Introduction

Ideally, a pandemic such as COVID-19 is supposed to have a vaccine that can be delivered in a single shot to ensure supplies can cover as many people as possible. The vaccine aforementioned should also trigger very mild side effects such as a sore arm. And, it shouldn’t require overly complicated transportation and storage conditions. One such vaccine has been developed for COVID-19. Keep reading to find out more.

But, before we proceed here is what you need to know about Coronavirus:

Coronavirus broke out in 2019 and is now a global pandemic that has caused countless hospitalizations and deaths. Most economies have also suffered devastating blows from this pandemic. 

Health officials speculate the origin of Coronavirus to be Wuhan in China. Apparently, markets in Wuhan sold live wild animals and dead carcasses that were consumed either for food, nourishing, boosting vitality, and various other purposes. This health officials suspect to be how the pandemic spread to humans.

This pandemic spread fast and within a short period, infections had skyrocketed. To curb the spread of this virus, administrations decide to put into place such measures as restricting travel, enforcing personal distance in public, shutting down most public places and businesses, and ordering people to wear face masks in public.

COVID-19 Vaccines have alleviated the pangs of Coronavirus and most people expect the normal resumption of day-to-day life very soon. Some countries are already gradually allowing people and businesses to resume a semblance of normal operations.

Before we dive into comparing these three vaccines let us first consider the question “Is the COVID-19 Vaccine Safe?”

Safety of COVID-19 Vaccines

Well, we at International Medical Aid have thoroughly discussed this question in a previous article. But, in nutshell, the preparation of the three COVID-19 vaccines we have included was monitored closely by the US Vaccine Safety System to ensure they are as safe as possible.

First, most people have been skeptical regarding the speed at which Covid-19 vaccines were developed. As we all know, vaccines need a lot of time and patience for creation. However, COVID-19 vaccines were created within less than a year. Their fast creation can be attributed to a few reasons:

  1. Some companies were already working on somewhat similar vaccines- most people think companies developed these viruses solely for Coronavirus. This is not entirely true. Some companies such as Pfizer and BioNTECH were already trying to create vaccines for infectious viruses.

  2. Genetic info exists in abundance now- Coronavirus isn’t a new virus. It is simply a SARS-COV-2 form with extra acceleration. As a result, China was already in possession of info regarding this virus family.

  3. Governments funded projects- Governments pooled their resources to ensure research into the development of COVID-19 vaccines wasn’t impeded by lack of funds. Developers were issued with huge sums of money which in turn hastened the creation of vaccines.

  4. Volunteers appeared in their thousands- Researchers needed a huge amount of data to tackle this pandemic and volunteers appeared in large numbers to help them out. Vaccines in their trial phases also didn’t suffer from a shortage of willing volunteers. 

  5. Innumerable patients- Developers of vaccines didn’t lack patients as this virus spread and became a global pandemic within less than a year. Millions of patients were available all over the globe. This ensured developers could invest time in vaccine development; time that would have otherwise been spent waiting for new patients.

  6. mRNA technology- This technology was specifically tailored for the speeding up of the whole process between the collection of genetic info and the creation of vaccines.

Vaccine Differences

The three vaccines i.e. Pfizer, Moderna, and Johnson & Johnson have a lot of differences. Pfizer-BioNTECH was initially developed by BioNTECH which is a German company. BioNTECH later partnered with Pfizer, an American Company. Pfizer supported the manufacture, clinical trials, and logistics involved with the Pfizer vaccine. Moderna, on the other hand, was developed by a pharmaceutical company called Moderna. Johnson & Johnson vaccine was developed by Janssen Vaccines in conjunction with Janssen Pharmaceuticals; its parent company. 

As we discussed before, an ideal vaccine should be administered in a single shot. Among the three vaccines we are going to discuss, Johnson and Johnson is the only vaccine that meets this requirement. On the 27th of February, the FDA authorized the use of this vaccine in an emergency. This vaccine has so far proved protection of 66% against covid-19 infections that range from moderate to severe in most countries. The most important aspect of the Johnson & Johnson vaccine is its 85% effectiveness in the protection against severe cases.

