Medical Examiner

Which Coronavirus Vaccine Should You Get? A Subjective Guide.

Our rankings are based on efficacy, delivery method, timing, celebrity proximity, and fun.

A medical professional wearing gloves holds a syringe up to a patient's upper arm
Not all of the contenders involve needles! Heather Hazzan/Flickr Creative Commons 2.0

With three COVID-19 vaccines sharing preliminary data from large-scale human trials, and dozens more in the works, it is time to start thinking about which COVID-19 vaccine is the best vaccine, subjectively speaking. In the coming weeks and months, the Food and Drug Administration will be carefully reviewing data to determine which candidates to approve for use with health care workers and then the general population. We will all soon (not soon enough, but soon) have to decide which vaccine to actually get.

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The process is going to involve a tangle of supercold storage distribution puzzles, ethical considerations around prioritization for high-risk groups, and pharmaceutical companies scrambling to pipette their products into enough syringes for the country (and world) to reach herd immunity. As the experts have said, due to these logistical quagmires, “we will probably take whatever we are able to get access to,” and also “one should feel quite happy about that.” Fine! Nevertheless, we live in a country where health care is a commodity. So it is our right—nay, our duty as Americans to have opinions about which life-saving inoculation we would prefer to have needled into our arm tissue.

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What follows are the top 10 American-led (or partly-USA-funded or somehow-USA-related) vaccine options. (Yes, efforts with which America has nothing to do could well yield all the best vaccines, in the end—based on the trajectory the overall pandemic has so far taken, that’s probably what will happen. But it would take a few more steps and agreements to have those options at your local doctor’s office.) Like any good experiment, the rankings are subject to change with new data—and there may yet be game-changing new data, as all of the promising vaccines are still in ongoing phase 3 trials and have only just begun being scrutinized by scientists and regulators. And like any ranking of things on the internet, our list is based on a questionable amount of interaction with the vaccine itself (in this case: zero). Really, when the time comes, you will probably just be grateful to take whatever vaccine you are offered (or whatever your doctor tells you to get). But in the meantime, here we go!

1. The Dolly Parton Vaccine

Due to her friendship with a doctor at Vanderbilt, and also due to being perfect, Parton donated a million dollars to COVID-19 research this spring. Some of that money ended up partially funding Moderna’s vaccine, which Parton herself reportedly learned when Moderna published a preliminary report in the New England Journal of Medicine in November. For some sense of scale, I will tell you that the U.S. government contributed a billion dollars to this particular vaccine. Creating a vaccine is pricey.

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The Moderna vaccine is genuinely very promising so far: In early data from the phase 3 trial, the vaccine had an efficacy of 94.5 percent. While the effectiveness of the vaccine out in the real world could be a little different, that’s much higher than the 70 percent efficacy rate that Anthony Fauci had said he would settle for early on in the pandemic. The company says it will apply for emergency use authorization “in the coming weeks” [Update, Nov. 30, 2020, at 9:47 a.m.: They’re doing it now!], so it could also be one of the first vaccines on the market. We tend to choose our alcohol, clothes, and even water by how proximate they are to famous people, and now we can follow through with that commitment when selecting an immunization against a deadly virus too.

2. The Sticker Vaccine

A vaccine that is a tiny sticker that goes on your finger is in early development at the University of Pittsburgh. The sticker is covered in “microneedles,” which means they are so tiny you can barely feel them. (If you want to practice, you can get all kinds of skin care stuff that involves microneedle patches.) You almost certainly will not be getting this vaccine as your first coronavirus vaccine because, to be clear, this is not yet in clinical trials (though you can throw your name in the hat to participate). There haven’t actually been any big updates on it recently—there was a “shows promise in mice” headline back April—but I am pulling for it in case we end up needing an annual coronavirus vaccine, the way that we do with the flu. Because again: The vaccine is a sticker. It is therefore a very good vaccine. I bet a lot of people would take a vaccine that comes as a sticker.

3. The Extremely Cold Vaccine

You may have heard promising news about the Pfizer/BioNTech vaccine, which is, numerically speaking, the most promising vaccine so far. It has an efficacy of at 95 percent, according to a press release, and it has been referred to as “the leading COVID-19 vaccine” because it has been out in the lead, timeline-wise. Pfizer has already applied for an EUA and is prepping doses to go to hospitals. In the U.K., it could be approved within a matter of days. Very exciting!

