Thread by @DrEricDing

Folks—J&J vaccine is not “inferior”. It gives 100% protection against deaths just like Pfizer and Moderna ones. 72% in US overall—but was tested in a different era with more variants. And faster deployment for poorer areas, but worries about perception. 🧵washingtonpost.com/health/2021/03…

2) “Decisions to send the shots to harder-to-reach communities make practical sense, because j&j single-shot vaccine is easier to store/use. But they could drive perceptions of a two-tiered vaccine system, w/ marginalized communities getting what they think is inferior product.

3) “The issue came up on a recent call between governors and Biden administration officials coordinating the country’s coronavirus response. Gov. Charlie Baker, stressed the need for prominent health officials to communicate clearly about the benefits of the one-shot vaccine

4) “The Johnson & Johnson vaccine proved safe and effective in a clinical trial, completely preventing hospitalization and death, including in South Africa against a more transmissible variant.

5) “When moderate cases were included, however, it was 66 percent protective, compared to efficacy of more than 90 percent reported for a vaccine jointly developed by U.S. pharmaceutical giant Pfizer and German biotech firm BioNTech and one from U.S. biotech company Moderna...

6) “Trials were conducted at different points during the pandemic, and in different countries with different transmission rates, which makes head-to-head comparisons impossible.”

7) “The apparent differences, Baker said, could nonetheless create uncomfortable questions for state and local leaders promoting the new vaccine to people who might ask, as one person paraphrased his comments, “Why didn’t you give us the good stuff?”

8) ““J&J is going to be a challenge for all of us,” WA Gov Jay Inslee.
In N Dakota, which has achieved one of the fastest rates of inoculation, Gov. Burgum said the new product intensified concerns not just about “vaccine hesitancy, but the potential for brand hesitancy as well.”

9) “The problem has been on display in Germany, where some residents are shunning shots developed by AstraZeneca in favor of those made by Pfizer-BioNTech, because of the different levels of protection reported in clinical trials, according to officials there.

10) “If we end up with a hierarchy that says all rich White people get Pfizer, and all poor Black people get J&J, that would be a problem,” said Helene D. Gayle, president and chief executive of the Chicago Community Trust

11) Also let’s look at the direct data given to the FDA... For severe outcomes it was 85% with 95% CI upper bound up to 96.9%. Hence it overlaps with the higher values for Pfizer and Moderna. This lower value seen for J&J could still be roughly comparable!
fda.gov/media/146219/d…

12) I literally design trials as one of the things I do as an epidemiologist, just like @VincentRK. If these are the results in a regular trials 85% vs 94-97%, I would not say J&J is inferior. (Besides, non-inferiority trials take a long time to do to truly prove not inferior)