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Coronavirus Update 121: Johnson and Johnson Vaccine - Efficacy and Safety vs. Pfizer & Moderna - YouTube
Channel: MedCram - Medical Lectures Explained CLEARLY
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Kyle Allred, MedCram Co-Founder and Producer: Dr. Seheult, vaccine shortages聽
are a big story right now,聽聽
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and certainly getting more people vaccinated is聽
a key part of getting us out of this pandemic.聽聽
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There's been some big news this past week with聽
Johnson & Johnson releasing preliminary data聽聽
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about their vaccine candidate. Tell us more about聽
that.
Dr. Seheult: Yeah, so on January 29th Johnson & Johnson and聽聽
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Janssen Pharmaceuticals released some preliminary聽
data on their phase 3 trials on their new vaccine聽聽
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candidate. We want to go through that data and聽
specifically how it relates to the other two聽聽
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vaccines that have already received early-use聽
authorization from the FDA here in this country.聽聽
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But before we get into that, let's talk about the聽
mechanism on how this new vaccine works. Now each聽聽
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person has about 37 trillion cells in their body,聽
and this screen is zoomed in way into just one of聽聽
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those cells. Here we have the cell right here. This聽
is the membrane of the cell. This area here is the聽聽
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cytoplasm, and this area here is the nucleus of聽
that cell. Now do vaccines work on just one cell of聽聽
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your human body? No, they work on a number of cells聽
and that's kind of dependent on the dose, but what聽聽
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we're going to do here is show what a vaccine does聽
to a single cell, and then you can multiply that.聽
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And whereas before with Pfizer-BioNTech and Moderna聽
they use lipid droplets to get the messenger RNA聽聽
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into the cells, this works a little bit differently.聽
So let's go through the steps. As we can see here聽聽
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in step number one in the laboratory, what聽
they've done is they've taken an adenovirus聽聽
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which can infect cells on its own -- has all the聽
machinery to do that -- and simply what they've done聽聽
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is they've taken the DNA inside of the adenovirus,聽
and they've spliced in the information for that聽聽
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spike protein that is on the surface of the聽
SARS-Cov-2 virus. And so here we have information聽聽
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for the cell to make the spike protein for the聽
SARS-CoV-2 virus, but it's encoded into a double-聽聽
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stranded DNA segment in the adenovirus itself.
And so this takes place in the laboratory and the聽聽
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vaccine is made. Now when they do this they take聽
out the parts of the DNA in the adenovirus that聽聽
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allows it to replicate. And so this virus, when it聽
infects the cell as the vaccine, will not be able聽聽
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to replicate. So the proteins on the surface聽
of the adenovirus are still able to interact聽聽
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with the proteins on the surface of human cells,聽
which then allows it to infect, as we can see here,聽聽
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the strand of DNA in the virus which is聽
supposed to go off to the nucleus and does聽聽
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and would normally tell the cell to make more聽
adenovirus particles, instead makes a messenger RNA聽聽
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that gets transported out into the cytoplasm where聽
the cell machinery, instead of making adenovirus聽聽
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particles like it would normally would, is now聽
going to make SARS-CoV-2 spike proteins and the聽聽
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same happens exactly as we would see from this聽
point on in the Pfizer or the Moderna vaccine.聽聽
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So the difference here is that we're actually聽
using an adenovirus as the mechanism or the聽聽
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vehicle to get the information into the cell.聽
That's the first difference here with the Johnson聽聽
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and Johnson vaccine. By the way this is also very聽
similar to how the Oxford-AstraZeneca vaccine聽聽
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works. The other difference here is that this is a聽
DNA particle that is going into the nucleus of the聽聽
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cell. Again, very similar to the Oxford-AstraZeneca聽
vaccine, making the messenger RNA and then on to聽聽
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the SARS-CoV-2 spike protein.
Kyle: Okay, now we have聽
a better understanding of how this vaccine works.聽聽
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I think what people really want to know is how聽
does this vaccine stack up to Pfizer and Moderna聽聽
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and AstraZeneca?
Dr. Seheult: Kyle, based on what we're seeing聽
here with this data, I would caution again,聽聽
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this is not published, peer-reviewed data, but the聽
data that we've been given is actually somewhat聽聽
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encouraging. There are some caveats to this, and聽
you have to dive deep into the numbers to get the聽聽
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information that you need. First thing off is聽
that it's a one-time shot. It's not like there's聽聽
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two shots like you need with the Moderna and the聽
Pfizer vaccine. If you look at the efficacy and聽聽
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how they define it. The definition of efficacy聽
here is that the patient did not get "moderate"聽聽
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or "severe disease," so "mild" was okay in terms of聽
the definition of efficacy. Now it's different聽聽
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in the other types of vaccine studies that we've聽
looked at with Pfizer and Moderna, whereas any kind聽聽
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of symptoms is what they wanted for efficacy. So if聽
you look at the efficacy of Pfizer and Moderna,聽聽
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that was 95 and 94, respectively, but remember聽
these were done at a time when the prevalence聽聽
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of variants, like the UK variant, the South African聽
variant, and the Brazilian variant, were not really聽聽
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that prevalent. And so what's kind of stacked聽
against the Johnson and Johnson candidate here聽聽
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is that they did their studies when there was much聽
more prevalence of these variants, and in fact they聽聽
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did the studies in those very countries on purpose聽
where those variants were, so it's going to be聽聽
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interesting to see how that pans out here. But if聽
we look at the numbers and we try to compare them聽聽
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as best as we can -- 95 for Pfizer-BioNTech, 94 for聽
Moderna, and 66 overall percent efficacy for the聽聽
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Johnson & Johnson -- but if you look deep down into聽
that and you look and see which countries they聽聽
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were in, you'll start to see that for instance in聽
the United States there was a 72 percent efficacy,聽聽
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where there's not a lot of variance in Latin聽
America it was 66 percent, and then of course聽聽
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in South Africa, where that worrisome variant聽
is in high prevalence, about 95 percent. There聽聽
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was 57 percent efficacy there, and so that on one聽
hand, on first blush, looking at that you're like聽聽
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"well that this is kind of a disappointment." But in聽
fact, this vaccine actually gets better with age.聽聽
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So if you look at the data a little聽
bit deeper, you'll see that at day聽聽
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28, overall, there was an 85 percent efficacy聽
in terms of preventing severe COVID that means聽聽
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hospitalization and death. Okay, and聽
that's really what the the whole purpose of聽聽
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trying to get this pandemic under control is is:聽
to prevent severe COVID-19 that causes you to聽聽
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go to the hospital and die. But what's really聽
interesting about this, Kyle, is that as the聽聽
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antibodies start to be produced, it's felt that聽
by day 49 -- okay, so 49 days after the vaccination聽--
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and again there's only one shot here, there was聽
100 percent efficacy that was preventative at severe COVID聽聽
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and also hospitalization. So nobody by day 49 was聽
hospitalized or had severe or died of severe COVID-19,聽聽
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even in places like South Africa where the South聽
African variant was very high, and I think that's聽聽
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very encouraging news.
