Sure, we’re all exhausted by the covid pandemic. Flummoxed by the continuously shifting science and pointers. Nervous about a succession of scary new variants, every with its personal identify, like hurricanes.

However a sizable minority — nearly 17 million U.S. residents, together with me — has its personal particular quandary. Our preliminary vaccine was Johnson & Johnson, which was only one shot, and that has many people confused. Are we absolutely vaccinated, even with a booster, or ought to we get a third shot to meet up with the 92 million vaccinees who bought two doses of Pfizer or Moderna early on and have since been boosted? Since J&J has largely disappeared from the general public eye, actionable data is in scarce provide — to not point out that the steering is consistently shifting, for everyone.

On April 4, 2021, I dutifully traveled throughout Los Angeles to line up for my J&J shot at a mass vaccination website. Like a lot of my J&J brethren, I used to be following the recommendation of public well being officers to take the primary out there vaccine.

On the time, J&J was type of a cool newcomer amongst covid-19 vaccines. The safety it supplied in opposition to sickness, although apparently lower than that afforded by the so-called messenger RNA (mRNA) vaccines from Pfizer and Moderna, appeared adequate to keep at bay severe sickness.

And whereas these vaccines required two pictures, J&J was billed as “one and executed” — a huge benefit for individuals with needle phobia and for transient populations, together with farmworkers, individuals dwelling in homelessness, and inmates in county jails. Its simple storage necessities, in contrast with the deep freeze wanted to deal with the Pfizer and Moderna vaccines, additionally made it a sensible choice for distant rural populations.

However simply days after I bought my shot, the popularity of J&J entered what would show to be a disastrous tailspin, with information of the vaccine’s hyperlink to a uncommon however probably lethal blood clotting dysfunction. That prompted federal well being officers to hit the pause button on it, solely to clear it 10 days later and then reverse course in December by recommending the Moderna and Pfizer vaccines over J&J’s, primarily due to research that intensified the blood clot concern.

Within the interim, J&J was affected by production snafus and issues about its vaccine’s efficacy. Analysis confirmed a disproportionate share of breakthrough infections amongst J&J vaccinees throughout a covid surge on Cape Cod final summer time. State data from California masking most of 2021 paints a comparable image, not just for infections but additionally for hospitalizations and deaths.

With J&J seemingly destined to be a benchwarmer amongst covid vaccines within the U.S., it typically has been omitted of public discourse and steering on covid.

“Little or no J&J vaccine is at present getting used, which is a part of the rationale that folks don’t speak about it very a lot anymore,” says Dr. William Schaffner, a professor of infectious illnesses at Vanderbilt College Medical Middle in Nashville, Tennessee.

When the Biden administration first recommended boosters in August, it initially excluded J&J vaccinees, citing a lag within the knowledge.

No marvel the residents of J&J Nation have been feeling a bit like uncared for stepchildren.

“I want I had chosen one thing that extra individuals had obtained so I might get extra data,” says Leah Justman, a 39-year-old resident of Los Angeles, who most popular the J&J shot final April as a result of she was breastfeeding her new child child on the time, was nervous concerning the new mRNA expertise, and thought J&J was “extra just like getting a common vaccine.”

Now, she says, she feels as if there’s a little bit of a stigma hooked up to being a J&Jer: “After I go to eating places or present that I’m vaccinated, persons are like, ‘Oh my God, you bought J&J.’ It’s nearly like a joke, the place individuals assume, ‘Thank God I didn’t get it.’”

In December, Justman bought the half-dose Moderna booster really useful by the Facilities for Illness Management and Prevention. That leaves her behind the curve in contrast with Moderna and Pfizer recipients who obtained two full doses initially and a booster afterward. She worries about how lengthy she shall be protected and what her subsequent transfer ought to be.

There seems to be a rising consensus in scientific circles that one shot of J&J was by no means sufficient and that it might account for the decrease efficacy in contrast with the mRNA vaccines.

