The TLDR: As of now, Indians’ vaccine options are restricted to just two: Covishield and Covaxin. But New Delhi’s big push on vaccine diplomacy has sealed deals to manufacture two other vaccines in India: Johnson & Johnson and Novavax. But are these the ‘only for export’ kind? Or will we natives get some too?

Tell me about these vaccines...

Johnson & Johnson: has been developed by the company in partnership with the Harvard medical school—and with the financial assistance of the US government. And it has been approved by the WHO and the US for emergency use. It is currently conducting advanced phase 3 trials with 44,000 participants across the US, Brazil and South Africa. Here’s how it works:

• Like the Oxford vaccine, it contains genetic material from the coronavirus’ spike protein.
• But unlike Moderna and Pfizer (explained here), it uses a double stranded DNA and not RNA to store these genetic instructions. 
• The genetic material is delivered using a modified adenovirus—i.e. a common cold virus. But this is the human variety—while Oxford uses a chimpanzee adenovirus—and has been used before to develop the Ebola vaccine.
• As for the rest, the vaccine works exactly like the others. Once inside your body, it gives cells instructions to produce copies of the spike protein—which in turn triggers an immune response. 

Novavax: is a Maryland-based company that has never developed a vaccine before. It has held phase 3 trials in the UK and the US. And it works a little differently than the rest:

• Again, scientists isolated the genetic material of the coronavirus’ spike protein, but they inserted it into a different ‘carrier’ virus called baculovirus.
• These were used to infect cells of moths—which then produced copies of the spike protein.
• The researchers then harvested the spike proteins from the moth cells and assembled them into nanoparticles.
• These nanoparticles are injected into your body along with the extract of the soap bark tree. And they attract your immune cells—and trigger a strong response.
• This technology is already proven to work on HPV and influenza vaccines. 

Point to note: There is a key difference between Novavax and its peers:

“[U]nlike the other three approved vaccines that ‘work by tricking the body’s cells to manufacture the parts of the virus that then trigger the immune system,’ it ‘is made up with proteins from the virus already attached to a carrier and these trigger the immune system directly’.”

Are they better than Oxford, Moderna etc?

Efficacy rates: J&J is 85.9% effective for severe forms of Covid, while it offers 66% protection against moderate to mild forms of the disease. And it offers 100% protection against death. OTOH, Novavax was found to be 95.6% effective against mild, moderate and severe cases in its UK trials. But it performs less well against variants (which we will get to next). 

Dosage: J&J’s biggest appeal is that it requires just one jab, while Novavax requires the standard two doses.

Storage: Both can be refrigerated—and do not need to be kept at freezing temperatures unlike Pfizer and Moderna. In the case of J&J, adenovirus-based vaccines are hardier than mRNA vaccines like Pfizer and Moderna—and DNA is not as fragile as RNA. This is a big deal since these vaccines are easier to store and distribute across the world—including in locations that do not have access to freezers. Novavax is also easier to manufacture than mRNA vaccines.

Those tricky variants: Both these vaccines held their phase 3 trials later in the pandemic. And so we have a far better sense of how they perform against the South Africa, UK and Brazil variants. 

• J&J reported 68% vaccine efficacy in Brazil and 64% efficacy in South Africa —and 72% efficacy in the US, where most cases involved the original coronavirus strain.
• For Novavax, its effectiveness dipped to 85.6% against the UK variant. But the real worry was its performance in South Africa—where its performance dropped to 50%. But that was a small 4000-person trial. And the jury remains out on its actual efficacy.
• Point to note: The Oxford vaccine showed an alarming 10.4% efficacy against the South Africa strain. 

So we’re going to make these vaccines?

Yes, as part of India’s big vaccine diplomacy push, Indian companies have sealed deals to manufacture J&J and Novavax vaccines. 

The Quad: The Quadrilateral Security Dialogue is a loose four-nation alliance of India, US, Australia and Japan (explained here). The big focus of a recent virtual summit was financing vaccine manufacturing in India—to help distribute them cheaper and faster to Southeast and the Pacific. As part of this deal,  Hyderabad-based Biological E inked a deal with J&J to produce 600 million doses per year. The company is the largest manufacturer of the tetanus vaccines and snake venom antidote in India. 

GAVI alliance: This international alliance aims to supply cheap vaccines to poorer countries—and Pune-based Serum Institute of India is a key player. GAVI signed a memorandum of understanding to procure 1.1 billion doses of Novavax—which will be manufactured by SII, at no cost to either company.

Will we get any of these vaccines?

Yes and no. In order to be authorised for use in India, a company has to conduct bridge trials (explained here) to ensure safety and effectiveness. 

No on J&J: According to Reuters, the company’s Managing Director declined to answer if the company could help J&J run a small local safety and immunogenicity study in India—which indicates that you are unlikely to get J&J as an option at your local hospital any time soon.

Yes on Novavax: Serum has already got approval to start bridge trials for the vaccine in India and will start stockpiling 40-50 million doses per month starting in April.

Point to note: Biological E has its own vaccine candidate, developed in partnership with Baylor College of Medicine in Houston and US-based Dynavax Technologies Corp—and is prepping for stage 3 trials in India.

The bottomline: More the merrier. Also: where can we sign a petition for a one-shot J&J vaccine? Oops, forgot it isn’t being manufactured by the government’s blue-eyed Serum.

Reading list

New York Times has very good overviews of the J&J and Novavax vaccines. Pharmaceutical Technology has a deep dive on how Novavax works, and its trial data. Mint looks at how the different vaccines perform against the South Africa variant. And for more context, read our explainers on the Quad and the big three vaccines.