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Good news for those who got Johnson & Johnson’s COVID-19 shot: The one-dose vaccine is protective against severe disease caused by the coronavirus, even the delta variant. In a large study by the drug maker that examined insurance records, Johnson & Johnson said one dose of its vaccine was 81% effective against hospitalization. The study was published online and hasn’t yet been peer-reviewed.

Additionally, Johnson & Johnson announced in a press release Tuesday that a booster dose of its coronavirus vaccine, given two months after the first shot, was 94% protective against symptomatic COVID-19 in the US and 100% effective against severe COVID-19, which puts it in the same league as its mRNA cousins, Pfizer and Moderna. Johnson & Johnson said the company has given its data to the Food and Drug Administration, which gave J&J emergency use authorization for one dose of its vaccine.

Fewer people have gotten Johnson & Johnson’s one-dose vaccine than Pfizer or Moderna — about 14.8 million people have been vaccinated with J&J, according to the Centers for Disease Control and Prevention, a small number compared to those vaccinated with Pfizer or Moderna. This is partly because it was available in the US later than both mRNA vaccines, went through issues with production that resulted in millions of wasted doses, and its administration was paused over a link to a rare but serious side effect (administration of the vaccine was paused briefly in April, but was quickly resumed).

But those who got the J&J have largely been left out of the country’s booster plans, including immunocompromised people who received the one-dose vaccine. (The CDC recommends moderately or severely immunocompromised folks who received Pfizer or Moderna get a third dose of mRNA vaccine, but says there isn’t enough data to make the same recommendation for those who received J&J.)

So, you got the Johnson & Johnson vaccine. What does all this mean? With the drug company’s announcement on the effectiveness of a second dose, we may expect more answers or more discussion from public health experts on second doses of J&J in the coming days or weeks. Over the weekend, Dr. Anthony Fauci said more data on additional doses of J&J and Moderna is “literally a couple to a few weeks away.” Right now, here’s what we know about J&J boosters.

I’m immunocompromised and got the Johnson & Johnson shot. Can I get an mRNA booster?

An extra dose of an mRNA vaccine (Moderna or Pfizer) is only recommended by the CDC, and authorized by the FDA, for people who got fully vaccinated with either vaccine — it is not recommended for immunocompromised people who received a J&J shot. This is because, according to the CDC, “There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.” That is, fewer people got J&J, so the available data on a third dose’s benefits for immunocompromised folks centers on those who got shots of Pfizer or Moderna.

However, there are many experts who disagree with the CDC and FDA’s stall on waiting for more data when it comes to those more vulnerable to severe COVID-19 who received J&J. Research shows that, while still protective against hospitalization and death caused by COVID-19, viral vector vaccines like J&J and AstraZeneca are likely less effective than mRNA vaccines, which affects certain folks in the US more than others.

In an editorial for The Washington Post on why public health agencies should allow J&J recipients to receive a dose of mRNA vaccine, physician and CNN medical analyst Dr. Leana Wen wrote: “This isn’t a one-size-fits-all recommendation, but rather an individualized decision based on people’s medical circumstances and exposures.”

While a healthy younger person is probably adequately protected with Johnson & Johnson, someone who is severely immunocompromised is “likely not optimally protected by the J&J,” Wen said, and the unknown risks of mixing vaccine types is “almost certainly” outweighed by the risks of severe COVID-19.

There may be some local exceptions: If you live in San Francisco and received J&J, you can get a dose of Pfizer or Moderna. However, the city’s health department stresses this is not a recommendation or change in policy, but an “accomodation” for Johnson & Johnson recipients who’ve asked their physicians about receiving a dose of mRNA vaccine.

If or when boosters become a reality in the US, it’s unclear how that will change the CDC’s definition of “fully vaccinated,” or how that will vary based on the type of vaccine you received.
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Will everyone who got J&J eventually get a booster? When?

Right now, we don’t know. Biden administration health officials say that they do expect J&J recipients will need a booster, but they’re waiting on more information. (It’s worth noting that the booster timeline for everyone who received mRNA vaccines is also up in the air right now.) When the newest information from J&J is reviewed by the FDA, it may decide to prioritize boosters or second doses for some people more at risk for severe COVID-19, like the FDA authorization for third doses of mRNA vaccines. But presently, it’s too early to tell how they’ll roll it out, or if they’ll roll it out.

There is also the argument that booster shots in the US and other wealthy countries should be stalled until there is more COVID-19 vaccine distribution in other countries. The World Health Organization in particular has been outspoken about the fact that nations including the US shouldn’t be giving extra doses to healthy people while as few as 2% of people in low-income countries have had a coronavirus vaccine, according to Our World in Data.

When boosters for J&J become available, will it be another dose of J&J or a dose of mRNA vaccine?

It is likely that the FDA might authorize a second dose of J&J, making it a two-dose vaccine, before it authorizes J&J recipients to get a shot of Pfizer or Moderna. This is because it appears studies being done on an additional dose of J&J are further along than studies being done to test mRNA vaccines in people who initially received J&J. And while many public health experts believe this “mix-and-match” approach will be safe, researchers and scientists need to conclude that the benefits of receiving two types of coronavirus vaccine outweigh any potential risks before they authorize or recommend people do it.

But in this pandemic, new information emerges daily and scientific opinion changes accordingly. When there’s news about the fate of Johnson & Johnson, we will update this story.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.