Those who got J&J’s COVID vaccine should seriously consider a Pfizer or Moderna booster, experts say

More than 16 million Americans rolled up their sleeves last year to get Johnson & Johnson’s COVID-19 vaccine because it promised to be a “one and done” shot.

But months after federal officials recommended they get a second shot to be adequately protected, newer information and booster authorizations suggest they should consider a third dose.

“My recommendation would be for someone who received a J&J dose last year to go ahead and get two doses of (either the Pfizer-BioNTech or Moderna) vaccine, especially if the individual is in what we consider a high-risk group,” said Brian Dixon, an epidemiologist at the Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health.

Dixon led a new study that found people who got a single J&J shot or one shot and a booster were less protected against a serious case of COVID-19 than those who received two initial doses and a booster of the Pfizer-BioNTech or Moderna vaccine. 

On Tuesday, two federal agencies authorized additional booster doses of Pfizer-BioNTech and Moderna vaccines for anyone 50-and-older, as well as people of any age with weakened immune systems. They are entitled to boosters at least four months after their most recent dose.

Neither agency mentioned J&J recipients specifically, though they are entitled to the extra booster.

Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, said he thinks people of any age who got an initial dose of J&J needs a second booster.

“If they received one dose of the J&J, they should get two additional doses,” he said.

Moss said he understands why those who got the J&J shot would feel disappointed and upset about the new study and booster authorization.

“This issue was not addressed head-on (by federal agencies) and it needs to be,” Moss said, adding he hopes it will come up during an April 6 Food and Drug Administration advisory committee meeting. “The FDA and CDC have kind of left the J&J folks out to dry a little bit without really weighing in on this with specific recommendations.”

The Pfizer-BioNTech and Moderna vaccines, which have been given to more than 190 million Americans, are based on mRNA technology. When someone receives an mRNA shot, their own cells are directed to make a protein found on surface of the virus that causes COVID-19.

The J&J vaccine uses a different, harmless virus to deliver the same protein, which trains the immune system to recognize and attack if the coronavirus actually arrives.

Early trial data suggested the J&J vaccine wasn’t as protective as the mRNA shots, but officials said it was just as good as the others because it only required a single dose.

Now, it’s clear multiple doses are needed for adequate protection.

A pharmacist holds a vial of the Johnson & Johnson COVID-19 vaccine at a hospital in Bay Shore, New York

Last fall, the FDA and Centers for Disease Control and Prevention recommended everyone who received an initial dose of J&J get a second shot at least two months after the first and to prefer a non-J&J vaccine as a booster.

At the time, immune responses to the different vaccines suggested the mRNA vaccines would be more effective. The new research from Dixon and colleagues at the CDC shows that one or two J&J shots prevented far fewer serious infections than the other vaccines.

In a study of 80,000 people who visited emergency departments or urgent-care facilities for COVID-19 infections, receiving a single dose of J&J prevented only 24% of visits compared to being unvaccinated. 

Two J&J doses prevented 54% of visits and one J&J shot plus one of the other vaccines prevented 79% of ER visits. Three mRNA shots (the original course plus one booster) prevented 83% of ER visits.

Among 25,000 hospitalizations for COVID-19, one shot of J&J prevented 31% of hospitalizations, two prevented 67%, mixed doses prevented 78% and three shots of Moderna or Pfizer-BioNTech prevented 90% of hospital visits compared to those who were unvaccinated.

A substantial majority of those requiring treatment were unvaccinated.

Bradley Sharp, of Saratoga, New York, gets the Johnson & Johnson vaccine from registered nurse Stephanie Wagner in New York.

Dr. Dan Barouch, who helped develop the J&J vaccine, said he still thinks its advantages will appear over time.

Barouch, who directs the Center for Virology and Vaccine Research at Brigham and Women’s Hospital in Boston, said some data indicates J&J recipients will be protected longer than those who only received an mRNA vaccine.

Earlier in the pandemic, more people who received just the J&J shot got COVID-19 than those who received an mRNA vaccine. But since December, with the rise of omicron, some data suggests J&J recipients have been better protected, he said.

Barouch agrees that everyone who got a J&J shot and then a booster probably needs another one. “The question is when,” he said. “Is there an urgency to do so now? That might depend on who you are.” 

People who are older, have weakened immune systems or have health conditions such as diabetes, may want to get that second booster now, regardless of which vaccines they’ve already received, Barouch said, echoing recommendations from the FDA and CDC.

“For the general public or a healthy 50-year-old,” he said, “the case is not entirely clear.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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