shots) and 66% (the overall efficacy of the J&J shot).

Monica Gandhi, an infectious diseases specialist and professor of medicine at the University of California, San Francisco, said these numbers don’t tell the full story. The overall efficacy number indicates how well a vaccine protects against any type of COVID-19 infection, which could be anything from a runny nose or headache to death.

Because of that wide range, Gandhi said she first looks at “what have these vaccines done to stop the things that I care about as a doctor, which is severe disease.”

When it comes to preventing hospitalization and death, the J&J shot has an efficacy of 100%. Like the mRNA shots, it fully and completely protects against hospitalization and death. “That’s the most profound outcome of all outcomes,” Gandhi said.

Last year, the FDA set a benchmark of at least 50% efficacy for a vaccine against the virus, which experts believed would have a significant effect on the pandemic. All of the vaccines that are coming out clear that goal right now.

There’s been a ton of news circulating about how even mild to moderate cases could lead to long-term complications. Naturally, you might wonder if you have a greater chance of being a COVID long-hauler if you get the J&J shot instead of an mRNA shot and end up getting the coronavirus.

Good news again: Your immune response generated from the vaccines “should prevent you from having what’s called innate inflammation or non-specific inflammation that will lead to long-term symptoms,” Gandhi said.

In addition, people with mild cases typically aren’t the people struggling with long-haul symptoms. (It’s usually people who have recovered from severe illness.) Of course, scientists will continue studying the vaccine in the months and years to come to see if there are any long-term side effects or if this changes at all.

What’s also interesting is that researchers have found antibody levels increase with time after the J&J shot. In clinical studies, the antibody levels grew stronger the further out from vaccination people got — scientists reported antibody increases at 14 days, then again at 29 days, and again at 69 days.

“It looks like the vaccine is going to keep on giving,” Gandhi said. “If we give it more time, it’s likely to be even more effective.”

It’s widely believed the mRNA shots will hold up against the variants overall (although efficacy is likely lower), but we have hard evidence that the J&J shot does.

When tested in South Africa where B.1.351 was the dominant strain behind COVID-19 cases, the J&J shot still had equally strong efficacy against severe disease. It also held up against the more transmissible variant (P.1) in Brazil.

“It showed us it has efficacy against those variants,” Gandhi said, noting the same will likely be true with the mRNA shots. “These vaccines work; they’re amazing.”

All three companies are also working on booster shots that will improve efficacy and target mutations of the virus. It’s likely we’ll have to get those updated doses some day, no matter which shot we receive.

Robert Amler, the dean of the School of Health Sciences and Practice at New York Medical College and a former chief medical officer at the Centers for Disease Control and Prevention, said we also have to look at the practicality of the shots in the real world.

The mRNA shots are tough to manufacture and are fragile — they must be carefully shipped and stored at freezing temperatures. They also require two doses, so people have to come back and get that second dose to get full protection. The J&J vaccine, on the other hand, is a one-dose shot that can be stored at refrigerator temperatures for up to three months. It’s also easy to make, which means we’ll be able to ramp up production fast and hit that 700 million dose goal by this summer. (And with a one-dose shot, 700 million doses means 700 million people — that’s huge.)

When you consider all this, Amler said, the practical efficacy of the vaccines is “practically equivalent.” “All three vaccines will be excellent tools to combat what is otherwise a terrible virus,” Amler said.

Perhaps the most important thing about having another shot in our arsenal is what this means for herd immunity. Between the mRNA vaccines, immunity from natural infection, and now the J&J shot, herd immunity is even closer within reach. We just need to put out an arm when any shot is offered to us.

“Not 100% of the herd has to have a 100% perfect vaccine to get to herd immunity,” Gandhi said. Once we get more shots in more arms, the coronavirus will naturally start to slow down.

“Virus can’t spread when enough of us are immune,” Gandhi said. That’s the way immunity works — we all depend on each other, the herd, to build immunity so the virus can’t find anyone new to infect.

At the end of the day, any shot is better than no shot. Getting no vaccine (or remaining unprotected until you can choose one) has 0% efficacy, Amler said. And with a virus that’s already claimed millions of lives, it doesn’t make sense to pass up immediate protection. “If it’s available and you’re eligible, get it,” Amler said.

For what it’s worth, when you go in for your vaccine appointment, you probably aren’t going to have a choice in the matter. Supply is tight, and the only way for us to get back to normal is to get vaccinated quickly. That means accepting whatever FDA-approved vaccine you can get. They’re all good options.

Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.