My assessment:
- People who can easily continue to guard against significant COVID risks for several weeks without much downside other than quality of life should wait several weeks for Pfizer or Moderna.
- (People who have to expose themselves to a non-trivial amount of COVID risk no matter what should take the J&J vaccine if they'd have to wait several more weeks for Pfizer / Moderna. I haven't run the numbers on this, but at some point I'd expect the additional risk exposure from being unvaccinated for several weeks to outweigh the difference in efficacy.)
My rationale:
1. Moderna and Pfizer provide significantly better protection against non-severe infections.
- J&J provides:
- 28 days after the injection: 66% protection against moderate to severe COVID infections (72% "in the United States", but I don't know to what extent that is robust to further spread of foreign variants in the US) and 85% against severe disease [1][2]
- 48 days after the injection: 100% protection against severe COVID. (I don't know what 100% protection means, exactly - a commenter pointed out that there is no such thing as 100% protection - but for the sake of argument, let's say it's close to that.) [3]
- Moderna and Pfizer provided 94.1% and 95% protection against any symptomatic infections generally after the 2nd dose [1]
2. I'd expect that even non-severe infections increase your risk of long-term lingering effects (in addition to being fairly unpleasant in the meantime, but I'm less concerned about that).
- I don't have great evidence for #2 yet. While mild infections have a non-trivial risk of long COVID [4], it seems like even initially asymptomatic cases account for about a 3rd of long-COVID cases [5]. I would hypothesize that the risk of long COVID is significantly less for asymptomatic cases than for symptomatic cases, but haven't researched that much yet.
Zvi said in his 2/4 COVID post, "I’d pay a substantial amount to get Pfizer or Moderna instead of J&J if I could get either one today, but given the choice between waiting and taking what’s available, I will happily accept the J&J vaccine now rather than hold out for Pfizer or Moderna."
What am I missing? Is this just a difference in the weight we place on resuming higher-risk activities sooner rather than later? Or am I overplaying the superior efficacy of the Pfizer and Moderna vaccines?
Sources:
[3] https://twitter.com/VirusesImmunity/status/1355149007220310019
There is also a risk of PEG immunity which will make one immune to lipid nanoparticle vaccine.