An extensive clinical trial of the Johnson and Johnson vaccine also resulted in no deaths or hospitalizations among subjects that received this vaccine. The overall efficacy of this vaccine has a little variance depending on geographic disposition. South Africa is affected most by the low success of this vaccine since the new coronavirus variant appeared.

We are going to differentiate these three viruses according to type, target population, required amounts per dose, side-effects, storage requirements, minimum purchasable amount, durability, and Efficacy. However, you should note that most of the globe’s nations are still to access COVID-19 vaccines due to scarce supplies so you are unlikely to have a choice of the vaccine that best suits your preferences.

1. Type

Moderna and Pfizer vaccines are developed using mRNA (messenger RNA). This is a technology that involves the delivery of a little amount of genetic code to cells for the stimulation of the immune response of your body. These types of vaccines generally carry information from mRNA. This information includes the code of the makeup of a specific virus. 

mRNA instructions make proteins that are responsible for the activation of the immune system. The system is therefore taught to consider the spike proteins introduced via these vaccines as alien. The system then develops measures e.g. antibodies in retaliation. If you receive this type of vaccine, your body will be able to target the virus and fight it quickly any time your body comes into contact with it. 

The main difference between mRNA and other conventional vaccines is: mRNA only contains the information needed by our body cells for the production of a virus trait. This, therefore, enables it to trigger the appropriate defense response. mRNA vaccines don’t contain the proteins of a specific virus.

Johnson & Johnson vaccines, on the other hand, use entirely different criteria for instructing the production of SARS-2 spike proteins. And, unlike mRNA vaccines which use RNA with a single strand, Johnson & Johnson vaccines use DNA that is double-stranded.

Johnson & Johnson vaccines are the results of decades’ worth of research on vaccines that are based 0on adenovirus. The first of Johnson & Johnson’s successes was an Ebola vaccine that was released in July. 

After the Johnson & Johnson vaccine has been administered to a human, the body cells and adenoviruses in the vaccine bump. This in turn enables the adenoviruses to stick onto proteins present on the cell’s surface. The cell then covers the adenovirus in a sort of ‘bubble’. The adenovirus is then pulled inside where it proceeds to leave the bubble and heads towards the nucleus. The nucleus is the storage chamber of the cell’s DNA. DNA is then pushed into the nucleus from the adenovirus. The adenoviruses’ engineering ensures it is unable to make replicas of itself. However, the spike protein’s gene is readable by the cell and can be replicated into mRNA molecules. These molecules leave the nucleus and the molecules of the cells proceed to read their sequence and spike proteins begin to get assembled.

2. Target Population

Moderna vaccine has a clearance of use for people that are 18 years or older. But, the company is conducting tests in 12-17 year-olds. Pfizer, on the other hand, is recommended for 16+ year-olds.

Johnson & Johnson is authorized for 18+-year-olds having been tested on people within the same age group. This vaccine is therefore inaccessible to anyone below the age of 18. This will remain so until necessary tests are conducted to verify safety and efficacy to people below the age of 18.

3. Efficacy

Moderna and Pfizer vaccines have both astounded health officials with impressive efficacy degrees which were witnessed when vaccination was still in its early stages. The degree of efficacy of these two vaccines is somewhat equivalent.

At two doses, Pfizer showed 95% efficacy at the prevention of symptoms that were consistent with infection of Covid-19. This vaccine’s protection seemed to be equal among subjects despite their racial, age, or ethnic disparities.

After the second dose of Moderna, this vaccine showed 94.1% efficiency at preventing the symptoms consistent with Covid-19 infection. The trial of Moderna, however, resulted in decreased efficacy in people above the age of 65 years. This lower efficacy, the company explained to the FDA, could be a result of fewer people above 65 years being present during the vaccine’s trial. Moderna vaccine appeared to have an equal level of effectiveness across participants of diverse racial and ethnic backgrounds.

Johnson & Johnson vaccine, on the other hand, showed protection of 66% against Covid-19 infections ranging from moderate to severe. This was percentage was obtained 28 days post-injection. Though geographic disposition seemed to affect the outcome with 72% protection shown in the US, 66% in South America, and 57% in South Africa.

