J&J booster shot - worth it?

January 7, 2024 10:57 PM

We've finally got access to booster shots again here in Cape Town - but apparently they only offer the original J&J. Is this worth getting?

We both got vaccinated in 2021 and boosted in January 2022 - the Pfiser boosters. Nothing has been available since then. It's summer here at the moment. I can't find any info on local Covid numbers (as far as I can tell the local wastewater surveillance stopped in Feb 2022) so it's anyone's guess what's going on with that.

We've also both had Covid multiple times - ( my husband works in a school with no Covid safety measures.)

posted by Zumbador to Health & Fitness (11 answers total)

This would be your second booster (and fourth total dose), yes? I checked to see whether additional (third) boosters were available, but it doesn't look like it.

I got my second booster in February last year, when it was still possible to get Pfizer. To the best of my knowledge I've never had COVID. I'm not sure what I would do in your situation -- I lean towards vaccine maximalism, but as far as I know J&J is marginally more risky, and marginally less beneficial, so YMMV. To some extent it would depend on the date of the last known infection. Recent? Probably no point. Long time ago? Maybe worth considering. I'm not a doctor, but my understanding is that you get a temporary immunity boost even if it makes little difference in the long term, so perhaps it should also be informed by your likely risk of exposure in the near future.

I've been checking the weekly respiratory illness and wastewater reports periodically in an attempt to keep track of what was going on, but it's hard to tell anything with such limited data. (They are still monitoring wastewater levels; I think it's just the dashboard that's not being updated with new data.)
posted by confluency at 12:54 AM on January 8, 2024 [1 favorite]

On This Week in Virology, Dr Griffin has made a point in the majority of episodes over the past couple of months to mention some new bit of research showing, again, that hybrid immunity - the kind you get by being BOTH vaccinated and having a Covid infection - is noticeably strongly and longer lasting than infection alone or vaccination alone.

My impression is that the evidence for that is gradually becoming quite strong. Here are a few research articles on the topic: 1 2 3.

For example, look closely at this figure. The top row is serious disease/hospital admission and the data show that infection + vaccination is noticeably stronger and longer last, and vaccination + booster + infection stronger yet (for the 2nd & 3rd graphs, the line starts out closer to the top and stays closer to the top for a longer period of time. "The top" represents no chance of being hospitalized with Covid, so that is what you're aiming for).

The bottom row shows the possibility of getting any Covid infection for previous infection alone, infection + vaccination, and infection + vaccination + booster. Again the difference among the three is very noticeable and the progression (improvement in outcomes) as you move rightwards is very noticeable.

So, there does appear to be something to the idea of vaccination plus infection plus booster being the best combination for both avoiding more infections and keeping them less serious when they do happen.

J&J was included in those analyses, by the way. There is nothing to indicate the response to J&J is that much worse than any of the others. They are all in the same general ballpark with relatively slight differences between them in this area and in most others.

Second, people kind of poo-poo the J&J vaccine as useless, but data gathered as the pandemic has progressed has shown then to be simply wrong.

J&J might be just a notch less effective than the other vaccines but it is FAR from useless and definitely way, way better than nothing.

We're talking about, the difference between 70% effective and 80% effective - that type of thing. I mean, if you had the choice between the two right in front of you, equal cost and equal availability, of course you would take the one that is a little better. But J&J is actually in the same ballpark as the others and way, way, way better than nothing.

(In fact, getting that type of immune response out of only one dose is rather impressive. The boost you get from a 2nd dose a couple of weeks later, and then a 3rd dose several months later - as the mRNA vaccines have worked out - is pretty huge. The fact that J&J can give protection in that same ballpark with just one dose tells me is is probably fundamentally the better vaccine. And from a public health perspective, there is no question that vaccination 3X the people with something 90% effective is the better and the smarter strategy.

Here is an article on the topic of the "surprising" strength of the J&J.

Here is a typically summary of the relative effectiveness of J&J vs the two mRNA vaccines:

“What we saw in the summertime and the fall during the Delta surge is that all three vaccines protected very, very well. But breakthrough rates in August, September of last year with the Janssen vaccine were slightly higher than Pfizer, and Moderna was slightly lower. But those differences were relatively small,” said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. He helped to develop and study the J&J vaccine.

“But what we saw over time is that those differences then narrowed,” he said. “And by the first week of December, what we saw in the data is that the lines cross,” with incidence rates for the J&J/Janssen vaccine becoming lower than the others.

