J&J Covid Vaccine Distribution in Poor, Black Communities Raises Race Questions

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  • J&J's vaccine is a highly effective shot, especially against severe illness and death, but it's perceived by some Americans as inferior to Pfizer's and Moderna's.
  • Sending J&J's vaccine to poorer ZIP codes in big cities and rural communities risks allegations of discrimination, health experts say.
  • State and local health officials must clearly communicate the benefits of J&J's vaccine and why it may be distributed in a certain way, experts say.

Detroit resident Logan Patmon knows Johnson & Johnson's Covid-19 vaccine is easier to distribute than Moderna's and Pfizer's shots. 

The 28-year-old Black attorney said he sees it as inferior because clinical trial data has shown J&J's is 72% effective at guarding against Covid in the U.S., compared with about 95% for the other two vaccines.

"Why go for 70 when you can get 95?" he said.

To public officials, J&J's shot is a blessing since it can be stored at refrigerator temperatures for months and takes just one dose — unlike Pfizer's and Moderna's, which require freezers and two rounds of jabs spaced about a month apart. That makes J&J's shot an important tool in getting lifesaving vaccines to people who may not be able to come back for a second appointment. It's especially valuable in getting the shots to hard-to-reach places that may not have reliable refrigeration, such as tribal lands, poorer neighborhoods as well as rural and border communities, officials say.

"Just because it is the easiest thing to do, it doesn't mean it's the right thing to do," Patmon told CNBC. "You don't want to it to be a situation where segregated, wealthier areas get the better vaccine and the poor, more minority areas are told, 'Just be happy.'"

Public officials are running into an unforeseen issue with distributing J&J's shots. Though unintentional, their lower efficacy rate has some people questioning whether it's just another example of subtly racist treatment of minorities in America. While J&J's vaccine is highly effective, especially against severe illness and death, Patmon and other Americans still see it as inferior. By sending it to poorer ZIP codes in big cities and rural communities, public officials risk allegations of discrimination, health experts say.

That could further erode trust in the vaccine rollout, especially in communities of color, experts say, as more data from states shows Blacks and Hispanics continue to make up a disproportionate share of Covid-19 fatalities but are receiving the vaccines at significantly lower rates than white people.

In New York, for example, Black people represent about 16% of the state's population and account for 23% of Covid-19 deaths, but have received just 8% of the shots so far, according to a March 3 report from the nonprofit Kaiser Family Foundation, which analyzed state-reported data. Hispanics make up 19% of the population and 23% of Covid deaths but have received just 9% of the shots.

White people account for 63% of the population and 40% of deaths, but they have gotten 81% of vaccinations, according to the KFF analysis.

Using J&J's vaccine primarily in hard-to-reach areas may introduce a "level of mistrust" and "increased hesitancy," Dr. Sonja Hutchins, a former CDC official, told the agency's Advisory Committee on Immunization Practices on March 1. "We have to be very careful and understand what might be some of the unintended consequences of targeting communities of color who some may feel are hard to reach when they are reachable," said Hutchins, who is now a professor at the Morehouse School of Medicine.

Comparing vaccines

J&J's vaccine was authorized for use in the U.S. on Feb. 27. The J&J shot demonstrated 72% efficacy in the U.S. about a month after the inoculation, 66% in Latin America and 64% in South Africa, where the more contagious and virulent B.1.351 variant is rapidly spreading. Most notably, it prevented 100% of virus-related hospitalizations and deaths. Pfizer's and Moderna's phase three clinical trials, which were completed in November, showed both vaccines had an efficacy rate of around 95%.

Calculating the effectiveness of a vaccine is tricky and can vary, depending on where the trial is being run, which types of variants are prevalent in the region and the level of community spread.

J&J's phase three trial started about two months behind Pfizer's and Moderna's, was conducted more broadly across the world and in countries where more infectious variants that are able to evade the vaccines had already taken hold.

White House Chief Medical Advisor Dr. Anthony Fauci said it's impossible to compare the three because they weren't evaluated in head-to-head clinical trials.

"So we're not saying one is better or worse than the other, we're saying all three of them a really quite good," he told MSNBC on Saturday. "With regard to getting them out to different groups, the president has made it very, very clear that we are going to have equity, which means we are going to distribute these equally among the different components the same as we did with the other two."

He said someone might prefer J&J's vaccine because it requires just one shot, "but there's not going to be a deliberate sending to one demographic group over another."

The federal government distributed nearly 4 million doses of J&J's vaccine to states, pharmacies and community health centers last week and says it plans to ship 16 million more by the end of this month. The company has a deal with the U.S. government for 100 million doses by the end of June.

