Staying Fit
As White House officials announced plans for COVID-19 booster shots, the nearly 14 million Americans who have gotten the Johnson & Johnson vaccine are wondering when their turn will come.
The plan so far is for those who took the two-shot Pfizer-BioNTech or Moderna vaccines to begin getting a third “booster” dose as early as Sept. 20. The nation's top medical leaders are recommending these extra shots be given eight months after people received their second dose. The proposed booster plan can't go into effect until the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) approve.
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But the one-shot J&J vaccine is not yet part of this plan. While the two other vaccines received emergency use authorizations (EUA) from the FDA in December 2020, the J&J vaccine didn't begin to be administered until March 2021. That means the eighth-month mark for the first J&J shot recipients won't come until November — and it's yet to be determined if eight months would even be the proper interval between J&J shots.
"We are engaging with the U.S. FDA, CDC and other health authorities and will share new data shortly regarding boosting with the Johnson & Johnson COVID-19 vaccine,” the manufacturer says in a statement on its website. The J&J vaccine is also known as the Janssen vaccine.
In the meantime, federal officials suggest contacting your medical provider with any questions. “I think right now my recommendation would be to stay put, to mask, wash your hands and socially distance,” Matt Harris, medical director for New York's Northwell Health vaccination program, said about the lag in J&J recipients being eligible for a booster.
J&J vaccine is different
The Pfizer-BioNTech and Moderna vaccines are similar in that they use the same basic technology — known as mRNA — to fight against COVID-19. This technology allows the vaccine to provide the genetic code to our cells to produce antibodies that can repel the virus. These vaccines essentially teach our cells how to make a protein that prompts an immune response without using the live coronavirus that causes COVID-19.
CDC Director Rochelle Walensky has outlined several studies that show a decline in effectiveness of these two mRNA vaccines over time, and the president's chief medical advisory, Anthony Fauci, has said that data shows the production of antibodies also wanes. That's why they are recommending third shots to reinforce the immune system. Both said, however, that these vaccines continue to protect against severe illness, hospitalization and death.
But the J&J vaccine is different. It also delivers a genetic code to our cells, but the methodology is not the same. This vaccine uses what's called an adenovirus — a harmless virus that can no longer replicate — essentially to send the genetic message to our cells. This vaccine goes into the nucleus of our cells and uses our own DNA to send the needed genetic code.
Because the J&J vaccine authorization came later, data on whether or when its effectiveness and antibody production declines over time and by how much is not yet available.
What about the immunocompromised?
CDC has already recommended that certain people with compromised immune systems begin now to get third doses of Pfizer-BioNTech and Moderna vaccines. This recommendation applies, for example, to people with organ transplants, those being treated for some cancers and people with advanced HIV.
But as with the plan for the general public, the recommendation for a third shot does not apply to people who have gotten the single-shot J&J vaccine.
William Schaffner, an epidemiologist and professor of preventive medicine and health policy at Vanderbilt University, said while the official recommendation for people who took the J&J vaccine is to wait for additional guidance, he has heard from colleagues that doctors are talking to J&J patients about potentially getting a dose of one of the two mRNA vaccines already cleared for immunocompromised people.
"That's what they are doing in Europe,” says Schaffner, where the AstraZeneca-approved vaccine that is built using the same technology as the J&J product is being widely administered. “In some countries they are giving one dose of AstraZeneca followed by one dose of either Moderna or Pfizer.” Schaffner suspects these conversations are happening especially among people with HIV, many of whom may have gotten the J&J vaccine because they were hard to reach and a one-dose regimen was easier to administer.
U.S. health officials have not yet indicated when booster guidelines for J&J vaccine recipients will be issued.
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.