However, the Johnson & Johnson vaccine proved to be 85% effective in the protection against severe infections. All 8 countries that were involved in this study showed no significant difference in the outcome. And the participants of the trial all had similar results despite age differences. During the 28 days required for the development of immunity after this vaccine was administered, no deaths or hospitalizations were witnessed.

However, you need to note that the comparison in efficacy between Johnson & Johnson vaccine and the other two is far from easy. One of the factors that make this task difficult is the fact that clinical tests at Phase 3 sought different outcomes; therefore their designs differed. The trials of Moderna and Pfizer both tested for Covid-19 infection according to prevalent symptoms. Pfizer began enumerating cases 7 days after the second dose of the vaccine had been administered while Moderna started counting cases 14 days after participants had received the vaccine.

In contrast to the criteria used by Moderna and Pfizer, J&J tried to determine the degree of protection its vaccine provided after the administration of a single dose. J&J also tested the efficacy of its vaccine against moderate-severe Covid-19 infections. What J&J considered as Covid-19 infection was the presence of at least one symptom in a participant coupled with a positive test. J&J required the symptom to be present 14-28 days following the administration of that single vaccine shot.

As you can see, comparing these vaccines is somewhat impossible owing to the different designs and expectations of trials. In addition to these differences, Moderna and Pfizer’s vaccines were tried before even more troubling variants of Covid-19 emerged in places like Brazil and South Africa. How effective these vaccines will be against the new variants is yet to be established.

Johnson & Johnson vaccine on the other hand was getting tested when the mutated variants showed up. The South African version of this vaccine’s trial included participants infected by the first Covid-19 variant, B.1.351, first found in South Africa.

It is yet to be established whether these vaccines are effective in preventing the infection of the SARS-CoV-2 asymptomatic virus. Researchers have also no verified whether people that have received the vaccine can transmit this virus when and if they get infected but fail to show any symptoms.

4. Dosage

Both Pfizer and Moderna vaccines need two shots. The first shot is known as the priming dose and the second shot is known as the booster shot. Moderna vaccine requires a 28day interval between these two shots whereas Pfizer requires a 21-day interval.

Every single dose of Pfizer has 30mcgs (micrograms) of the vaccine. Moderna on the other hand has a higher vaccine content at 100mcgs per dose. This, as is evident, means Moderna uses up to 3X the vaccine amount present in Pfizer, per person. This is so although Moderna isn’t getting better efficacy results than Pfizer. In response to this, Operation Warp Speed, a government program in charge of the development of vaccines, has requested Moderna to look into ways of reducing the amount of vaccine in each of their dosages. The reduction should be without compromising the protection level of the vaccine.

As we mentioned before, the Johnson & Johnson vaccine is administered in a single shot. The J&J company is also trying a regimen that will require administration in two doses. The two shots for the J&J regimen are expected to be administered with an interval of 8 weeks between the first and second shots. The results of the testing of this regimen are expected later on in May.

Tests are also underfoot to determine how antibodies respond when a person receives a small J&J vaccine shot booster after receiving the one-dose regimen. This was revealed by Janssen Vaccines’ managing director Johan Van Hoof.

5. Side-effects

Reactogenic is a jargon used in vaccinology. It refers to the ability of a vaccine to produce somewhat expected and common adverse side effects in most recipients. Most of the Covid-19 vaccines that have tabled data from their trials, including the three we are comparing, can be categorized as reactogenic. In fact, one of the panels of experts that advises the CDC, the Advisory Committee on Immunization Practices, recommended that hospitals vaccinate their staff randomly and gradually just in case some employees become too unwell after vaccination.

The most prevalent side effects reported after vaccination include headache, joint and muscle pain, and fatigue. Some participants reported moderate fever too. The side effects of Moderna and Pfizer vaccines are commonly reported after the booster shot. Interestingly enough, older adults with a weaker immune system as compared to young adults reported lesser side effects.

mRNA vaccines have also triggered severe allergic reactions in some cases. On a few rare occasions, Both Moderna and Pfizer have resulted in anaphylaxis. Anaphylaxis is a reaction that is extremely severe and fatal in some cases. Epinephrine, a drug present in EpiPens, is required to treat this reaction. Hospitalization may also be necessary if the patient’s airways need to be kept open. So far, Johnson and Johnson’s vaccine has triggered only one anaphylaxis case after administration.

