MarketJanssen COVID-19 vaccine
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Janssen COVID-19 vaccine

The Janssen COVID‑19 vaccine, (Ad26.COV2.S) sold under the brand name Jcovden, is a COVID‑19 vaccine that was developed by Janssen Vaccines in Leiden, Netherlands, and its Belgian parent company Janssen Pharmaceuticals, a subsidiary of American company Johnson & Johnson.

Medical uses
The Janssen COVID19 vaccine is used to provide protection against infection by the SARS-CoV-2 virus in order to prevent COVID19 in people aged eighteen years and older. There is no evidence that a second booster dose is needed to prevent severe disease in healthy adults. Efficacy A vaccine is generally considered effective if the estimate is ≥50% with a >30% lower limit of the 95% confidence interval. Efficacy is closely related to effectiveness, which is generally expected to slowly decrease over time. In October 2021, Janssen reported at a meeting of the US Food and Drug Administration Vaccines and Related Biological Products Advisory Committee (VRBPAC) that a single dose produced durable protection against severe disease and hospitalization for at least 6 months in the United States, even when Delta emerged, but also a global decrease in protection against moderate disease attributed to emerging variants outside the US. Janssen also reported that a booster dose given 2 months after the primary dose increased efficacy against symptomatic disease to globally and to in the US and that it also increased efficacy against severe disease to nearly globally. == Pharmacology ==
Pharmacology
The vaccine consists of a replication-incompetent recombinant adenovirus type 26 (Ad26) viral vector expressing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein in a stabilized conformation. It is similar to the approach used by the Oxford–AstraZeneca COVID-19 vaccine and the Russian Sputnik V COVID-19 vaccine which use human embryonic kidney (HEK) 293 cells for adenovirus vector replication. The Ad26 viral vector lacks the E1 gene required for replication. Therefore, it cannot replicate in the human organism. == Chemistry ==
Chemistry
The vaccine contains the following excipients: citric acid monohydrate, trisodium citrate dihydrate, ethanol (alcohol), 2-hydroxypropyl-β-cyclodextrin (HBCD) (hydroxypropyl betadex), polysorbate 80, sodium chloride, sodium hydroxide, and hydrochloric acid. == Manufacturing ==
Manufacturing
Unpunctured vials may be stored between for up to twelve hours, It is not shipped or stored frozen. In July 2020, the partnership was expanded to include Catalent's facility in Anagni, Italy. In September 2020, Grand River Aseptic Manufacturing agreed with Johnson & Johnson to support the manufacture of the vaccine, including technology transfer and fill and finish manufacture, at its Grand Rapids, Michigan facility. In December 2020, Johnson & Johnson and Reig Jofre, a Spanish pharmaceutical company, entered into an agreement to manufacture the vaccine at Reig Jofre's Barcelona facility. In February 2021, Sanofi and Johnson & Johnson struck a deal for Sanofi to provide support and infrastructure at Sanofi's Marcy-l'Étoile, France facility to manufacture approximately twelve million doses of the Johnson & Johnson vaccine per month once authorized. In March 2021, Johnson & Johnson and Aspen Pharmacare made a deal to manufacture 220 million vaccines at Aspen's Gqeberha facility in Eastern Cape, South Africa. They plan to distribute the vaccine to other countries, mainly in Africa, and also through the COVID-19 Vaccines Global Access (COVAX) program. In March 2021, Merck & Co and Johnson & Johnson struck a deal for Merck to manufacture the Johnson & Johnson vaccine at two facilities in the United States to help expand the manufacturing capacity of the vaccine using provisions of the Defense Production Act. That same month, human error at a plant run by Emergent BioSolutions in Baltimore resulted in the spoilage of up to fifteen million doses of the Johnson & Johnson vaccine. The error, which was caught before the doses left the plant, delayed expected shipments of the Johnson & Johnson vaccine within the United States. As the error had involved combining ingredients of the Johnson & Johnson vaccine with the AstraZeneca vaccine, the Biden administration gave control of the plant to Johnson & Johnson and said the plant should produce only the Johnson & Johnson vaccine to avoid further mix-ups. In July 2021, the FDA authorized Emergent to resume production (but not distribution) of the Janssen vaccine. 400million doses were destroyed. == Adverse effects ==
