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Brian Lehrer: It's the Brian Lehrer Lehrer Show on WNYC. Good morning again everyone. The Johnson & Johnson single-dose vaccine, as you just heard on David's newscast, was approved over the weekend. Governor Murphy said people will be getting it in New Jersey by tomorrow. You heard that clip. There's a lot of confusion and uncertainty over the numbers in the clinical trials, which show 100% effectiveness at preventing hospitalizations and deaths. We have to emphasize that. 100% effectiveness at preventing hospitalizations and deaths, but less than the Pfizer and Moderna ones, apparently, at preventing what they call mild or moderate COVID cases.

What does this mean and what are the implications for equity in a world where some communities have been hit so much harder than others, and long-haul COVID from moderate cases in some people is a documented thing. On Friday's show, I asked Mayor de Blasio about vaccine equity with the J&J rollout coming. He said he understands the concern--

Mayor de Blasio: Our doctors are adamant that any effort to portray Johnson & Johnson as lesser is misguided. The whole job one here is to save lives and protect people from ending up in the hospital or in bad shape and danger.

Brian Lehrer: Even if it allows more cases of moderate disease that are short of hospitalization?

Mayor de Blasio: Yes, "Look, it's a wartime dynamic." Johnson & Johnson, this is a single-shot vaccine. We're getting more done more quickly for folks.

Brian Lehrer: The Mayor here on Friday. With me now on that and more is Dr. Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University. The director of the Global Health Program ICAP there. Director of the Global Health Initiative at Columbia's Mailman School of Public Health. Always good to have you on Dr. Wafaa El-Sadr. Welcome back to WNYC.

Dr. Wafaa El-Sadr: Thank you and my pleasure.

Brian Lehrer: Listeners, your Johnson & Johnson and other vaccine and variants questions, we're definitely going to talk about the new variants in relation to the vaccines in this segment. Your COVID equity questions, and other questions for Dr. Wafaa El-Sadr. Welcome at 646 435 7280, 646 435 7280, or tweet a question @BrianLehrerLehrer. Dr. El-Sadr, can you explain the differences in effectiveness between the Johnson & Johnson and the others now available in this country, as you understand them. Can you take us a little more deeply into what this 62% versus 72% versus 94%, what this actually means?

Dr. Wafaa El-Sadr: Yes. Thank you. Let me start first by highlighting that we're very fortunate to now have, and will have three vaccines. Three vaccines that are effective and they're also safe. They will be available for vaccination in the United States shortly. I think it's important before we get into the numbers, to appreciate that the studies that looked at the Pfizer-BioNTech, the Moderna, and now the J&J Janssen vaccine; they were done at different times during the pandemic. The Pfizer-BioNTech and Moderna were done a bit earlier than the study from which we're deriving now the data for the J&J Janssen vaccine.

That also can play a part in terms of what the data are telling us. I think importantly, I always tell people, if you're offered a vaccine, please take the vaccine. Whichever vaccine out of these three is offered to you, it behooves you to take the vaccine. From the perspective of public health and perspective of public health experts and researchers, they're all excellent vaccines. Now, maybe to dig deeper, I think that data show that the J&J Janssen vaccine overall had about 66% efficacy. The study that was done was done in the United States, in several Latin American countries, as well as also in South Africa.

When you disaggregate these data and you look just at the results, based on the results in the United States, the efficacy was about 74%. I think that's the distinction. 66% overall in these many countries, but efficacy of 74% if you subsegment the findings and look at the United States. Then, importantly, is obviously we want to prevent severe disease. We want to prevent hospitalizations. We want to prevent deaths. The good news is that this vaccine was shown to be about 85% or so effective against severe COVID-19. I think it's good news and it's one more tool in our toolbox that we can fight this pandemic with.

