Astra Zeneca in June or Pfizer in August?

May 27, 2021 12:02 PM

My partner and I are looking for some advice on COVID vaccines— essentially, Astra Zeneca/Johnson & Johnson in early June or Pfizer/Moderna in late August?

We live in a Northern European country where COVID is very under control. The only vaccines available from the public health system are Pfizer and Moderna—we are scheduled to get one of those by late August.

However, the private sector is offering the Astra Zeneca (AZ) and Johnson & Johnson (J&J) vaccines on relatively short notice for anyone that opts in and passes a screening. (The government took AZ and J&J out of the official program due to side effects but has a stockpile they'll use up for anyone that wants it). We’re trying to decide whether to wait for the Pfizer/Moderna shot or get one of the other ones sooner.

In our mind, it would be great to get the AZ or J&J vaccine now and be able to travel back to the US in July, see family, stop getting quick tests multiple times a week, etc. However, we're worried about the chance the AZ/J&J vaccines are less effective in the short- and long-run. One partner travels a lot in East Africa and Asia for work (or will again, as things reopen), and we're especially worried about the varying degrees of effectiveness between the different vaccines with the Indian and South African variants.

We get the science is still developing, but based on what's known now, what would you do?

(I know there may be a knee-jerk reaction to say, “Get the very first vaccine available,” especially from those in a country that has gone through or is still in going through a precarious COVID situation. But please trust me when I say it is both safe for us and responsible from a public health perspective to wait for Pfizer/Moderna August. Our public health system actually advises against taking the AZ and J&J vaccines early unless there’s a particular reason to do so.)

posted by anonymous to Health & Fitness (24 answers total)

This policy is what is happening here, in Denmark. You may be here.
The reason the AstraZeneca and Johnson & Johnson vaccines have been taken out of the government program is the risk of serious side effects. It is a very small risk, but it is there. As I understand it, the risk is greater for women under 50, so if one of you is a woman under 50, you should probably just wait till August. I would, but I am oldish, and just had my first shot yesterday. If I were a man under fifty, I would perhaps apply, because the screening finds everyone who might be at risk within that demographic.
The AZ and J&J vaccines are for all purposes as efficient as the others, they have not been taken out for lack of efficiency, only because of the side-effects. There are some other vaccines that seem less efficient, but none of those are used in Denmark (or Germany, which has similar rules), I don't know about the other Northern European countries.
BTW, at least here, the waiting lists for the voluntary option are very long, so the "short notice" might not be what it seems to be.
posted by mumimor at 12:15 PM on May 27, 2021 [2 favorites]

All the advice I've seen has said that the best vaccine is the one you can get today.

In the short run, you get extra protection when you need it (now when fewer people are vaccinated). In the medium term? Lots of people are vaccinated and it won't matter as much how good the vaccine is. And in the long term? There will almost certainly be boosters, or variant vaccines, and it's not really going to matter which one you got today.
posted by wotsac at 12:31 PM on May 27, 2021 [7 favorites]

I don't know what to tell you on this one. The reason why I wanted Pfizer was specifically because of the variants. But literally waiting a few months could be dangerous too.

I guess I wonder if there's some way to get the first shot now and see if you can get the Pfizer later as well in your country.
posted by jenfullmoon at 12:35 PM on May 27, 2021 [1 favorite]

This is a tough one. Three months is a long time. We (my family) decided to wait a week to get Pfizer rather than J&J, and I think that was a good decision for us. The AZ/J&J shots are simply not, for all purposes, as efficacious as the MRNA-based vaccines. Public Health officials are making recommendations that serve the public health. Those recommendations don't necessarily serve you, a specific person with unique circumstances. I'll paste what I wrote to a family member at the time here, but it basically boils down to: our goal in getting vaccinated was not just to reduce the risk to our own health, but also to reduce the risk to the health of the people we live with who can't get vaccinated.

The odds of either of us getting a severe case are small, whether we're vaccinated or not. What worries me is the risk of us getting a mild or asymptomatic case and giving it to the kids/older family members who can't get vaccinated.

There's not a ton of information about this, but what there is suggests Pfizer and Moderna are much better than J&J.

In its Phase 3 trials J&J reduced moderate to severe cases by 66%. There were 193 cases that occurred at least 28 days after vaccination in the placebo group and 66 in the vaccine group. I can't find any information about mild cases (they may not have tracked that given the short term goal of the vaccine/trial), but it's certainly not more effective at preventing mild and asymptomatic cases than preventing severe cases. And these trials were conducted before the more contagious/severe variants were circulating.