Adverse effects
Review of Vaccine Adverse Events Reporting System (VAERS) safety monitoring data by the US Centers for Disease Control and Prevention (CDC) through 21 April 2021, (by which time 7.98million doses of the Janssen COVID19 vaccine had been administered), showed that "97% of reported reactions after vaccine receipt were nonserious, consistent with preauthorization clinical trials data." The most common side effects of the vaccine in the trials were usually mild or moderate, occurred within two days after vaccination, and got better within 1 or 2 days. The most common side effects are pain at the injection site, headache, tiredness, muscle pain, and nausea, affecting more than 1 in 10 people. Coughing, joint pain, fever, chills, redness, and swelling at the injection site occurred in less than 1 in 10 people. This syndrome, marked by formation of blood clots in the blood vessels in combination with low levels of blood platelets 4–28 days after the vaccines administration, occurred at a rate of about 7 per 1 million vaccinated women aged 18–49 years old and it occurs more rarely in other populations (i.e., women 50 years and older and men of all ages). Allergic reactions, including anaphylaxis, can occur in rare cases within a few minutes to one hour after receiving a dose. The European Medicines Agency (EMA) listed Guillain-Barré syndrome (GBS) as a very rare side effect of COVID19 Vaccine Janssen and added a warning in the product information. In August 2021, the Pharmacovigilance Risk Assessment Committee (PRAC) recommended updating the product information to the European Medicines Agency (EMA) that "cases of dizziness and tinnitus (ringing or other noises in one or both ears) are linked to the administration of COVID19 vaccine Janssen." Tinnitus was later labeled as "very rare" in a final safety study by the manufacturer. In December 2021, the CDC accepted the recommendation from a panel of experts for a preference of using the Pfizer-BioNech and Moderna vaccines over the Janssen vaccine due to rare but serious blood clotting events. In May 2022, the FDA limited the use of the Janssen vaccine to those over eighteen unable to access other vaccines or who are otherwise "medically ineligible" for other vaccine options. == History ==
History
The stabilized version of the spike proteinthat includes two mutations in which the regular amino acids are replaced with prolineswas developed by researchers at the National Institute of Allergy and Infectious Diseases' Vaccine Research Center and the University of Texas at Austin. During the COVID19 pandemic, Johnson & Johnson committed over toward development of a not-for-profit vaccine in partnership with the Biomedical Advanced Research and Development Authority (BARDA) Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS). Johnson & Johnson said its vaccine project would be "at a not-for-profit level" as the company viewed it as "the fastest and the best way to find all the collaborations in the world to make this happen". In November, Johnson & Johnson announced that Janssen would commit about $604 million and BARDA would commit $454 million to fund the ENSEMBLE trial. facility where, in collaboration with Johnson & Johnson, vaccines are produced Johnson & Johnson subsidiary Janssen Vaccines, in partnership with Beth Israel Deaconess Medical Center (BIDMC), was responsible for developing the vaccine candidate, based on the same technology used to make its Ebola vaccine. Clinical trials Preclinical trials indicated that the vaccine effectively protected hamsters and rhesus macaques from SARS‐CoV‐2. Phase I–II In June 2020, Johnson & Johnson and the National Institute of Allergy and Infectious Diseases (NIAID) confirmed that they planned to start clinical trials of the Ad26.COV2.S vaccine in September 2020, with the possibility of phaseI–IIa human clinical trials starting at an accelerated pace in the second half of July. A phase I–IIa clinical trial started with the recruitment of the first subject in July 2020 and enrolled study participants in Belgium and the US. Phase III A phase III clinical trial called ENSEMBLE started enrollment in September 2020 and completed enrollment in December 2020. The trial was paused in October 2020, because a volunteer became ill, In January 2021, Janssen announced safety and efficacy data from an interim analysis of ENSEMBLE trial data, which demonstrated the vaccine was 66% effective at preventing the combined endpoints of moderate and severe COVID19 at 28 days post-vaccination among all volunteers. The interim analysis was based on 468 cases of