Brian Lehrer: I've already heard from people who are saying, "Well, 72% or 84%, that's still worse than 94% with the Pfizer or the Moderna. I'm going to try to make sure that when I go for my vaccine, whenever that is," these people say that "I'm going try to ask for the Pfizer and Moderna just so I have those greater chances." What would you say to those people?

Dr. Wafaa El-Sadr: I would say that, again, these studies were done at a different time period. That's important to keep in mind. More recent studies, of course, they were done in an era where we had different variants that were circulating in the community, for example. That's something to keep in mind.

Brian Lehrer: They may actually be equivalent based on the data that we have there's no way to know?

Dr. Wafaa El-Sadr: We don't know that for a fact. We haven't looked at that and looked at the distribution of different variants during the time periods where these different studies were done. That's important. The next vaccine studies will be done in a very different context again where we have different variants that are circulating, where the epidemic may be in a different phase as well. It's very hard to compare one vaccine to another when they haven't been studied what we call head to head.

When there hasn't been a study that actually compared three, one to the other. We don't have such studies. We probably never would have such studies. I think it's really important to step back and think about the context in which these studies were done and put the results in that context.

Brian Lehrer: This is WNYC-FM, HD and AM New York, WNJT-FM 88.1, Trenton, WNJP 88.5, Sussex, WNJY 89.3, Netcong, and WNJO 90.3, Toms River. We are in New York and New Jersey Public Radio with Dr. Wafaa El-Sadr from Columbia University as we talk about the Johnson & Johnson vaccine rollout. Governor Murphy says New Jerseyans may be getting it by tomorrow. I haven't heard New York officials say explicitly tomorrow, but it is expected to be within the next few days at very least in New York as well. Before we go to some of the many phone calls that are coming in, Dr. Wafaa El-Sadr, just to relate what you were just saying to the equity question.

We know who's been hardest hit. We know who from the Governor Murphy clip in the newscast and other things, they're saying the Johnson & Johnson vaccine is being seen as the most appropriate to help people in rural areas. People for whom return visits might be doubtful, which they included college students on that list, in one report I heard over the weekend, areas that are underserved with pharmacies. That might indicate low-income neighborhoods that have a lot of Black and brown Americans.

We know who's been hardest hit. Should policymakers prioritize people in those vulnerable zip codes, those vulnerable living situations, those vulnerable groups for the so-called best vaccines?

Dr. Wafaa El-Sadr: I think what we should be doing is trying to get to the vulnerable groups as soon as possible with vaccines and that's just any vaccines of these vaccines. All of them are excellent vaccines. I just need to stress that and that's very important. It's important from the equity perspective. It's also important from public health perspective. What we want to do in order to get the best benefits from these vaccines is to reach the people who are at most risk for getting COVID-19 number one, number two, to reach the people who are at most risk for getting severe complications of COVID-19.

Because of these, what we find in our country is that there are some subgroups in our communities who are both most vulnerable meaning they're most at risk for getting infected. They also happen to be the same groups that are most at risk for getting complications of COVID-19. It's very compelling from an equity perspective, as well as from a public health perspective that we have to reach the people who need to be reached first, as soon as possible with these vaccines.

Brian Lehrer: Let's take some phone calls, Jane in Chelsea you're on WNYC with Dr. Wafaa El-Sadr. Hi Jane.

Jane: Hi, I'm a woman in the midst of her 9th decade. I have received both of my Moderna shots, but obviously ethically when it's possible, should I also try and get the Johnson & Johnson?

Dr. Wafaa El-Sadr: I'm very glad that you were able to receive your two doses of the Moderna vaccine. No, you do not need to take the Johnson & Johnson Janssen vaccine.

Brian Lehrer: There's no reason to get.

Dr. Wafaa El-Sadr: There's no reason to double up with vaccines at this point based on what we know. What we want for people is to get the course of any of these vaccines like the two doses from Pfizer or the two doses from Moderna or one dose from the Johnson & Johnson Janssen vaccine, no need to double up with vaccines at this point.