Kyle: We've talked before about聽
how mild side effects are relatively common with聽聽
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the COVID-19 vaccines that have been authorized聽
so far -- pain at the injection site, maybe some fever,聽聽
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feeling fatigue -- how do the adverse effects聽
stack up with the Johnson & Johnson vaccine聽聽
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versus the other ones that have been authorized聽
so far?
Dr. Seheult: So the Johnson & Johnson vaccine, Kyle, it's聽聽
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kind of interesting. The serious adverse events聽
were actually very low. In fact, they were lower聽聽
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in the intervention arm. So those people that聽
actually got the vaccine had lower adverse events,聽聽
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serious adverse events, than those in the placebo聽
arm, and so it's a question, why would that be? Well,
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it may have been statistically or instatistically聽
significant. What they believe is it could be聽聽
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related to the fact that those in the placebo arm聽
were unprotected from getting COVID-19 and so聽聽
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there may have been some idea, but maybe the聽
effects of the COVID-19 that they got may have聽聽
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been increasing the serious adverse events, like聽
fever and the symptoms that you would get from聽聽
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from getting COVID-19. But it brings a bigger聽
point, here, is that here's a vaccine that is聽聽
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a one-shot. It doesn't need special refrigeration聽
and it appears as though it may actually have less聽聽
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side effects than the other vaccines, but we don't聽
know that because it wasn't a direct comparison聽聽
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in this vaccine compared to the other vaccine.聽
So we can't say that it has less than the other聽聽
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vaccines, but we could say that it's pretty low,聽
pretty low profile of serious adverse events.聽聽
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Kyle: Of course, scaling this vaccine up and having聽
it fill the gap increase the supply in聽聽
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the United States is a priority. It's a priority聽
for every country around the world right now.聽聽
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So what do we know about cost of this vaccine?聽
Dr. Seheult: Yeah, so Johnson & Johnson has been committed, and聽聽
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they've they've said this in black and聽
white print, that they are committed to聽聽
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using this and producing this in a non-profit聽
way, so that it can be distributed to the world聽聽
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as quickly and as inexpensively as possible. Kyle: Do we聽
know anything about this vaccine and its ability聽聽
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to block transmission or the spread of COVID-19
to other people?
Dr. Seheult: No, we have not gotten that聽聽
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type of information at this point. You know, one of聽
the ways that we learned about that with the, for聽聽
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instance, the Moderna vaccine was that there was a聽
special screening done at the second dose of the聽聽
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Moderna vaccine, and it was based on that data聽
that they were able to come up with about a 67聽percent
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reduction -- two-thirds reduction -- in asymptomatic聽
transmission with the Moderna vaccine.聽聽
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Obviously, there's no second dose here with the聽
Johnson and Johnson, so I think we're going to be聽聽
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waiting for more data. There's probably going to聽
be some blood tests and things of that nature聽聽
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if we want to look at that with the Johnson and聽
Johnson vaccine.
Kyle: Okay, Dr. Seheult, I'm going to put聽聽
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you on the spot here. If you had a family member or聽
friend come to you and say, "all right there's two聽聽
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vaccines in the United States that have been given聽
emergency-authorization. There's a couple other聽聽
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viable candidates: There's AstraZeneca, there's聽
this Johnson & Johnson. Which vaccine should I
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get?
Dr. Seheult: You should get the vaccine that you could聽
get into your -- if you choose to get the vaccine聽--
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you should get the vaccine that you can聽
get into your arm as quickly as possible.聽聽
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Look, thousands of people are dying every day聽
here in the United States from COVID-19, and聽
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hundreds of thousands of people are coming down聽
with SARS-CoV-2 infections every single day.聽聽
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So the one that's going -- all of these work聽
effectively at preventing the worst outcome,聽聽
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which is hospitalization and death. I would hate聽
to see somebody wait to get the vaccine that they聽聽
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think was better and in the interim come down with聽
a case that could be fatal. That would be a waste,聽聽
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in my opinion. So the reason why there's so many of聽
these is because we need so many vaccines. 聽聽
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We can't just depend on one type of vaccine. So I'm聽
glad there's different ones. It's another tool聽聽
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in our toolshed in the fight against COVID-19. I
would say sign up and whichever one is closest to聽聽
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you in terms of timing, get that one. Don't forget聽
to check out our other videos at MedCram.com,聽聽
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and check out my interview with Lewis Howes at聽
the School of Greatness. Thanks for joining us.
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