symptomatic COVID19 among 43,783 adult volunteers in Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa, and the United States. No deaths related to COVID19 were reported in the vaccine group, while five deaths in the placebo group were related to COVID19. Plasma from 8 participants showed greater neutralization activity against the Delta variant than against Beta. In February 2021, Janssen applied to the EMA for conditional marketing authorization of the vaccine. The European Commission approved the COVID19 Vaccine Janssen in March 2021. United States In February 2021, Janssen Biotech applied to the US Food and Drug Administration (FDA) for an emergency use authorization (EUA), and the FDA announced that its Vaccines and Related Biological Products Advisory Committee (VRBPAC) would meet in February to consider the application. In February, ahead of the VRBPAC meeting, briefing documents from Janssen and the FDA were issued; the FDA document recommends granting the EUA, concluding that the results of the clinical trials and the safety data are consistent with FDA EUA guidance for COVID19 vaccines. At the 26 February meeting, VRBPAC voted unanimously (22–0) to recommend that an EUA for the vaccine be issued. The FDA granted the EUA for the vaccine the following day. In February, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended the use of the vaccine for those aged 18 and older. In April 2021, the CDC and the FDA issued a joint statement recommending that use of the Janssen vaccine be suspended, due to reports of six cases of cerebral venous sinus thrombosis—a "rare and severe" blood clot—in combination with low levels of blood platelets (thrombocytopenia), in six women between the ages of 18 and 48 who had received the vaccine. The symptoms occurred 6–13 days after they had received the vaccination, and it was reported that one woman had died and a second woman had been hospitalized in critical condition. In April, the FDA and the CDC determined that the recommended pause regarding the use of the Janssen COVID19 Vaccine in the US should be lifted and use of the vaccine should resume. The EUA and the fact sheets were updated to reflect the risks of thrombosis-thrombocytopenia syndrome (TTS). In June 2023, the FDA revoked the emergency use authorization for the Janssen COVID-19 vaccine at the request of its manufacturer. In December 2020, Johnson & Johnson entered into an agreement in principle with the GAVI vaccine alliance to support the COVAX Facility. In February 2021, Johnson & Johnson submitted its formal request and data package to the World Health Organization for an Emergency Use Listing (EUL); an EUL is a requirement for participation in COVAX. Johnson & Johnson anticipated providing up to five hundred million doses through 2022 for COVAX. The World Health Organization issued an EUL for the Janssen COVID19 vaccine Ad26.COV2.S vaccine in March 2021. In February 2021, the vaccine received emergency authorization in South Africa. The program resumed in April 2021. In February 2021, Bahrain authorized the vaccine for emergency use. In February 2021, the South Korean Ministry of Food and Drug Safety began a review of Johnson & Johnson's application for approval of its vaccine. In late November 2020, Johnson & Johnson submitted a rolling review application to Health Canada for approval of its vaccine. In March 2021, the vaccine received emergency authorization in Colombia. In March 2021, the vaccine was authorized under interim order in Canada. In April 2021, the Australian government stated that it would not be purchasing the Janssen vaccine, as it "does not intend to purchase any further adenovirus vaccines at this time". The Therapeutic Goods Administration granted provisional approval for use of the Janssen vaccine in Australia in June 2021. In May 2021, the vaccine received conditional marketing authorization in the United Kingdom. In June 2021, Malaysia's National Pharmaceutical Regulatory Agency (NPRA) issued conditional registration for emergency use of the vaccine. In June 2021, COVID19 Janssen Ad26.COV2.S was granted provisional approval in Australia. In July 2021, the vaccine received provisional approval for use for people aged 18 and above in New Zealand. In August 2021, Health and Family Welfare Minister of India announced that Johnson and Johnson single-dose vaccine was approved for emergency use in India through a supply agreement with homegrown vaccine maker Biological E. Limited. In September 2021, National Agency of Drug and Food Control (BPOM) issued emergency use authorization in Indonesia. In November 2021, the vaccine's authorization under interim order in Canada was transitioned to approval for use under the country's Food and Drug Regulations. Further development Homologous prime-boost vaccination In October 2021, the FDA and the CDC authorized the use of either homologous or heterologous vaccine booster doses. Heterologous prime-boost vaccination In October 2021, the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) authorized the use of either homologous or heterologous vaccine booster doses. The authorization was expanded to include all adults in November 2021. == Society and culture ==