A key selling point to J&J's vaccine is that it can be stored at 36 to 46 degrees Fahrenheit for at least three months and is a single dose. By comparison, Pfizer's and Moderna's vaccines are two-dose regimens. Pfizer's shot needs to be stored in ultra-cold freezers that keep it between minus 112 and minus 76 degrees Fahrenheit, though the FDA recently allowed the company to store it for two weeks at temperatures commonly found in pharmaceutical freezers. Moderna's needs to be shipped at 13 below zero to 5 degrees Fahrenheit.

Allocating to states

Jeff Zients, President Joe Biden's Covid czar, said J&J's vaccine is being allocated to states based on a their total adult population — the same as Pfizer and Moderna. Once the vaccine arrives, states can distribute the doses as they see fit, though the CDC is recommending prioritizing those most at risk.

In New York City, Mayor Bill de Blasio said the J&J vaccine would be dedicated to homebound seniors and others who cannot easily get to distribution centers. He acknowledged the vaccine could present a "communication challenge" for state and local health officials due to its lower efficacy rate.

"There's a lot of misinformation out there that we have to overcome," he told reporters on March 1. "Once you're vaccinated, you're protected. It makes so much sense to use it. And I'm really worried that people are going to get the wrong understanding of it and then hesitate to get vaccinated exactly when we need them most to get vaccinated."

In Louisville, Kentucky, health officials said they will deploy the vaccine to transitory folks who are at high risk and can't easily return for a second shot, like the homeless. In Harris County, Texas, where Houston is located, the J&J vaccine will be administered at mobile vaccination sites, which change locations each week as providers try to reach underserved groups who are most vulnerable to Covid.

Detroit Mayor Mike Duggan rejected an initial allotment of J&J's vaccine last week, saying, "Johnson & Johnson is a very good vaccine. Moderna and Pfizer are the best. And I am going to do everything I can to make sure that residents of the city of Detroit get the best."

He later walked back those comments, telling CNBC in a statement that the city already has enough capacity with the Moderna and Pfizer shots to vaccinate thousands of residents. He said the city will open a new vaccination site for J&J shots when demand from eligible residents exceeds its supply of Moderna's and Pfizer's doses.

'Extremely cautious'

Kasisomayajula Viswanath, a professor of health communication at Harvard T.H. Chan School of Public Health, told CNBC he is worried about how states will distribute the vaccine, even if their plan makes sense.

Viswanath, whose research focuses on addressing inequities in health care, said state and local health officials must communicate why J&J's vaccine is being distributed in a certain way or risk allegations of racism and mistrust.

"We have to be extremely cautious," he said, adding that there is a perception that the Moderna and Pfizer vaccines are superior to J&J.

Viswanath recommended that states enlist the help of local organizations that communities trust, such as churches or activist groups, in their communication efforts.

"If you start distributing this vaccine to certain groups and certain neighborhoods, without explaining why it is being done that way, then there is likely to be a perception that 'my group, my neighborhood, my town is getting this low efficacy vaccine compared to that group, that neighborhood or that town,'" he said.

In Black communities, in particular, there is already hesitancy due to the ongoing discrimination they face "day in and day out" from the health-care system, Viswanath said.

"The daily discrimination, the daily disrespect, that is what breeds mistrust," he said.

Changing minds

Dr. Stephen Schrantz, who was part of the team that led a J&J vaccine trial at the University of Chicago Medicine, said communication is key. He added providers don't want their patients to think they are getting "a more effective vaccine than another person."

People's perceptions can change, he added, especially as more data on the vaccines comes out and people hear from folks their own inner circles.

Veronica Takougang, a Black first-year medical student in Cincinnati, said she's heard a lot of concerns from her peers and others about the J&J vaccine and whether it will be used predominately in communities of color.

Takougang said she tells people there are plenty of benefits to the vaccine, including that it prevents severe disease and is a single dose, eliminating the need to make a second appointment about a month later.

"People are paying attention to the numbers a lot," Takougang said. She added that their concerns about J&J's vaccine are "valid" and that people shouldn't be excluded from getting the other vaccines just because they may not be able to take an extra hour off work.

Get vaccinated

The White House is telling the public to take the first vaccine you can get.

"We have three highly effective vaccines with a very good safety profile," Fauci told reporters Friday. "Each of them are very effective in preventing clinically apparent disease. But importantly, all three of them have a very important effect of being extraordinarily effective against severe disease and preventing hospitalizations and deaths."

"The most important thing is to get vaccinated and not figure out whether one may be better than the other," he added.

J&J CEO Alex Gorsky on CNBC on March 1 also spoke about the lower efficacy rate, saying the vaccine will be an important tool in the fight against the virus because it prevents hospitalizations and deaths.

"There's a lot of different ways to try and do comparisons," Gorsky said in an interview on "Squawk Box." "But when you really look at what's the objective here, keeping people out of the hospital, keeping people from dying, we believe this is an incredibly important tool to be added — to health-care systems let alone for patients around the world."

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