“Numerous us consider it ought to have been a two-dose vaccine all alongside,” says Bradley Pollock, affiliate dean for public well being sciences on the UC Davis College of Medication. In coming months, he says, “it’s totally doable that they’re going to say a three-dose schedule is full vaccination.”

That bought me fascinated with whether or not I’m absolutely vaccinated. Factoring within the half-dose Moderna booster I obtained in late October, I’m nonetheless behind those that’ve had three Pfizer or Moderna pictures.

I’ve spoken to a number of J&J vaccinees who, pondering comparable ideas, sought a second booster despite the fact that the current federal guideline for J&J vaccinees calls for only one mRNA booster, two months or extra after the preliminary vaccination.

I not too long ago went on-line to e-book an appointment for a second Moderna booster. On my first attempt, I bought a message from the pharmacy saying I wasn’t eligible. A second pharmacy allowed me to e-book a slot, however I canceled on the final minute after receiving dissuasive emails (albeit gentle ones) from two of my skilled sources.

“It’s not as quantitative as you’re making it out to be,” wrote Dr. George Rutherford, a professor of epidemiology at UCSF. The J&J and mRNA vaccines work in a different way, he stated, “so it’s not like one J&J plus one Moderna equals 1.5 Pfizer doses. I don’t assume it’s going to make you sick, however I’d simply sit tight. Omicron goes away.”

New research means that as few as two covid pictures may very well be sufficient to guard most individuals from severe sickness and dying for a lot of months, and even years.

If you’re among the many practically 17 million J&J individuals and have had a booster, take into account standing pat like I lastly did. However in the event you haven’t had a booster but, achieve this ASAP. It appears clear, or a minimum of as clear as something may be the place covid is worried, that if you’re vaccinated and boosted, your threat of creating extreme sickness may be very low.

New federal guidance permits for a second booster in case your immune system is compromised by, for instance, most cancers remedy, HIV, or an organ transplant. For those who’re not immunocompromised however are frightened about weak safety, you possibly can attempt to persuade a pharmacist or the staffers at a vaccination website to present you one other shot. It received’t be simple, nevertheless it’s doable. Or speak to your physician, who could also be prepared to prescribe one.

Now that I’ve spent most of this column stating the issues with the J&J vaccine, it’s solely truthful that I say a few constructive issues about it.

First, despite the fact that it seems to be much less efficient than the Pfizer and Moderna pictures, the J&J vaccine nonetheless supplies a excessive diploma of safety in opposition to severe sickness and is vastly preferable to no vaccine. J&J, which is cheaper than the mRNA vaccines and simpler to move, additionally has a crucial function to play in low-income international locations with massive rural populations and poor transportation infrastructure.

Even in america, the place use of the J&J shot has declined sharply, it’s useful to have the vaccine in inventory. It’s a good different for individuals who are anxious concerning the mRNA pictures and would in any other case not get vaccinated.

And it’s at all times doable that demand for it might return. The mRNA vaccines carry a threat of coronary heart irritation for younger males, a aspect impact that seems to be brief time period generally. But when future research present it could actually result in everlasting injury and even dying, “that might make the J&J vaccine probably a minimum of as enticing, if no more enticing,” says Dr. Walter Orenstein, a professor of epidemiology at Emory College in Atlanta.

The vaccines are nonetheless new, many scientific trials have but to yield unambiguous outcomes, and each new variant throws doubt on knowledge collected when a completely different pressure was dominant.

“It might turn into true that three doses or two doses and a variant-focused booster are going to turn into finest. We don’t know but,” says Dr. Gregory Poland, director and founding father of the Mayo Clinic’s Vaccine Analysis Group in Rochester, Minnesota. “And the best way issues have been going, we’ll barely be getting the solutions to these questions, and extra time can have handed, and a new variant will arrive.”

This story was produced by KHN, which publishes California Healthline, an editorially impartial service of the California Health Care Foundation.

Bernard J. Wolfson: [email protected], @bjwolfson