Take whatever COVID vaccine you can get. All of them stop death and hospitalization.
Waiting for a more effective vaccine is actually the worst thing you can do to lower your risk of getting severely ill and dying of COVID-19.
Almost every day, we get the same questions from family, friends, and strangers who happen to find our emails: Which COVID-19 vaccine should I get? Should I wait to get the “best” vaccine?
Johnson & Johnson has followed Moderna and Pfizer with an application to the Food and Drug Administration for emergency use authorization of its vaccine. Novavax and AstraZeneca might not be far behind. Not surprisingly, people are concerned about getting the “wrong” vaccine when they hear that some are 66% effective while others reduce infections by 95%.
Our advice is simple: Take whatever vaccine is offered to you. Right now, all of the vaccines are the “best.” This is what we’re doing for ourselves.
The varying “effectiveness” rates miss the most important point: The vaccines were all 100% effective in the vaccine trials in stopping hospitalizations and death. Waiting for a more effective vaccine is actually the worst thing you can do to lower your risk of getting severely ill and dying of COVID-19.
No death or serious illness in 7 trials
We do not vaccinate to prevent a minor case of the sniffles. The reason we have vaccines is to prevent severe disease and death caused by infections. The polio vaccine prevents paralysis. The measles vaccine prevents pneumonia, brain infections and blindness. Annual influenza vaccines prevent pneumonia, sepsis and heart attacks. If COVID-19 only caused a cold, we would not have bothered to develop vaccines for it. While there are many mild cases of COVID-19, about a fifth of infections result in severe disease, and nearly 1% of infected people die. For older people and those with underlying health problems, the risk of death can be anywhere from 10 to several hundred times higher.
All seven COVID-19 vaccines that have completed large efficacy trials — Pfizer, Moderna, Johnson & Johnson, Novavax, AstraZeneca, Sputnik V and Sinovac — appear to be 100% effective for serious complications. Not one vaccinated person has gotten sick enough to require hospitalization. Not a single vaccinated person has died of COVID-19.
Not all infections are equal. People who are vaccinated against viruses still occasionally get infected. But thanks to a vaccine-primed immune system, the infections never progress to make them seriously ill. The vaccine efficacy rates vary only with respect to mild forms of COVID-19 illness. When it comes to the measures that really matter — hospitalizations and death — they are all functionally the same.
It is not just the vaccinated individual who benefits from vaccination. Most vaccines also reduce transmission of infection among people, and in so doing, help protect those who fail to mount an effective immune response to vaccines or who can’t get vaccinated because of their age or because they have a compromised immune system.
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It is hard to know how well COVID-19 vaccines prevent transmission, or how quickly we will get to herd immunity by looking only at individuals. We do not know yet how much transmission can occur from vaccinated persons with milder infections. But a vaccine does not need to prevent all infections to make a big dent in transmission; lowering the amount of virus a person sheds could be enough.
Meanwhile, the SARS-CoV-2 virus is mutating. Viruses can only mutate when they replicate, and we have allowed them to spread — and replicate — like wildfire. The best way to prevent mutations is to reduce transmission, and this requires wearing a high-quality mask, staying in our social bubble, and ensuring good ventilation and air filtration.
Don't hold out for the 'best' vaccine
The bad news is some mutant virus variants can be more dangerous. Variants of concern are those that are more transmissible, more virulent, or capable of evading the immune protection acquired from vaccination or natural infection. The B.1.1.7 variant, first detected in the United Kingdom, seems to spread more easily and cause more severe disease, while the variants first found in South Africa (B.1.351) and Brazil (P.1) seem to at least partially evade immunity from current vaccines, natural infection as well as certain therapies.
For now, however, our vaccines remain effective, especially at preventing hospitalization and death. In Israel, where the majority of people 60 and older have been vaccinated, COVID-19 cases have dropped by 41% and hospitalizations are down by a third, despite the arrival of more dangerous variants.
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Importantly, vaccine effectiveness is not the only thing you should care about. Durability of immunity, convenience and side effects also matter. It will be easier to vaccinate many “hard to reach” populations (like migrant workers and homeless people) with a single dose, and only the Johnson & Johnson vaccine was studied as a one-dose regimen. The Pfizer and Moderna vaccines have a rare but nonzero chance of severe allergic reactions, which have not been observed in the Johnson & Johnson vaccine. We will not have long-term data on the duration immunity with any of the vaccines until enough time has passed. No study, no matter how expensive, can speed up time.
When it comes to COVID-19 vaccines, time is the most important factor. Every day that passes without getting vaccinated is a day where you have a higher risk of getting infected, becoming seriously ill and dying. Whatever benefit you think you might get from waiting for the “best” vaccine isn’t worth the risk you take on while waiting. The best thing you can do is get vaccinated as soon as you’re able with whichever vaccine is available to you first.
Dr. Ezekiel J. Emanuel (@ZekeEmanuel), Dr. Celine Gounder (@celinegounder), epidemiologist Michael Osterholm, Ph.D. (@mtosterholm), Dr. Luciana Borio (@llborio), Dr. Atul Gawande (@Atul_Gawande) and immunologist Rick Bright, Ph.D. (@RickABright) are members of the Biden-Harris Transition COVID-19 Advisory Board.
