Third Coronavirus Vaccine Option On The Way

With doses of a new vaccine possibly arriving in California within days, health officials are pondering how best to deploy the still-scarce resource and whether to offer people a choice in the type of shot they get.

The U.S. Food and Drug Administration gave emergency authorization to Johnson & Johnson's COVID-19 vaccine on Saturday, and California Gov. Gavin Newsom on Monday said the state could receive about 300,000 doses this week.

But it's not clear whether the millions of residents still waiting to be inoculated will get to select from among the new Johnson & Johnson vaccine and the ones from Pfizer and Moderna that have been in use since mid-December.

Besides helping ease the vaccine supply crunch over time, officials have several reasons to welcome the arrival of vials from Johnson & Johnson.

In Los Angeles County, Department of Public Health Director Barbara Ferrer said last week she was looking forward to FDA approval of the Johnson & Johnson vaccine because it represents two important advantages.

"It doesn't require any freezers," Ferrer said. "That's good news because it makes it much more portable and allows many more sites to use it. And it's also

one dose."

Both Pfizer's and Moderna's vaccines must be stored at freezing temperatures until shortly before use. Prior to a new FDA advisory last week, the guidance was to keep the Pfizer vaccine in ultracold freezers that pop-up vaccine sites and most clinics don't have. Now, officials say, it can safely be kept in typical pharmaceutical freezers for up to two weeks.

The two-dose regimen prescribed by the Pfizer and Moderna vaccines requires that recipients return for a second shot: 21 days later for the Pfizer vaccine and 28 days later for the Moderna vaccine. The logistics, Ferrer said, create a burden on providers and those getting the vaccine.

Having a single dose without complicated storage needs will allow smaller settings, such as local clinics, more access to vaccine doses.

"Lots of people are going to be very happy when we start getting the Johnson & Johnson vaccine, where you come in once for your vaccination and you're done," Ferrer said.

Officials initially thought the one-dose option might be more appropriate for harder to reach people, such as homeless people who aren't in shelters and others who might be harder to track down for a second appointment, Orange County Health Care Agency Director Dr. Clayton Chau told county supervisors last week.

Orange County health officials said this week their plan is to offer people information about all three vaccines and then give them a choice when they schedule their appointment.

While officials stress that all three vaccine types are highly effective at preventing severe disease and death from COVID-19, an FDA analysis found Johnson & Johnson's vaccine doesn't do quite as well with preventing milder infections. In the United States, it was 72% effective at preventing COVID-19.

"We want the public to make an informed decision," Orange County Deputy Health Officer Dr. Regina Chinsio-Kwong said Monday. "I don't think we're going to go into the game of deciding for someone what they get."

Late last week, Riverside County public health officials said it is too early to tell if residents will get to choose which vaccine they receive because there are "extremely limited quantities" of doses on hand right now, and they don't know when the supply might increase.

Riverside County Health Officer Dr. Cameron Kaiser said the only reason Johnson & Johnson's efficacy is even a question is because Pfizer and Moderna have established such good track records.

"If the J&J vaccine had come out first, it would have been a slam dunk to go get it," he said.

San Bernardino public health officials said the question of a "choice" has not come up yet because the county doesn't know if and when it will get any of the new Johnson & Johnson vaccines. But officials are advising residents to accept whichever vaccine is available as soon as they become eligible to receive it.

The one thing people need to ensure is that their second dose is the same brand as the first, officials said.

To Chinsio-Kwong, holding the Johnson & Johnson vaccine up against Pfizer and Moderna is not really an apples-to-apples comparison, because the former was tested in countries where different variants of the coronavirus were circulating, and more data needs to be gathered on mRNA vaccines such as Pfizer and Moderna.

Most health experts stress that while people with concerns may want to consult their doctor, it's important for anyone who's eligible to sign up for whatever vaccine is being offered.

Vaccine "shopping" among the soon-to-be inoculated is sure to happen, but "there's the potential of really gumming up the works if people walk out of Disneyland (an Orange County mass vaccination site) because they didn't get the vaccine they wanted," said Andrew Noymer, epidemiologist and population health scientist at UC Irvine.

"The public health message is, take the first available vaccine that's offered to you," he said. "We've heard a lot about variants lately, and perhaps the most scary variant is the one that hasn't emerged yet. They emerge from mutations that occur while the virus is replicating in an individual. So, the ‘OG' (original) virus goes in, and a more dangerous variant comes out. The vaccines protect against the OG virus, which can stop it from turning into an even worse virus.

"What we need to do is vaccinate as many people as possible, as quickly as possible, using all the swords in the scabbard and arrows in the quiver," he said.

Chinsio-Kwong noted that typical vaccine efficacy is usually between 40% and 60%, and all three COVID-19 vaccines available in the U.S. do much better than that at preventing severe disease. They're also 100% effective at preventing hospitalization and death.

Noymer and other experts said whether people get to choose their vaccine may not be much of an issue in Southern California, with Pfizer and Moderna ramping up production while Johnson & Johnson is just getting out of the gate. (As of late February, about 1.4 million people were getting vaccinated a week statewide.)

While getting a third choice in any quantity will be a help, Orange County Supervisor Doug Chaffee said the continuing uncertainty about which vaccines and how many doses will be arriving has made it frustrating for local officials trying to plan and meet high demand.

"The main thing is let's just get some of this thing in stock," Chaffee said. "Then we'll worry about what to do with it."