Which COVID-19 Vaccine Is Best for You, Pfizer, Moderna, Johnson & Johnson or AstraZeneca?

President Biden said that all adults in the U.S. would be eligible for a vaccine by April 19, accelerating the timeline he announced last month. This means that millions of people will have the chance to line up for their shot in less than three weeks.

You might have already decided that you prefer one COVID-19 vaccine over another based on the characteristics of each of the options.

But the question of which vaccine is “best” doesn’t have a straightforward answer. Considering the data we have available now as well as available vaccine supply, the vaccine that’s best for you is likely the vaccine that’s available to you.

COVID-19 Vaccine types

• Pfizer and Moderna: The first two COVID-19 vaccines to be greenlit in the United States use messenger RNA (mRNA).

The material from the vaccine quickly disintegrates and never enters the cell’s nucleus, so it can’t alter the recipient’s DNA. The presence of the harmless spike proteins triggers the immune system to create antibodies and activate T-cells that mount an immune response.

The Pfizer vaccine requires two doses administered 21 days apart and the Moderna vaccine requires two doses 28 days apart.

• Johnson & Johnson: The third vaccine to receive emergency use approval in the United States uses another relatively new vaccine technology that tweaks a harmless adenovirus — a type of virus that causes a common cold — to deliver the coronavirus spike protein instructions.

The Johnson & Johnson vaccine requires only one dose.

• AstraZeneca: This vaccine is not yet approved in the United States, but it’s manufacturers plan to seek approval in the coming weeks. It works in a similar way to the Johnson & Johnson vaccine, except it uses a reengineered adenovirus that typically infects chimpanzees.

The AstraZeneca vaccine currently requires two doses given four weeks apart, but there is some uncertainty about how far apart the doses can be administered.

Effectiveness of COVID-19 Vaccines

Efficacy data depends on many factors, including when and where the clinical trials took place.

Some have speculated that the Pfizer and Moderna vaccines — with their roughly 95% efficacy rates in clinical trials — are better than the Johnson & Johnson vaccine (66% efficacy) and the AstraZeneca vaccine (76% efficacy).

But comparing the different vaccines’ efficacy rates is sometimes like comparing apples and oranges, according to Anna Durbin, MD, as stated on aamc.org.

In fact, experts say that the Johnson & Johnson vaccine has some advantages over the mRNA vaccines, including that it does not require ultra-cold storage and can be given as a one-dose regimen.

The Centers for Disease Control and Prevention (CDC) says that a person can consider themselves fully vaccinated two weeks after the single shot of Johnson & Johnson or the second shot of Pfizer or Moderna.

Side Effects Of COVID-19 Vaccines

All the COVID-19 vaccines currently authorized by the FDA for emergency use include commonly reported side effects of pain/soreness at the injection site, headache, fatigue, muscle aches and nausea, which usually fully subsided within one to two days after vaccination.

The Moderna and Pfizer vaccines include some additional commonly reported side effects, such as chills, fever, joint pain and swollen lymph nodes. These side effects were more often reported after the second dose, though they are possible after either dose.

Since the Johnson & Johnson vaccine doesn’t require a second dose, there’s no increased risk of common side effects with a second dose.  Only the commonly reported side effects with first dose would apply.

Anaphylaxis is a very uncommon but potentially life threatening reaction to a vaccine.  People who develop anaphylaxis must be treated with epinephrine — the medication in EpiPens — and may need to be hospitalized to ensure their airways remain open. The CDC says people should be monitored for 15 minutes after getting a Covid-19 shot, and 30 minutes if they have a history of severe allergies.  Monitoring allows recently vaccinated persons to remain in a safe environment during the time anaphylaxis is most likely to occur – within 15 to 30 minutes of the injection.

Are the Vaccines Safe and Can They Cause Blood Clots?

There is a concern that came up with the AstraZeneca vaccine that resulted in several countries pausing or limiting its use due to reports of blood clots.

The European Medicines Agency (EMA) said Wednesday (April 7, 2021) that a particular combination of unusual blood clots with low blood platelet counts should be listed as a side effect of the vaccine, but stopped short of recommending its use be limited. The benefits of the shot outweigh the risks and Covid-19 is a “very serious disease,” it added.

Some countries, including Canada, France, Germany and the Netherlands, have suspended the use of the AstraZeneca vaccine in younger people while the investigations continue.

However, some experts are saying not all adverse reactions that happen around the time of vaccination are caused by the vaccine. As people with underlying conditions — particularly older individuals — receive a vaccine, heart attacks or strokes will happen and could be coincidental.

In fact, the number of people who have experienced blood clots after being vaccinated by the Astra Zeneca vaccine in that country is lower than what would be expected proportionally in the everyday population.

Do the Vaccines Protect Against the Variants?

The optimism that came with the approval of COVID-19 vaccines in late 2020 was tempered by the emergence of several coronavirus variants that had mutated to be more contagious, deadlier, and potentially able to evade the vaccines.

But the data so far suggest that currently available vaccines work well against the variants.

The World Health Organization says that the vaccines are likely to provide at least some protection against each of the variants because they prompt a broad immune response beyond just targeting the spike protein that is the focus of the vaccines.

The Bottom Line With COVID-19 Vaccines

According to Andrew Thomas, MD from osu.edu, we are trying to prevent:

• COVID-19 infection
• COVID-19 transmission
• Severe COVID-19 cases that would require hospitalization or cause either long-term effects or death.

Every vaccine available right now is much more effective than no vaccine, and they all significantly reduce the likelihood of severe illness and death.

This means that even on the chance that someone gets infected after receiving a COVID-19 vaccine, they’re less likely to spread it to others and less likely to end up in a hospital’s intensive care unit.

Mark Mulligan, MD also told readers on aamc.org: “What I tell my patients and family members is to take whatever vaccine you can get. They are all highly effective. You can’t really make any discernment from one to another.”

A saying this author has heard many times over the last little while is, “The best vaccine is the one you can get right now.”

It is still a race between vaccination and variants. The key to ending the pandemic is getting vaccines administered to people across the globe. As of March 30, 2021 there had been only 7.4 vaccine doses administered per 100 people globally, and many low-income countries had not yet administered a single dose.

References:

• aamc.org
• statnews.com
• osu.edu
• nytimes.com
• cnn.com