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Once dismissed as less effective, the vaccine now seems to be preventing infections and illness about as well as the two mRNA options. Roughly 17 million Americans received the Johnson & Johnson Covid vaccine, only to be told later that it was the least protective of the options available in the United States. But new data suggest that the vaccine is now preventing infections, hospitalizations and deaths at least as well as the Pfizer-BioNTech and Moderna vaccines. The reasons aren’t clear, and not all experts are convinced that the vaccine has vindicated itself. But the accumulating data nonetheless offer considerable reassurance to recipients of the vaccine and, if confirmed, have broad implications for its deployment in parts of the world. In Africa, for example, distribution of a single-dose vaccine that can be refrigerated for months is by far the most practical option. Johnson & Johnson has at least temporarily shut down the only plant making usable batches of the vaccine. But the South Africa-based Aspen Pharmacare is gearing up to supply large quantities to the rest of the continent. Only about 13 percent of Africans are fully vaccinated, and only about 1 percent have received a booster dose. “In the setting of Africa, where we have the need to quickly get vaccines out, the single dose is very exciting,” said Linda Gail-Bekker, director of the Desmond Tutu H.I.V. Center at the University of Cape Town, who has studied the vaccine’s effectiveness in South Africa. The Johnson & Johnson vaccine was billed as an attractive option for communities with limited access to health care, including some within the United States, because of its ease of delivery and mild side effects. But it has had a bumpy journey.
The shot seemed to produce a weaker initial immune response, and more people who got the single-dose vaccine had breakthrough infections, compared with those who got two doses of Pfizer or Moderna, the mRNA vaccines.
In April, federal health officials in the United States and in South Africa paused the J.&J. vaccine’s distribution as they examined reports of a rare blood-clotting disorder in women. Though both countries resumed the rollouts soon after, the vaccine’s reputation never fully recovered. But the notion that the vaccine is inferior has grown outdated, some experts said: More recent data suggest that it has more than held its own against its competitors. “We’ve been aware that J.&J. has been kind of downgraded in people’s minds,” Dr. Gail-Bekker said. But “it punches above its weight for a single-dose vaccine.” Until last June, the cumulative data from the C.D.C. showed that immunization with the Moderna vaccine resulted in the lowest rates of breakthrough infections; those who got Johnson & Johnson saw the highest rates, with Pfizer-BioNTech somewhere in the middle. During the summer months, the gaps — particularly between J.&J. and Pfizer — began to narrow. By now, all the vaccines seem to be performing about equally well against coronavirus infections; in fact, Johnson & Johnson appears to be holding up slightly better. As of Jan. 22, the latest data available, unvaccinated people were 3.2 times as likely to become infected as those who received the single-dose Johnson & Johnson vaccine; they were 2.8 times as likely to become infected as those who received two doses of the Moderna vaccine and 2.4 times as likely as those with two doses of Pfizer-BioNTech. Overall, then, the Johnson & Johnson vaccine appeared to be somewhat more protective against infection than the two alternatives. Among Americans who got booster doses, all the vaccines appeared to have roughly the same effectiveness against infection. A booster shot did not add much to Johnson & Johnson’s previous level of protection (although the data do not indicate who received which type of booster shot). The data were collected by the C.D.C. from 29 jurisdictions, representing 67 percent of the population....
