Johnson & Johnson single-dose option could dramatically boost the world’s fight against SARS-CoV-2. All of the other COVID-19 vaccines with proven protection to date require a second dose weeks later. A single dose vastly simplifies administering vaccines, and the J&J product can also be transported under normal refrigeration, not the subzero temperatures required for the messenger RNA (mRNA) vaccines. “Simple is beautiful,” says Matt Hepburn, who works on vaccines for the U.S. government’s COVID-19 Response—the new program that absorbed the Warp Speed program when President Joe Biden took office. If the J&J vaccine helps countries quickly ramp up vaccination, it could also help slow the emergence of other variants, Fauci and other scientists stressed. Fauci concedes there will be a “messaging issue” about which COVID-19 vaccine people should get, because the first two to be approved in the United States, from the Pfizer-BioNTech collaboration and Moderna, showed even higher efficacy against all cases of the disease. If a person comes in for a vaccine and is told “go to the door on the left and you get 94% to 95%, go to the door on the right and you get 72%, what door do you want to go to? That obviously is something that needs to be messaged.” Fauci told Science “it would have made comparisons clearer” if the vaccine trials from the outset had made severe disease an additional primary endpoint, although that may have slowed trials because such cases occur less frequently.

Brazil has a similar variant to the one in South Africa that appears to have weakened the J&J vaccine’s overall efficacy. Gray says that is leading her to rethink the 50% efficacy data recently reported from the trial in Brazil of a vaccine made by China’s Sinovac Biotech. She expects these variants might also lead to “a diminishing effectiveness in other vaccines that are currently being rolled out at a global level.” Mammen went further and cautioned against comparing the efficacy of the J&J vaccine with that of mRNA vaccines. “They ran their studies in a different time when the pandemic was less complex,” he says. “There were not the variants and there was not the same level of [COVID-19] incidence which puts pressure on vaccine efficacy.” He suggests that if the Pfizer-BioNTech collaboration and Moderna ran their efficacy trials today, “you’d likely see different results.”

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