Society and culture
About 19.4million doses of the Janssen COVID-19 vaccine were administered in the EU/EEA from authorization to 26 June 2022. Economics Given the Janssen vaccine is a single dose and has a lower cost, it was expected to play an important role in low and middle-income countries. Since it is a single dose vaccine, it has been a popular vaccine to distribute to the homeless, the incarcerated, This is due to the fact that it is difficult for these aforementioned demographics to be contacted for vaccines that require a second dose. With lower costs and lower requirements of storage and distribution in comparison to the COVID19 vaccines by Pfizer and Moderna, the Janssen vaccine is more easily transported, stored, and administered. South African health minister Zweli Mkhize announced on 9February 2021 that the country would sell or swap its one million doses of AstraZeneca vaccine. Once it did so, South Africa began vaccination using the Janssen vaccine in February 2021, marking the vaccine's first use outside of a clinical trial. In July 2020, Johnson & Johnson pledged to deliver up to three hundred million doses of its vaccine to the US, with one hundred million upfront and an option for twenty million more. The deal, worth more than $1billion, is funded by the Biomedical Advanced Research and Development Authority (BARDA) and the U.S. Department of Defense. The deal was confirmed on 5August. In August 2020, Johnson & Johnson signed a contract with the US federal government for $1billion, agreeing to deliver one hundred million doses of the vaccine to the US following the Food and Drug Administration (FDA) grant of approval or emergency use authorization (EUA) for the vaccine. In February 2021, through congressional testimony by a company executive, Johnson & Johnson indicated that the company could deliver twenty million doses to the US government by the end of March and one hundred million doses in the first half of 2021. In February 2021, Johnson & Johnson announced that it planned to ship the vaccine immediately following authorization. Shipments of the vaccine were scheduled to start in the second half of April 2021, with a commitment to deliver at least two hundred million doses to the EU in 2021. The European distribution of the vaccine was slightly delayed until the EMA decided that rare cases of vaccine-induced blood clots did not outweigh the benefits of helping to fight the COVID19 pandemic. Controversies The United States Conference of Catholic Bishops expressed concern about the vaccine because the cell line Per.C6, which is used in development and production, was originally derived from the retinal tissue of an 18-week-old fetus electively aborted in 1985. Although the use of fetal tissue in vaccine development has become common since the 1930s, especially with cell-based vaccines, there are currently alternatives that do not carry the same potential ethical concerns as the Janssen vaccine. Some bioethicists dismiss that ethical concerns to using cells derived from ethically compromised sources should be addressed or alternatives sought. Others advance the view that the cells used for COVID19 vaccines are thousands of generations removed from their source material and do not contain any fetal tissue. However, the key objection to using these vaccines still remains. In September 2021, after criticism that doses of its single-shot COVID19 vaccine produced in Aspen Pharmacare's facility in South Africa were being exported to Europe, millions of doses that had been shipped to Europe and stored in warehouses will be returned to Africa, and newly manufactured doses will be shipped to African countries. Misinformation Videos on video-sharing platforms circulated around May 2021 showing people having magnets stick to their arms after receiving the vaccine, purportedly demonstrating the conspiracy theory that vaccines contain microchips, but these videos have been debunked. ==Notes==
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