Ethics around COVID vaccine shopping: Johnson and Johnson, Pfizer or Moderna?

Written by Amy Ta, produced by Rosalie Atkinson

Johnson & Johnson says it will ship out nearly 4 million doses of its COVID-19 vaccine this week — after the FDA authorized it for emergency use on Saturday. It’s a single shot and doesn’t need to be stored in special freezers. However, it’s slightly less effective at preventing severe COVID-19 symptoms than the two-shot Pfizer and Moderna vaccines.

That small difference in efficacy is opening big ethical questions. Will some people opt to wait for the Pfizer or Moderna vaccine? Will state and local governments unintentionally create a two-tiered vaccination system by sending the Johnson & Johnson vaccine primarily to communities with historically poor access to health care? 

KCRW talks about this with Brendan Parent, Assistant Professor of Medical Ethics at NYU Grossman School of Medicine.

KCRW: Dr. Anthony Fauci was on Meet the Press on Sunday, encouraging people to get any vaccine they can. However, some people appear to be hesitating on the Johnson & Johnson vaccine. Is that because of the efficacy difference? How important are these differences?

Brendan Parent: “That might be why people are hesitant, but it's not a good reason. The trials were done in different populations with different outcome expectations at different times, so you really can't compare them head to head. What's important is that all three of the vaccines are very effective at preventing severe illness and death. So if you get offered a vaccine, you take it. I'm on team Fauci for this one.” 

What do you say to people who want to wait for a more efficacious vaccine? 

“Because there isn't time to wait, we say these vaccines weren't tested on a sort of letter grade scale. It was pass/fail, right? And they all passed the test. And we don't really have the luxury of being able to pick and choose vaccines right now. We need to get everybody vaccinated now. And the best way to do that is to take what's available, especially because what's available works. And that includes the Johnson & Johnson vaccine.”

There’s apparently some discussion on a federal level that a two tier system might be unintentionally created if the Johnson & Johnson vaccine gets sent to places that historically don't have a lot of health care available, and don't have deep freezers that are needed for the other vaccines, and people might think they’re getting a substandard shot.

“We want to prevent that misconception, right? That the two tiered framing is just wrong. I think it's better to look at a couple other facts. One is the fact that Johnson & Johnson was tested later, gives us indication that it's protective against some of the new variants that are circulating, which might be more infectious.

… It's also a huge plus that it doesn't have to be stored as cold. It's one shot. And both of those features prevent it from being a logistics nightmare that is unfolding with the other vaccines that we see currently.”

Do you think anyone anticipated this hesitancy based on (perceived) efficacy? 

“Yeah, I don't think we can blame people, right? Because everyone wants to be protected. No one wants coronavirus. No one wants to be a victim here. And so it's important to have transparency regarding the numbers. So I think it's fair to expect the concern. But we have to do everything we can to educate people and try to influence everyone to take what is available, so that we can get closer and closer to herd immunity, especially at this pivotal moment, as we see these new strains popping up.”

When you talk about the ethics of it, people are thinking about not getting infected themselves, first and foremost. But should they also be thinking about other people (who they don’t know)? 

“I think someone can wear both a sort of public health policy hat — at the same time as looking out for their own interests and the interests of their family. 

… We need to create a community approach that looks out for everyone as well as possible. And we are doing that because the Johnson & Johnson vaccine wouldn't have been approved if it doesn't do its job right. So we need to complement this with education around the need to continue doing other things to prevent spread. 

… If somebody is really looking out for themselves, looking out for their family, what they would do is take whatever vaccine is available, continue to social distance, continue to wear a mask. And that's the best thing you can do. 

Waiting for another vaccine that might have a slightly higher efficacy rate in a completely different trial — would probably be the worst thing you can do because that subjects you and your family to greater risk.”

Shouldn't governments consider the perception of a lower efficacy? If they’re going to send the Johnson & Johnson vaccine to so-called medical deserts, shouldn't they anticipate some blowback and anger? Maybe they should instead put the Johnson & Johnson vaccine in other communities with more health care access? 

“Yes, absolutely. The public perceptions, regardless of what we say on the show or anywhere else, the perceptions exist, and we have to do our best to address them. So I do think it would be a mistake to only send the vaccine to these areas that are harder to reach. 

Send it everywhere that people are going to take it, right? And these so-called deserts aren't the only place that the vaccine could make a positive difference. Send it to hotspots. Send it to places where we see significant surges, where we see restaurants opening up too quickly. 

… The failing is … just not getting the vaccines that were already approved into these places, despite the technical challenges. We need absolutely to protect everyone, avoid the misconceptions, but really just just get shots into arms.”



  • Brendan Parent - assistant professor of medical ethics at NYU Grossman School of Medicine; director of transplant ethics and policy research