Kyle Allred, MedCram Co-Founder and Producer: Dr. Seheult, vaccine shortages are a big story right now,
and certainly getting more people vaccinated is a key part of getting us out of this pandemic.
There's been some big news this past week with Johnson & Johnson releasing preliminary data
about their vaccine candidate. Tell us more about that. Dr. Seheult: Yeah, so on January 29th Johnson & Johnson and
Janssen Pharmaceuticals released some preliminary data on their phase 3 trials on their new vaccine
candidate. We want to go through that data and specifically how it relates to the other two
vaccines that have already received early-use authorization from the FDA here in this country.
But before we get into that, let's talk about the mechanism on how this new vaccine works. Now each
person has about 37 trillion cells in their body, and this screen is zoomed in way into just one of
those cells. Here we have the cell right here. This is the membrane of the cell. This area here is the
cytoplasm, and this area here is the nucleus of that cell. Now do vaccines work on just one cell of
your human body? No, they work on a number of cells and that's kind of dependent on the dose, but what
we're going to do here is show what a vaccine does to a single cell, and then you can multiply that.
And whereas before with Pfizer-BioNTech and Moderna they use lipid droplets to get the messenger RNA
into the cells, this works a little bit differently. So let's go through the steps. As we can see here
in step number one in the laboratory, what they've done is they've taken an adenovirus
which can infect cells on its own -- has all the machinery to do that -- and simply what they've done
is they've taken the DNA inside of the adenovirus, and they've spliced in the information for that
spike protein that is on the surface of the SARS-Cov-2 virus. And so here we have information
for the cell to make the spike protein for the SARS-CoV-2 virus, but it's encoded into a double-
stranded DNA segment in the adenovirus itself. And so this takes place in the laboratory and the
vaccine is made. Now when they do this they take out the parts of the DNA in the adenovirus that
allows it to replicate. And so this virus, when it infects the cell as the vaccine, will not be able
to replicate. So the proteins on the surface of the adenovirus are still able to interact
with the proteins on the surface of human cells, which then allows it to infect, as we can see here,
the strand of DNA in the virus which is supposed to go off to the nucleus and does
and would normally tell the cell to make more adenovirus particles, instead makes a messenger RNA
that gets transported out into the cytoplasm where the cell machinery, instead of making adenovirus
particles like it would normally would, is now going to make SARS-CoV-2 spike proteins and the
same happens exactly as we would see from this point on in the Pfizer or the Moderna vaccine.
So the difference here is that we're actually using an adenovirus as the mechanism or the
vehicle to get the information into the cell. That's the first difference here with the Johnson
and Johnson vaccine. By the way this is also very similar to how the Oxford-AstraZeneca vaccine
works. The other difference here is that this is a DNA particle that is going into the nucleus of the
cell. Again, very similar to the Oxford-AstraZeneca vaccine, making the messenger RNA and then on to
the SARS-CoV-2 spike protein. Kyle: Okay, now we have a better understanding of how this vaccine works.
I think what people really want to know is how does this vaccine stack up to Pfizer and Moderna
and AstraZeneca? Dr. Seheult: Kyle, based on what we're seeing here with this data, I would caution again,
this is not published, peer-reviewed data, but the data that we've been given is actually somewhat
encouraging. There are some caveats to this, and you have to dive deep into the numbers to get the
information that you need. First thing off is that it's a one-time shot. It's not like there's
two shots like you need with the Moderna and the Pfizer vaccine. If you look at the efficacy and
how they define it. The definition of efficacy here is that the patient did not get "moderate"
or "severe disease," so "mild" was okay in terms of the definition of efficacy. Now it's different
in the other types of vaccine studies that we've looked at with Pfizer and Moderna, whereas any kind
of symptoms is what they wanted for efficacy. So if you look at the efficacy of Pfizer and Moderna,
that was 95 and 94, respectively, but remember these were done at a time when the prevalence
of variants, like the UK variant, the South African variant, and the Brazilian variant, were not really
that prevalent. And so what's kind of stacked against the Johnson and Johnson candidate here
is that they did their studies when there was much more prevalence of these variants, and in fact they
did the studies in those very countries on purpose where those variants were, so it's going to be
interesting to see how that pans out here. But if we look at the numbers and we try to compare them
as best as we can -- 95 for Pfizer-BioNTech, 94 for Moderna, and 66 overall percent efficacy for the
Johnson & Johnson -- but if you look deep down into that and you look and see which countries they
were in, you'll start to see that for instance in the United States there was a 72 percent efficacy,
where there's not a lot of variance in Latin America it was 66 percent, and then of course
in South Africa, where that worrisome variant is in high prevalence, about 95 percent. There
was 57 percent efficacy there, and so that on one hand, on first blush, looking at that you're like
"well that this is kind of a disappointment." But in fact, this vaccine actually gets better with age.