Pfizer and Moderna just published a "real world" study, which tracked mild and asymptomatic infections, and was conducted when the more infectious variants were circulating (unlike their original trials). It basically stops you getting covid of any seriousness, and therefore stops you giving it to someone else: "There were 161 Covid infections in the unvaccinated workers, compared with 16 in workers who had received only one dose by the time of their infection and only three infections in people who had received both doses and were two weeks out from their second dose. The vaccine effectiveness following two doses was 90% — roughly in line with the 95% and 94% that the Pfizer and Moderna vaccines showed, respectively, in the clinical trials that supported their emergency use authorizations."

But I'm not sure if the logic above stretches as far as waiting for several months, and I also haven't followed the research since I got my own shot (maybe there's more data about J&J/AZ now?). There's certainly stronger evidence that Pfizer/Moderna stop mild and asymptomatic cases than there was two months ago. I didn't mention side effects because they weren't known at the time, but nothing I've seen about those would change what I wrote.

But given the delay of 3 months, I would probably lean toward getting the first shot I could, including J&J and AZ.
posted by caek at 12:35 PM on May 27, 2021 [2 favorites]

The only one you can count on for July travel is J&J - you'd need two doses of AZ spaced apart and then a couple of weeks after the second to be considered fully vaccinated. So, may as well wait? I mean, if your area isn't in crisis, and you don't plan to see anyone, there's no rush. When I got my first AZ dose (Canada) we were in crisis and it was no doubt the right thing to do. Listen to your public health people - but not just for which vaccine to take, but what to do or not do while you're waiting for immunity.
posted by wellred at 12:35 PM on May 27, 2021 [6 favorites]

The reporting on risk of side effects, etc. came to a head when it was a relevant question for me (ie, I was unvaccinated) so I paid attention. I personally reached the conclusion that not only would I take J&J (or AZ) happily, I would opt for it even if I had another option just a week later.

1. The estimates you see on effectiveness are pretty theoretical. They were different trials, not measuring exactly the same thing, etc. Until you run a head-to-head trial I wouldn't have confidence there's even a measurable difference, let alone a meaningful one.

1a. The estimates of effectiveness against variants are even more uncertain, and in any event what you really want to worry about is not this batch of variants but the next generation that evolves to escape the vaccine.

2. The risk of side effects, even if you take the highest estimates in the most at risk population, is incredibly small. It's definitely on par with other risks I take daily. Since I did this math I think the actual incidence has been lowered by about 5x with extra data.

3. One shot vs. two shot. This is a little trivial compared to the other stuff, but my vaccination process was six weeks, and it would have been cool to be moving out and about under reduced lockdown protocol (and feeling safer!) a month earlier.
posted by mark k at 12:35 PM on May 27, 2021 [7 favorites]

If you opted for AstraZeneca, it would be early September before you could get your second shot, so I wonder if you'd be allowed in to the U.S. before that? J&J is one and done, so if speed is your primary concern, that's your shot. This article offers some comparisons.
posted by kate4914 at 12:38 PM on May 27, 2021 [1 favorite]

I'd take the j&j now, and consider taking the pfizer/moderna additionally when the option arrived.
posted by february at 12:54 PM on May 27, 2021 [2 favorites]

If it was me I'd take the first vaccine available. All 4 of your options are all very well studied, and VERY effective vaccines with exceedingly rare serious side-effects. My qualifications (besides just being a person) are I'm a nurse.
posted by latkes at 1:05 PM on May 27, 2021 [23 favorites]

I’ll add that if, over the long term, there is a demographically measurable difference in vaccine protection, I would expect booster shots will become available, or be tuned, to address that difference. Perhaps as early as this fall, which is nearly your waiting time frame.
posted by meinvt at 1:09 PM on May 27, 2021 [9 favorites]

If the main concern is about short-term effectiveness, I would get the vaccine you can get now, which is definitely much more effective in the very short term than a vaccine you can't get until later! If your concern is the potential side effects, that's a different question.

I don't think it's true at all that we can definitively say that the AZ/J&J vaccines are less effective against the new variants than the mRNA vaccines - to say that with certainty we would need to do a clinical trial of the AZ vax against the Pfizer vax (e.g.). Each of the vaccines has been tested at a different point in the pandemic in different populations against different background levels of disease and different levels of variants. They have never been tested head-to-head.