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But there is one problem with the Pfizer vaccine. It needs to be kept at minus 80 degrees Celsius. Have we fully absorbed how cold this is? While this is not as cold as the coldest outdoor temperature on planet Earth ever recorded using instruments at ground level—that would be minus 89 degrees Celsius, at a Russian outpost on the East Antarctic Plateau in July of 1938—it sure is close! This means it is pricey to ship and store and will be harder to get to rural areas, which tend to not have tons of the high-tech storage capabilities it requires. You can’t even open the freezer where it’s kept too many times in a single day, or else it might be rendered useless.

Tied for 4 and 5: The Pill Vaccines

Sort of like the sticker vaccine, efforts from Vaxart and Merck (along with IAVI) each earn a relatively high ranking purely for their lack of big needles. In fact, these oral vaccines involve no needles at all. It’s still very early days for these, which are in the first phase of clinical trials. The most recent public data (in the case of Vaxart) involves a press release on something called a Hamster Challenge Study. So we’ll see. But pill vaccines would be cool and easy to take.

6. The SARS Vaccine

This one’s a bit maddening! Baylor College of Medicine and Texas Children’s Hospital researchers have had a vaccine for SARS-CoV (the current coronavirus’s cousin) just hanging out in a freezer for years. They’d shown that it protected against SARS in animals, but when the SARS furor died down, they couldn’t get enough funding to keep working on it. And then SARS-CoV-2 came along and we all realized that it sure would have been awfully useful to have years of human safety and efficacy data on a vaccine for a similar-ish virus! Once the current coronavirus started wreaking havoc, the researchers booted things up again, licensing the repurposed SARS vaccine to a company in India, where it is now undergoing early clinical trials for COVID-19.

7. The Cigarette Vaccine

According to the New York Times vaccine tracker, there is a vaccine made by “Kentucky BioProcessing, an American subsidiary of British American Tobacco, the maker of Lucky Strike,” slated to start a phase 1 clinical trial right about now. The basis for this vaccine comes from “a wild relative of tobacco called Nicotiana benthamiana [engineered] to make viral proteins.” I do not have any reason to think this vaccine will end up being delivered in the form of an actual cigarette, but if it works, what a turnaround for tobacco’s track record with human health.

8. The Single-Dose Vaccine

The vaccines on this list that involve needles all require two doses, spaced a few weeks apart. Johnson & Johnson’s vaccine involves getting jabbed just once. Well, maybe—the company, which has the single-dose clinical trial in progress now, recently decided it will run a two-dose clinical trial as well, just in case.

9. The Underdog Vaccine

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The biotech firm Novavax is just 33 years old and has never actually succeeded in making a vaccine that made it to market (the news arm of the journal Science called the company “tiny”). The ETA for the vaccine’s phase 3 data is early next year. That’s not first, but it’s not bad either.

In the meantime, there’s a burgeoning cottage industry of personal essays from participants in Novavax trials. “The charming young doctor smiled broadly and said ‘that’s a really good question’ for all the world as though everyone he saw had not asked the same question,” wrote one trial participant in the Guardian; the question was if the participant could peace out of the Novavax trial if another vaccine was approved in the meantime, and the answer was yes. Another participant wrote in MarketWatch that “there’s a monthly ‘vaccine registry’ newsletter, the latest of which insisted that it does make sense to keep researching and trying.” That author admitted that “I still root for Novavax,” which makes sense because he has already (potentially) gotten that vaccine, and, I have to admit, I find the commitment admirable.

10. The “Whoops” Vaccine

AstraZeneca and Oxford’s vaccine is either 62 percent effective or 90 percent effective, depending on whether you’re looking at data from trial participants who were given the correct dose, or participants who received an accidental, smaller dose, respectively. This error revealed that a lower first dose of the vaccine might actually be more effective. This isn’t scientific kismet, as the company is trying to spin it, so much as a “monumental fuck-up,” since a clinical trial is not the place to knock things around and see what happens! And there have been some—well, a bunch of—other criticisms too. None of this is a great sign for the AstraZeneca vaccine, though it could still get FDA approval (the agency has so far refused to talk to the press about the consequences of the error for the EUA process). But really, mistakes are why we have the FDA, independent experts, and, in extreme cases, endearingly handsome whistleblowers.

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