It's sort of like arguing about whether LeBron James, Michael Jordan, or Magic Johnson was the best basketball player in history.

Certainly one of them has the edge over the other two in most ways, and they each are better than the others in some ways. But when we get arguing about "who is better" we tend to vastly overexaggerate relatively small differences.

And we forget that all three are so much better than the average schlumpf on the couch (ie, the person who's getting all worked up about this argument) that it's difficult to even put into words. With that perspective, all three are amazingly good and you would never hesitate a second to take any one of the three on your dream team - and you'd never even consider the average schlumpf on the couch.

The three vaccines are LeBron, Michael, and Magic and no vaccine is the average schlumpf on the couch.

And in general we get so down on the fact that we don't have PERFECT vaccines - and guess what, we don't have perfect vaccines for pretty much every respiratory virus there is; they are very, very difficult - that we forget how absolutely amazing are the vaccines that we do have.

Don't let the perfect be the enemy of the good. And J&J is pretty damn good.
posted by flug at 3:13 AM on January 8, 2024 [11 favorites]

Strongly seconding flug.

I got the J&J vaccine when the vaccines first were made available in the US. A local fire and rescue squad was doing a public immunization drive with J&J at a time when it was tough to schedule a Pfizer or Moderna vaccination.

As far as I know, I've never contracted COVID. Some lifestyle factors are relevant -- I'm able to work from home several days a week and I generally am an introvert who doesn't go out much -- but I would also take the clinical data cited by flug into account.
posted by virago at 4:22 AM on January 8, 2024 [2 favorites]

PS So my first two doses were J&J*, and my subsequent three doses were the mRNA vaccines.

*J&J is no longer available in the US; Novavax is the only option for people in the US who want to avoid mRNA COVID vaccines.
posted by virago at 4:35 AM on January 8, 2024

If the choice is nothing or the original JJ, I would take that shot in a heartbeat. It's unlikely to cause any harm, and there is some level of potential benefit. Not as much as a new formulation, but not nothing either (just like people who got the original shots only are still somewhat protected by those).

If it was a choice between getting that now, or potentially getting a new one in a few months, that would be a harder decision for me, but it doesn't sound like you believe that would be the case.
posted by Dip Flash at 6:26 AM on January 8, 2024 [1 favorite]

Yes, I'd get it in your shoes on the theory that there are minimal downsides and at least some potential upside.

The one thing I would consider is when the annual peak tends to be where you are, and whether it would make sense to wait a bit and time the J&J shot for stronger protection during that time. But if the supply chain has been dicy enough that it might be now or never, I'd go for now over "wait and hope it's still available in the fall" or whatever the peak time for you might be.
posted by Stacey at 6:32 AM on January 8, 2024 [1 favorite]

Don't want to threadsit, but an additional factor here is that it's hard to say what availability is going to be like in the future. It may very well be a case of now or never (maybe not literally never, but maybe whenever it becomes possible to get boosters privately here, or whenever you travel overseas to where they are available). Given the woeful uptake of the last government-purchased doses, and also gestures pessimistically at the general state of the nation I'm sceptical that we're going to be seeing the government buying more Pfizer or J&J any time soon. Basically nobody seems to give a shit anymore.
posted by confluency at 7:19 AM on January 8, 2024 [1 favorite]

I think you sound like you have to grab any shot you can and can't afford to wait or be picky about it where you are.
posted by jenfullmoon at 8:03 AM on January 8, 2024 [3 favorites]

Response by poster: If I could ask a follow-up question, does the efficacy of J&J mentioned already take the new variants into consideration? The article that flug posted is from March 2022.

The only place I've found that offers shots is only doing so on Tuesday mornings between 9-12 so it means taking time off work, with no guarantees that the shots will actually be available. I am feeling discouraged.

But it does seem that even a small advantage is still an advantage so 🤷
posted by Zumbador at 9:44 AM on January 8, 2024

I looked on Google Scholar, but I couldn't find any studies on the J&J/Janssen COVID vaccine that take the new JN.1 variant into consideration.

My feeling is that the protection provided by the J&J vaccine is better than forgoing it and waiting possibly months for the supply to be renewed.
posted by virago at 10:42 PM on January 8, 2024 [2 favorites]

This Week in Virology Clinical Update has a regular section where they respond to listener questions. The question you asked here is right in line with other Covid questions they have gotten. I would suggest sending your question for Dr. Daniel Griffin: [e-mail] .
posted by gudrun at 12:39 PM on January 9, 2024 [1 favorite]