Brian Lehrer: There is also in the news, however, Pfizer and Moderna, I believe both of them starting to develop and at least one of them starting to test a new generation or a booster of the vaccine. You're telling me what's the proper terminology, to try to address some of the new variants that are now circulating, including in this area. Do you think it's likely that people who've been Moderna or Pfizer vaccinated or who will be J&J vaccinated, will likely want to go for additional shots in the coming months, given the competition? Some people have characterized it as a race between the vaccines and the variants right now, what about the likelihood of additional shots in that regard?

Dr. Wafaa El-Sadr: I think it's likely that as this virus is evolving and these new variants are evolving, if there is evidence that some of these new variants are able to outsmart our vaccines or there's evidence that the vaccines that we have now are not as effective against these new variants, that's why then there would be a good reason to get another dose of a vaccine that's been developed specifically against these variants.

Brian Lehrer: What is the evidence in your opinion that the variants do evade the vaccines?

Dr. Wafaa El-Sadr: I think we have some evidence already, for example, from the variant that was isolated in South Africa. We have a pretty strong evidence based on data from vaccine studies that were done in South Africa, that the variant that was identified there, when you look at the data, the effectiveness of the vaccine is much diminished in that context. This tells us that the South Africa variant is able to outsmart our vaccines. That's the one example, the most extreme example that we have now. We don't have a strong evidence that any of the variants that are circulating widely in the United States now have this ability to do so with our current vaccines.

Of course, we don't know what's going to happen in the future. It is possible that similar to, for example, influenza vaccination, where everybody knows that every year we need to get a new influenza vaccine that's developed based on the circulating influenza viruses that are exist in the world at that time. It's possible that we might need to have potentially an annual vaccination against this Coronavirus.

Brian Lehrer: Here, I think is a follow-up question to that from a contact tracer, Denise in Bed-Stuy in Brooklyn. You're on WNYC. Hi, Denise.

Denise: Hi Brian. Hi Dr. Wafaa El-Sadr. Thank you so much for taking the call. I'm really curious about [beeps]

Brian Lehrer: Whoops, did we lose you, Denise? I think we did. I'm going to ask her question because I know what she said to our screener. Dr. Wafaa El-Sadr, she was going to ask if people should quarantine when they've been exposed to the virus if they've already been vaccinated, since the amount of transmissibility of asymptomatic COVID, even after vaccination remains unknown.

Dr. Wafaa El-Sadr: That's a very excellent question. The CDC came up with some new guidance, maybe about a week or so ago or two weeks ago. In their new guidance, what they're recommending is for a close contact of a case. If that close contact has been completely vaccinated, meaning they've received, for example, two doses of the Pfizer-BioNTech or the Moderna vaccine. That last dose was two weeks or more since that exposure, that they don't need to be quarantined. That's based on the fact that we do have evidence as I mentioned, that these vaccines are excellent at protecting the vaccinated individuals from getting this virus, getting COVID-19.

We don't have definitive information yet, as to whether these vaccines prevent somebody, the vaccinated person from getting an asymptomatic infection. Meaning that they may be infected, but they're not symptomatic. Therefore mean if they don't wear a mask, for example, they may unknowingly transmit it to somebody else. We do know that these vaccines work and work well at protecting individuals from coming down with COVID-19. That's the reason why the CDC has moved to again, recommend that anybody who's been fully vaccinated at least two weeks and within three months, that person does not need, if they're a close contact of a case, they do not need to quarantine.

Brian Lehrer: Here's Dr. Fauci on CNN yesterday on a related question, asked if people can start resuming normal life after being fully vaccinated and waiting the two weeks for that to fully kick in. He said this, for example.

Fauci: One of the things that I think is going to become clear that if you have individuals, adults who are vaccinated, two people that are doubly vaccinated and are protected, then you can do things that we weren't talking about before. You could have dinner in a home without masks on. You could have friends who are doubly vaccinated and are protected together with you. You can start doing things essentially in the home and in a setting where you're not out in the community, where there are 70,000 new infections per day. You could start doing some of the things that you weren't able to do before.