So if you look at the data a little bit deeper, you'll see that at day
28, overall, there was an 85 percent efficacy in terms of preventing severe COVID that means
hospitalization and death. Okay, and that's really what the the whole purpose of
trying to get this pandemic under control is is: to prevent severe COVID-19 that causes you to
go to the hospital and die. But what's really interesting about this, Kyle, is that as the
antibodies start to be produced, it's felt that by day 49 -- okay, so 49 days after the vaccination --
and again there's only one shot here, there was 100 percent efficacy that was preventative at severe COVID
and also hospitalization. So nobody by day 49 was hospitalized or had severe or died of severe COVID-19,
even in places like South Africa where the South African variant was very high, and I think that's
very encouraging news. Kyle: We've talked before about how mild side effects are relatively common with
the COVID-19 vaccines that have been authorized so far -- pain at the injection site, maybe some fever,
feeling fatigue -- how do the adverse effects stack up with the Johnson & Johnson vaccine
versus the other ones that have been authorized so far? Dr. Seheult: So the Johnson & Johnson vaccine, Kyle, it's
kind of interesting. The serious adverse events were actually very low. In fact, they were lower
in the intervention arm. So those people that actually got the vaccine had lower adverse events,
serious adverse events, than those in the placebo arm, and so it's a question, why would that be? Well,
it may have been statistically or instatistically significant. What they believe is it could be
related to the fact that those in the placebo arm were unprotected from getting COVID-19 and so
there may have been some idea, but maybe the effects of the COVID-19 that they got may have
been increasing the serious adverse events, like fever and the symptoms that you would get from
from getting COVID-19. But it brings a bigger point, here, is that here's a vaccine that is
a one-shot. It doesn't need special refrigeration and it appears as though it may actually have less
side effects than the other vaccines, but we don't know that because it wasn't a direct comparison
in this vaccine compared to the other vaccine. So we can't say that it has less than the other
vaccines, but we could say that it's pretty low, pretty low profile of serious adverse events.
Kyle: Of course, scaling this vaccine up and having it fill the gap increase the supply in
the United States is a priority. It's a priority for every country around the world right now.
So what do we know about cost of this vaccine? Dr. Seheult: Yeah, so Johnson & Johnson has been committed, and
they've they've said this in black and white print, that they are committed to
using this and producing this in a non-profit way, so that it can be distributed to the world
as quickly and as inexpensively as possible. Kyle: Do we know anything about this vaccine and its ability
to block transmission or the spread of COVID-19 to other people? Dr. Seheult: No, we have not gotten that
type of information at this point. You know, one of the ways that we learned about that with the, for
instance, the Moderna vaccine was that there was a special screening done at the second dose of the
Moderna vaccine, and it was based on that data that they were able to come up with about a 67 percent
reduction -- two-thirds reduction -- in asymptomatic transmission with the Moderna vaccine.
Obviously, there's no second dose here with the Johnson and Johnson, so I think we're going to be
waiting for more data. There's probably going to be some blood tests and things of that nature
if we want to look at that with the Johnson and Johnson vaccine. Kyle: Okay, Dr. Seheult, I'm going to put
you on the spot here. If you had a family member or friend come to you and say, "all right there's two
vaccines in the United States that have been given emergency-authorization. There's a couple other
viable candidates: There's AstraZeneca, there's this Johnson & Johnson. Which vaccine should I
get? Dr. Seheult: You should get the vaccine that you could get into your -- if you choose to get the vaccine --
you should get the vaccine that you can get into your arm as quickly as possible.
Look, thousands of people are dying every day here in the United States from COVID-19, and
hundreds of thousands of people are coming down with SARS-CoV-2 infections every single day.
So the one that's going -- all of these work effectively at preventing the worst outcome,
which is hospitalization and death. I would hate to see somebody wait to get the vaccine that they
think was better and in the interim come down with a case that could be fatal. That would be a waste,
in my opinion. So the reason why there's so many of these is because we need so many vaccines.
We can't just depend on one type of vaccine. So I'm glad there's different ones. It's another tool
in our toolshed in the fight against COVID-19. I would say sign up and whichever one is closest to
you in terms of timing, get that one. Don't forget to check out our other videos at MedCram.com,
and check out my interview with Lewis Howes at the School of Greatness. Thanks for joining us.