However, coming with a solid estimate of the frequency of side effects from these Covid-19 vaccines will require more time. The CDC recently released data that indicated out of 1 million Moderna and Pfizer doses administered, around 2.5 cases of anaphylaxis were reported for Moderna, 4.7 cases for Pfizer. Most of the participants that reported this severe reaction either had previous anaphylaxis episodes or had a reported history of susceptibility to severe allergic reactions.

6. Storage

A cold chain is required for the storage of mRNA vaccines. Cold-chain is the term that describes conditions mandatory for the proper storage of these vaccines either as they are being distributed, stacked in hospital’s offices, clinics or pharmacies before administration.

Between Moderna and Pfizer vaccines, Pfizer required more complicated storage conditions. First, Pfizer required super cold freezers during shipping and storage. These freezers should be able to maintain the temperature of the vials at -94ºF. However, the FDA recently announced that Pfizer vaccines could be stored and shipped in regular pharmacy freezers with temperatures of between -13ºF and 5ºF but only for a period that doesn’t exceed 2 weeks. This somewhat makes the whole process between production and administration a tiny bit easier. You must use a Pfizer vaccine vial within a period of 5 days after thawing.

On the other hand, Moderna requires conditions within -4ºF during shipping. This temperature is within the limits of a regular pharmacy freezer. At this temperature, this vaccine remains stables for up to 30 days and 12 hours at normal room temperature.

Johnson and Johnson vaccine vials don’t need any special storage conditions. This is one of the best features of this vaccine. It can be stored anywhere for more than 3 months at a common refrigerator’s temperature. An un-punctured vial of the J&J vaccine can also be stored for up to 12 hours at room temperature. After the withdrawal of the first dose from the vial, you can store it in a refrigerator for up to 6 hours or 2 hours at room temp.

7. Minimum Order Required for Purchase

Pfizer vaccine has a few challenges and the cold-chain storage requirement is just one of them. This vaccine has a minimum purchasable order of 1,170 doses per location. This is a sensible amount if you’re considering high demands like that of a large hospital but plenty of other locations have no need for more than 1,000 doses especially during the initial stages of vaccination. This is a disadvantage at the current stage of vaccination but as states start vaccinating citizens in their numbers, this may cease to be a problem.

Moderna on the other hand requires locations to purchase not less than 140 doses at one time. This is a number that is more manageable than Pfizer’s.

J&J’s minimum purchasable order according to CDC is 100 doses per order. This is lower than both Pfizer and Moderna’s minimum order.

Johnson & Johnson vaccines are shipped in vials with 5 doses, Pfizer’s vials contain 6 doses and Moderna’s vials come with 14 doses per vial.

8. How Long Protection Lasts

This is another feature that will take time to fully determine. Volunteers will need to have their blood drawn periodically to determine the condition of their antibodies. This despite the fact that a decrease in protection isn’t always heralded by a decrease in the level of antibodies in a human body. However, a chunk of this task will possibly incorporate carefully studying reports from people that have been infected with COVID-19 after immunization. These infections need to be in large numbers and the response we can expect from health officials is a recommendation for booster shots after a certain period.

9. Effect on Pregnant Women or Lactating Mothers

Pregnancy is a condition that usually results in the exclusion of people when participants are needed for the clinical trials of a drug. The approval of the initial two COVID-19 vaccines for use by federal regulators in the US also offered pregnant and lactating mothers the option to decide to get or to refrain from immunization.

At the moment, no risks to pregnant women have been identified after a COVID-19 vaccination. However, Pfizer has started an intense trial phase to determine whether its vaccine affects pregnant people. Moderna also fulfilled the FDA’S requirement to test whether their vaccine can affect pregnancy or even harm a developing fetus. They reported no discernible harm from tests done on pregnant animals with the Moderna vaccine.