Brian Lehrer: Dr. El-Sadr, I wonder if you heard Dr. Fauci say that on CNN yesterday, or even if you just heard it here. How you heard it, was he's saying that fascinated people can hang out with vaccinated people, not from their households in ways that maybe they couldn't before, but only if they're not going out into the world and having a lot of other exposures.

Dr. Wafaa El-Sadr: No, I think what he was saying is that if you have a small, like what people have been calling pods with these small numbers of individuals that they socialize with then that's fine. That's good. What he was saying is that it's potentially possible to expand that a little bit and to enable other individuals who have been fully vaccinated to be part of these small gatherings. That's what he was talking about. That's a very limited easing of restrictions. I think in general, my advice is this, when people ask me and they do ask all the time, "What can I do the day after I get vaccinated versus what I was able to do the day before I was vaccinated?"

I always say, "Nothing different, nothing different. You have to continue to do exactly what you've been doing." I think that's really important because we do have this race between the vaccination and the vaccines and the variants. We're in a very fragile moment where we have to continue to scale up vaccination as quickly as possible, but at the same time, we have to suppress transmission of this virus also as much as possible through observing the usual public health measures that we have all been talking about for the past year.

Brian Lehrer: This is where people get confused because it gets complicated. That we're saying on the one hand that these vaccines are going to prevent you from getting sick enough to be hospitalized or sick enough to die in basically 100% of the cases. That it probably reduces transmissibility from you to other people, but don't change your behavior yet even if you're vaccinated. People if not confused might get a little discouraged.

Dr. Wafaa El-Sadr: I think it is a complex message. I think, I always say there's no vaccine, that's 100% effective. We don't have a vaccine that's 100% effective. It does take time for the protection to take hold two to four weeks, for example. With some vaccines, we need the second dose to achieve the maximum, optimal protection. Also, we don't know truly if it prevents asymptomatic infection, if the vaccines prevent asymptomatic infections. That's the reason why we should remain cautious even though we've been, some of us have been vaccinated. The important thing is we need to reach what is called population immunity or herd immunity.

It's not just about us getting vaccinated, it's about how many people around this are getting vaccinated are protected. I think what we need to do is to continue as much as possible to observe these protective measures until we reach a level of population immunity, a level of coverage of uptake by these vaccines at a population level of 70% to 80% of our population being vaccinated. It's at that point that we can then truly start relaxing some of these restrictions. We have long way to go. We're way, way, way away from a 70% or 80% coverage in this country.

Brian Lehrer: One more question. We're almost out of time, but I'm going to let Cliff in Manhattan sneak in, his question, which is a different one. Cliff, we've got 30 seconds for you. Thanks for calling in.

Cliff: Good morning. My question is, is there anyone tracking people that have received two vaccines to see how long it takes for protective antibodies to reproduce in their system. How long these antibodies last and if there are any studies, being done in New York city that people can volunteer for this issue?

Dr. Wafaa El-Sadr: Thank you very much. That's a critical question is how long this protection lasts. There are ongoing studies to try to determine these both in terms of following the original people who were in the original vaccine studies; they're being followed long term. They're getting measurements of their antibodies in their bloodstream. We can hopefully then get a better sense of how long their protection is going to last. These studies are ongoing and hopefully, in the next several months, we'll have some answers to these questions.

Brian Lehrer: Dr. Wafaa El-Sadr, MD, MPH, MPA, professor of epidemiology and medicine at Columbia University, Director of the Global Health Program, ICAP, and director of the Global Health Initiative at the Mailman School of Public Health at Columbia. Dr. Wafaa El-Sadr, thanks as always.

Dr. Wafaa El-Sadr: Thank you, my pleasure.

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