A certified medical assistant prepares doses of the Pfizer-BioNTech COVID-19 vaccine at a vaccination center at the University of Nevada, Las Vegas. The US took a major step in the pandemic this week by clearing the Pfizer vaccine for youth ages 12-15. (Image via AP Photo/John Locher, File) Vaccine Rollout Continues
A certified medical assistant prepares doses of the Pfizer-BioNTech COVID-19 vaccine at a vaccination center at the University of Nevada, Las Vegas. The US took a major step in the pandemic this week by clearing the Pfizer vaccine for youth ages 12-15. (Image via AP Photo/John Locher, File)

A third COVID-19 vaccine made by Johnson & Johnson could be approved by the FDA soon, and make it easier to vaccinate people in rural areas of NC.

Amid a vaccine rollout  in North Carolina hindered by delays and limited supply, the two vaccines currently in circulation could be getting some needed reinforcements.

A vaccine produced by Johnson & Johnson is in its final trial, the results of which are expected to be released any day now. If the results show the vaccine to be safe and effective, the US Food and Drug Administration could soon grant it emergency approval, which would start the widespread manufacturing and delivery process. 

But, the excitement for this particular vaccine is not just because it can backup the Moderna and Pfizer vaccines, which requires two doses each. The Johnson & Johnson vaccine’s design could make it easier to store and administer. That eventually may speed the journey from manufacturer into waiting arms, especially in NC’s rural areas.

A Single Dose, With Caveats

The most crucial aspect of Johnson & Johnson vaccine is that it could be only one dose. 

Some initial trial results showed that a single dose of the Johnson & Johnson vaccine produced significant immune responses. In the limited data set of the initial trials, Johnson’s single dose ranges from 70 to 90% effectiveness. The data that Johnson & Johnson said it would release this month will offer a clearer picture of the single dose’s effectiveness, or efficacy.  In comparison, Moderna and Pfizer’s two doses are 95% effective in preventing a COVID-19 infection, their complete trials showed. 

You have questions about the vaccine. We have answers. Check out Cardinal & Pine’s ongoing coverage of the vaccine campaign.

Anupama Neelakanta, an infectious disease physician at Charlotte’s Atrium Health, told reporters Thursday that even if the one dose Johnson and Johnson vaccine falls short of the Moderna and Pzifer vaccines, it can still do a lot of good in a disease that has killed more than 9,000 North Carolinians since March.

“Even a 70[%] efficacy in protecting systematic disease goes a long way,” she said.

If the single dose of the Johnson & Johnson vaccine is effective, it is likely a double dose will offer more protection, especially long term, said Sam Fazeli, a journalist who covers the pharmaceutical industry for Bloomberg, told the the publication’s editorial board.

“How long the protection lasts will not be known for a long time, but the [preliminary results] are promising and suggests a single dose is sufficient, at least in the near term,” he said. “But there is an open question about whether a second dose would be better over the long term.”

How the Vaccines Work

The science behind vaccines is complicated, of course, but it all comes down to subterfuge and snitches.

All three of the COVID vaccines find a way to mimic the DNA of the virus’s signature spike protein, which it uses to latch on to and infiltrate cells, and to pass that intel to the body’s defense systems. In this way, the vaccine acts as an informant working for the other side. 

It triggers a body’s immune system to immediately recognize the signature DNA if the virus ever comes sneaking around and to unleash an all out assault before the virus can latch on to the cells.

The Moderna and Pfizer vaccines use single-strand messenger RNA to mimic the spike protein. This method is very effective, but it makes the vaccine fragile. The doses have to be stored at extremely cold temperatures, requiring the use of industrial strength freezers many medical facilities don’t have.

The Johnson & Johnson vaccine, however, mimics the spike protein by using double stranded DNA and inserting it into a virus that causes the common cold. This Trojan virus is robbed of its ability to make anyone sick, but the immune system attacks it and remembers the signature DNA, laying in wait for the novel coronavirus.

This method, which is also used in vaccines for Ebola, Zika, and other serious viruses, can be safely stored in a simple refrigerator for at least two years, Johnson & Johnson officials say.

“We believe this stability will help make it easier to transport and distribute our COVID-19 vaccine candidate without the need for shipping at special temperatures,” Dr. Mathai Mammen the global head of Janssen Research & Development, an arm of Johnson & Johnson, said on the company’s website.

The special freezers have had to be shipped to all vaccination sites for the existing vaccines, adding outsized cost and burden. Nearly all medical facilities have refrigerators. 

Why a Single Shot Will Help Rural Areas

NC has been short of vaccine supplies across the state, but the problem is especially acute in rural areas, many of which are simply not equipped to deliver large numbers of vaccines in a short period of time. 

Avoiding the extra logistical burdens of double doses and expensive freezers could make huge differences in the ability to more efficiently inoculate these areas, where the community spread is already in the highest level of urgency.

There are several logistical issues that can make a two-dose vaccine program onerous to enact, especially when trying to vaccinate an entire country quickly.

The body needs time to adjust between vaccines, a break that exacerbates supply and scheduling problems.

The optimal time frame between doses sits at three weeks for the Pfizer vaccine and four weeks for Moderna, Dr. Neelakanta said. Federal officials say that efficacy should remain up to six  weeks between doses. But there are few promises that the supply will endure across the break or those who get dose one will be able to get scheduled in time.  

There is also the risk that someone might get sick between the doses, with COVID or any other ailment, which would tax their immune system and make them have to delay the second dose. 

None of these are issues if there is only the one dose.

And then there is the matter of simple math. Shipping a million doses of the Moderna and Pfizer vaccines, incoulates only half a million people. A million does of the Johnson & Johnson vaccine however, could cover them all.

In its initial projections, Johnson & Johnson said it hoped to ship 100 million doses in the US by the end of the year.