Should people who got a J&J shot be getting a follow-up shot from Moderna or Pfizer?

From the start, J.&J.’s single-shot vaccine has appeared to be less effective than the two-shot vaccines from Moderna and Pfizer. The J.&J. shot still provides good protection against serious illness, but not as much as the others. And the Delta variant may be widening the gap.
Federal officials have suggested they are likely to approve a booster shot for J.&.J recipients eventually. But any approval seems to be weeks away, if not months.
Regardless, many J.&J. recipients are less interested in receiving a second J.&J. shot than in getting a follow-up shot with either the Moderna or Pfizer vaccine — sometimes known as a “mix-and-match” approach.
Many experts believe that this approach will be effective, maybe even more effective than two shots of the same vaccine. Britain has used this strategy, giving many people who received the AstraZeneca vaccine (which is similar to J.&J.’s) a second shot with Moderna’s or Pfizer’s.
But there is still not much data on the benefits or the risks of combining a J.&J. shot with a different vaccine.
Numerous doctors and experts who themselves received the J.&J. vaccine aren’t waiting for the government to act. They have gotten a follow-up Moderna or Pfizer vaccine. San Francisco also began offering a Moderna or Pfizer booster shot to J.&J. recipients about a month ago.
When Rochelle Walensky of the CDC was asked whether she considered it a mistake for J.&J. recipients to pursue a Moderna/Pfizer follow-up shot, she said, “Not with what I’ve seen so far.” From the head of a notoriously cautious agency, that was a remarkable and telling statement.
Getting a follow-up shot with the Moderna or Pfizer vaccines may not be easy. Doctors often refuse to give them. Many people are understandably frustrated: It can feel like there is one set of rules for people with medical connections and another set of rules for everyone else.
Still, if you want a shot, you have a few options. You can try different drugstores, hoping to find one willing to give a Pfizer or Moderna shot to a J.&J. recipient — or one that won’t ask about your history. You can also choose to be less than fully honest. You won’t be alone.
The case for: The available evidence suggests you will benefit. There are no signs of worrisome side effects so far. And the Delta variant is bad. By waiting, you may be allowing bureaucratic caution to get in the way of your health.…
The case against: A single shot of J.&J. still provides good protection, and the government may soon allow a second shot. There is not yet rigorous data on mix-and-match with J.&J. And you may need to resort to some deviousness to get another shot.…
I understand why so many people are flummoxed.


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More from @DLeonhardt

15 Sep
In California, Covid caseloads and hospitalizations, which were already well below the national average, have been falling for about two weeks….
… If anything, statewide comparisons understate the power of the vaccines; every state, including California, has areas with relatively low vaccination rates. When you instead look at California on a county basis, the picture is striking….
Check out the strong relationship between vaccination and hospitalization rates in California’s countries.… Image
Read 5 tweets
10 Sep
The current Covid situation is grim: very high caseloads, full ICUs, more than 1,500 deaths a day.

Amid this grimness, there are three reasons for some hope:

1. The vaccines continue to be highly effective against serious illness.

Seattle - a highly vaccinated place - is telling. Over the past *month*, the death rate for fully vaccinated people has been about 1 in 100,000, and the hospitalization rate has been 5 in 100,000.
2. The Delta surge has led to more aggressive actions on vaccine mandates. And vaccine mandates tend to make a big difference.

Some evidence on their effectiveness:…
Read 10 tweets
9 Sep
The Delta variant is clearly more contagious than earlier Covid. But does Delta also cause more severe illness in the average person who's infected?

1. We don't yet know.
2. The evidence so far suggests Delta is similarly severe - maybe a little more, maybe a little less.

This question is especially relevant to kids and vaccinated adults. In both, earlier versions of Covid were overwhelmingly mild. If Delta is not more severe, then that's still true.

If Delta is more severe, it calls for a much more cautious approach.
What are the reasons to think - tentatively, until we get more evidence - that Delta is not fundamentally different in severity from earlier versions?

Read 11 tweets
1 Sep
What explains Covid's mysterious Two-Month Cycle?

In one country after another, the number of new cases has often surged for roughly two months before starting to fall. The Delta variant, despite its intense contagiousness, has followed this pattern.

* After Delta took hold last winter in India, caseloads there rose sharply for slightly more than two months before plummeting at a nearly identical rate.

* In Britain, caseloads rose for almost exactly two months before peaking in July.
* In Indonesia, Thailand, France, Spain and several other countries, the Delta surge also lasted somewhere between 1.5 and 2.5 months.

* In the U.S. states where Delta first caused caseloads to rise, the cycle already appears to be on its downside....
Read 12 tweets
25 Aug
Too much Afghanistan commentary suffers from naïveté. It lacks critical thinking, as one journalist said to me.

Bottom line: Did Biden make mistakes? Clearly. Was there a clean way to leave? Almost certainly not.

🧵 to follow...

Longer version:…
A lot of commentary presumes that there was a clean solution for the U.S., if only Biden (and, to a lesser extent, Trump) had executed it. The commentary never quite spells out what the solution was, though.

There is a reason for that: A clean solution probably did not exist.
The fundamental choice, as @helenecooper says, was between a permanent, low-level U.S. war in Afghanistan — a version of what McCain once called a 100-year war — and a messy exit.

“It was always going to be an ugly pullout," Helene says.
Read 16 tweets
24 Aug
The much-celebrated impact of full F.D.A. approval - new mandates from the military, colleges, companies, local governments - has a flip side: The months-long wait to reach this point has almost certainly cost American lives. 🧵…
FDA officials have suggested that they had no choice to move as cautiously as they did. But that's not the case. They did have a choice. They picked caution.
There are two basic ways to see that the F.D.A. could have acted more quickly than it did:

1) The agency has acknowledged that it moved more quickly in this case than normal. A typical vaccine approval process takes between 8-12 months; this one was 3.5 months.
Read 11 tweets

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