And if one vaccine does come out statistically on top, it's extremely likely that you will be able to get a booster of that vaccine. If you are comfortable getting one of these vaccines now, you are not throwing away your shot (ha) at ever getting an mRNA COVID vaccine in the future.
posted by mskyle at 1:19 PM on May 27, 2021 [6 favorites]

This was my ask that was very similar. The first shot available to me was AZ at the end of April, and I took it as was recommended I take the first available and because my area was in the grips of a brutal third wave. A month later the wave is subsiding, and as it turns out I could have gotten an Pfizer/Moderna shot 3-4 weeks later. Had I known that at the time - I would have waited. I stressed out about the clotting issue. I only just emerged from the "4 week risk window". Someone in my town, my age, lost a couple feet of intestine to an AZ clot. I'm fine, but the stress for me from the clot risk was about equal to my personal covid stress (given I rarely leave my house and work from home). For my second shot I'll be probably getting one of the others, even though there is still limited data on what happens when you mix the two types. (Prelim results sounds extra promising, but everything changes so fast...). YMMV obviously, but I thought i'd share my personal experience anyway.

I'm not trying to scare people from the AZ shot if it is the only one available - take it. But if you are fortunate to have options, they are worth considering given your own personal situation.
posted by cgg at 2:22 PM on May 27, 2021 [2 favorites]

I don't think it's true at all that we can definitively say that the AZ/J&J vaccines are less effective against the new variants than the mRNA vaccines - to say that with certainty we would need to do a clinical trial of the AZ vax against the Pfizer vax (e.g.). Each of the vaccines has been tested at a different point in the pandemic in different populations against different background levels of disease and different levels of variants. They have never been tested head-to-head.

To match the known efficacy of mRNA-based vaccines against recent variants, AZ and J&J would have to be significantly more effective at stopping mild and asymptomatic cases caused by current variants than they were stopping only severe cases of the original variant. This seems extremely unlikely.

A lot of the trial results got compressed to "this vaccine basically stops severe cases", and that's true of all the vaccines discussed here, but that doesn't capture the full situation.
posted by caek at 3:12 PM on May 27, 2021 [2 favorites]

Sounds like the US trip is the main motivation for going for the AZ or J&J... is there anyone there you think you might not have the chance to see by the fall? Even if the VIIT rates for those vaccines is “low”, if you’re the one who gets it, it’s still pretty tragic. Between that and the better efficacy of the mRNA vaccines for variants - especially since one of you *has* to travel for work - I don’t see why you should rush to get the adenovirus vaccines, if risk of Covid in your area is low.
posted by cotton dress sock at 3:58 PM on May 27, 2021

Consider that:
1. Places where things seem under control can enter a new surge at the drop of a hat. See Manitoba, Michigan, etc.
2. AstraZeneca has 99% efficacy against serious illness and death.
3. Vaccine delivery schedules have moved up recently, for example by several months in Canada.
4. We'll all need boosters in 6-12 months, and in Canada at least, changing vaccine types will likely be allowed.

Given all that:
- If you work from home and avoid shared air strictly, as strict or stricter than anyone you know, then you might consider waiting for mRNA. It might be available sooner than you think.
- If you are not super-strict, and occasionally dine indoors or visit friends at home, then get the AZ first dose, not to travel but to protect yourselves.
- Flying to the US with one dose of AZ is not my idea of prudent.

A caveat about the wisdom of the hivemind:
- Does anyone else remember that in late February of 2020, many people urged someone to carpe diem and go to a party in NYC? (Not to harsh anyone's mellow; please don't shoot the messenger.)
posted by dum spiro spero at 4:31 PM on May 27, 2021 [4 favorites]

https://www.nbc15.com/2021/04/27/vaccine-team-qa-can-i-get-the-pfizer-or-moderna-vaccine-after-getting-jj/
By Tajma Hall
Published: Apr. 27, 2021 at 3:48 PM UTC|Updated: Apr. 27, 2021 at 5:00 PM UTC
MADISON, Wis. (WMTV) -The NBC15 Vaccine Team is answering your questions about mixing vaccine brands after you’ve already been vaccinated. You can find a full list of NBC15 Vaccine Team Q&A’s HERE.
I received the single dose J&J vaccine in early April. However, due to lower efficacy than the other vaccines, I would like to get another brand. How long should I wait to get the Pfizer or Moderna vaccine?
-Jeremy
ANSWER:
Dr. Matt Anderson with UW-Health says he does not recommend seeking the Pfizer or Moderna vaccine after you’ve been vaccinated with the Johnson & Johnson shot.
He says anyone wondering about this should not be concerned about the lower efficacy of the J&J vaccine.
He says it still provides adequate protection against severe illness and hospitalization from COVID-19.
Copyright 2021 WMTV. All rights reserved.
posted by SageTrail at 5:20 PM on May 27, 2021 [1 favorite]

