Vaccinate to Educate

J&J Makes Three: COVID-19 Vaccines Work in Obesity

Yesterday, FDA released a detailed analysis of all the available data on a third COVID-19 vaccine up for approval in the U.S. Tomorrow, an independent advisory committee will meet to review this vaccine from Johnson & Johnson. But it already looks like it is heading for approval. For one thing, FDA reviewers concluded the vaccine is effective. In fact, it is very effective for preventing serious infections and death. They also found no safety concerns that would weigh against approval. And then finally, the data show quite clearly that – just like the two COVID-19 vaccines that came before – this one works equally well whether a person has obesity or not.

On top of all that, the J&J vaccine offers a big practical advantage. It takes only one dose to be fully effective. It doesn’t require super-cold storage, either.

Direct Evidence Versus Speculation

J&J COVID-19 Vaccine Efficacy, Subgroup AnalysisThis makes three vaccines in quick succession that have good effectiveness for people with obesity. The numbers for overall efficacy are a little lower for this one than the two that came before. For preventing both moderate and more severe cases, its effectiveness was 72 percent. While this number is lower than the numbers for the first two vaccines, it is higher than the typical numbers for a flu vaccine.

Perhaps more important, though, is the efficacy for preventing severe infections. In the U.S., it was 86 percent effective in preventing severe cases. It was 100 percent effective in preventing deaths due to COVID.

The numbers for people with obesity are in the table on the right. In 10,541 subjects with obesity, the overall efficacy after 28 days was 66 percent. For people without it, the efficacy was 69 percent. Statistically, those results are indistinguishable.

These facts directly disprove prior speculation that obesity might be a problem for vaccine efficacy.

Weight Bias and the Me-First Ethos

We are indeed fortunate to have two, and soon three vaccines available that are very effective for preventing COVID-19. But we do have a problem with getting the vaccines fast enough to all the people who want them. And that brings out an ugly feature of humanity – the me-first ethos. The desire to jump to the front of the line. OAC board member and former chair describes it:

“A year ago, we were trying to grab toilet paper that was disappearing from store shelves. Today people are understandably clamoring for the COVID vaccine. But the angst we all feel doesn’t explain or excuse some of the bad behavior and vile comments directed at people who have the greatest medical needs, such as people living with obesity.”

For good reasons, guidance from CDC suggests that we should be vaccinating people who face the highest risks first. Not the people with the sharpest elbows. That means older people, people who get exposed a lot because we need them on the front lines, and people with pre-existing conditions that put them at a high risk for death if they get infected.

The Risk Is Real

The data from the clinical trials with the J&J vaccine illustrate this risk starkly. Roughly 40,000 patients participated in these placebo controlled studies. Only seven died from COVID-19. All seven of them received the placebo. Of those seven who died, six had obesity.

The risk is real. But COVID-19 vaccines are quite effective for people living with obesity. They save lives.

Click here, here, and here for more reporting on the J&J COVID-19 vaccine. To dive into the detailed analysis of these data, click here. Finally, for some excellent perspective on vaccination for people living with obesity, click here.

Vaccinate to Educate, photograph © Phil Roeder / flickr

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February 25, 2021

2 Responses to “J&J Makes Three: COVID-19 Vaccines Work in Obesity”

  1. February 25, 2021 at 2:08 pm, Allen Browne said:

    So, the big question is how to move people with the disease of obesity to the front of the vaccination line.

    • February 25, 2021 at 4:10 pm, Ted said:

      CDC guidance is to vaccinate PWO with everyone else who has a medical risk condition. Makes sense. But it attracts some unfortunate static.