The reason the AstraZeneca and Johnson & Johnson vaccines have been taken out of the government program is the risk of serious side effects. It is a very small risk, but it is there.

I crunched the numbers re: AstraZeneca risk (not of death but of serious side effects) and concluded I had a better chance of getting murdered, a magnitudes better chance of accidentally poisoning myself. Those numbers are for my particular region, not global, so make of them what you will.
posted by philip-random at 5:36 PM on May 27, 2021

I went through the same decision in Germany about a month ago. Many young people have been able to get AZ appointments, while biontech and moderna should be readily available 3-4 weeks from now. For me, in my region, the incidence fell steeply around the time I could have tried to get an AZ appointment. It is now only about 20 cases/100,000. A study out of the UK (which I'm unable to find now, but was from one of the big universities) indicated that for people in the 20-30 age bracket, when incidence falls below 50/100,000 they estimate the risk of severe AZ side effects to be greater than the risk of a severe course of COVID. The odds of course change when you are in a high-incidence region, but since the numbers have been remaining low, I decided to wait for one of the mRNA vaccines.
posted by unid41 at 12:05 AM on May 28, 2021 [2 favorites]

Anecdote time. My family is in India, fully vaccinated with AstraZeneca, and got infected anyway. It’s effective against serious illness, it seems, since many of them are old and have various chronic issues and yet did ok, but they had enough symptoms to be out of commission for a couple of weeks.
posted by redlines at 2:07 AM on May 28, 2021

One of my colleagues had her first (Pfizer) shot, and then unfortunately caught the disease. She is still very ill. The full effect doesn't happen before 1-2 weeks after the second shot. Just so everyone is clear about this.
posted by mumimor at 5:56 AM on May 28, 2021 [1 favorite]

The full effect doesn't happen before 1-2 weeks after the second shot. Just so everyone is clear about this.

I was told three weeks when I got my shot
posted by philip-random at 7:10 AM on May 28, 2021 [1 favorite]

Get one of them in your country now and if you have the ability for down time, consider getting a Pfizer booster shot when you're in the US. We are swimming in vaccines and many state/county run vaccination sites don't ask for ID or insurance.
posted by mcgsa at 7:14 AM on May 28, 2021

I crunched the numbers re: AstraZeneca risk (not of death but of serious side effects) and concluded I had a better chance of getting murdered, a magnitudes better chance of accidentally poisoning myself. Those numbers are for my particular region, not global, so make of them what you will.

I think it is the same here, but because the people who are most at risk are younger women with undetected preconditions, we have had a few frontline nurses suffering really bad side effects, and AFAIK even one dying. So that is politically really toxic, at least as long as the situation is controlled and there is a clear ending to the whole thing in August.

No one knows what will happen if a mutant strain turns out to be vaccine resistent.
BTW, the vaccines bought by the Danish government that are not used will go to other countries where the priorities are different. Some of them as donations, for instance to some African countries and India.
posted by mumimor at 9:56 AM on May 28, 2021 [2 favorites]

I had a choice in the US in March between Pfizer and J&J and I took the J&J. Solely because being finished after one vaccine seemed much simpler to me and a month sooner. The efficacy difference between the two is not nearly as big as the basic numbers might suggest. It might not even be a real effect, given the difference in the testing protocols.

BTW you mentioned wanting to be able to come to the US in July. At this time being vaccinated or not has no bearing on whether you can come in to the US. The main thing is whether you're a US citizen and where you've been recently: European citizens are basically barred from coming directly to the US. (You can spend 14 days in an intermediate country and then come). Folks are expecting the US to relax these policies some soon in response to the EU opening up but there are no plans as of yet. And in general the US has been quite resistant to the idea of asking people for proof of vaccination, it's not clear we will ever have a system that gives preference to vaccinated visitors.
posted by Nelson at 6:43 AM on May 29, 2021 [2 favorites]