Answers to Key Questions About the COVID-19 Vaccine Rollout, and the Science Behind the Shots
To help answer common vaccine questions, we consulted Dr. Stanley Perlman, a professor at the University of Iowa’s Carver College of Medicine and a member of the U.S. Food and Drug Administration’s (FDA) vaccine advisory committee, and Angela Shen, a visiting scientist with the Vaccine Education Center at Children’s Hospital of Philadelphia.
When can I get a vaccine?
Estimates vary. Federal health authorities have said vaccines should be available to anyone who wants one by April 2021. But in December 2020, U.S. Surgeon General nominee Dr. Vivek Murthy said people should be prepared to wait until summer or even fall of 2021, depending on how smoothly rollout goes.
People who fit into several high-risk groups, however, will be eligible for vaccines much earlier, if they aren’t already.
Each state gets to determine its own vaccine distribution, though the U.S. Centers for Disease Control and Prevention (CDC) has published recommendations to guide the process.
Frontline health care workers and residents of long-term care facilities are currently eligible for vaccination across the country. Many states have chosen to first vaccinate health care workers who are directly involved in COVID-19 care, or who have a high risk of coming into contact with the virus.
After that, federal recommendations say access should next open up to adults 75 and older, as well as front line workers who have direct and frequent contact with other people in fields including education, agriculture and emergency services. Some states, including Florida and Nevada, have already begun vaccinating elderly residents.
After that, adults ages 65 to 74, people with underlying health conditions and remaining essential workers (including restaurant workers, bank tellers and construction workers) should get vaccinated, according to the recommendations.
After those groups get access to vaccines, they will be rolled out to remaining American adults and teenagers. (For more information on kids and vaccination, click here.)
I’m in a high-risk group. How do I make sure I get vaccinated early?
Those plans are still coming together.
The CDC’s vaccine advisory committee has laid out vaccination tiers for essential workers based on a list made by the Cybersecurity and Infrastructure Security Agency. People who work in very public-facing fields or those that come with a heightened risk of infection—including education, child care and emergency services—should be vaccinated before essential workers in lower-risk jobs, such as bank tellers and construction workers, according to the guidelines.
The CDC has also specified that people with certain medical conditions, including cancer, COPD, type 2 diabetes and heart disease, are at increased risk of severe COVID-19, which will likely make them eligible for early vaccination. Elderly adults will also qualify earlier than younger people.
But it’s not entirely clear what people should do if they fall into one of these groups.
Perlman says the FDA’s vaccine advisory committee first discussed plans for getting the vaccine out to health care workers and nursing home residents, both of which are fairly fixed populations that are easy to locate. For people in later waves—like essential workers and people with underlying medical conditions—it might take “some self-advocacy,” Perlman admits.
“What I can imagine is people coming to a clinic, being told there are enough doses for people who have diabetes and are older, they’ll prove they have those things, and then they’ll get vaccinated,” Perlman says by way of example. In states like Florida, where older adults can currently get vaccinated, clinics have seen hours-long waits as people rush to get their shots.
Further complicating the situation, each state will handle vaccine distribution a little differently, since each one had to put together its own plan. The demographic makeup of a particular state, how many doses it has received and how they’re being divided up could all determine who gets vaccinated, and when.
While there are a lot of unanswered questions right now, expect more details on the specifics of distribution in the coming weeks and months.
Where will COVID-19 vaccines be available?
“This is really going to be dependent on the vaccine[s]” available in your area, Perlman says. The Pfizer-BioNTech vaccine, for example, must be stored at extremely cold temperatures and comes in boxes that contain 1,000 or more doses. A small clinic may not have the resources required to store the shots, or the demand to go through that many before they expire, which will probably make the Pfizer vaccine a better option for large hospitals or public vaccination centers.
Moderna’s shot, by contrast, can be shipped at temperatures achieved by normal freezers and stored in standard refrigerators. That will make them easier to distribute in places like retail pharmacies and clinics. Pharmacies have already been authorized to give COVID-19 vaccines when they’re approved, but it may take a little while for them to get doses.
Perlman also says it’s unlikely that you’ll be required to get vaccinated in the state where you live, at least once supplies are large enough to reach the general public, but that’s another question without a clear answer. “It would be pretty ludicrous if we made every college student go home to get their vaccination, so I would hope that’s not the case,” he says. (Neither the CDC nor its Advisory Committee on Immunization Practices offered further details before press time.)
How much will it cost to get vaccinated?
Nothing for the vaccine itself. The federal Operation Warp Speed program funded vaccine development with the intent that they be offered free to all Americans, regardless of insurance status.
The caveat: The facility where you get the vaccine may choose to charge something like an administrative fee.
Can I choose which vaccine I get?
Probably not—especially not at first.
Vaccine distribution plans vary from state to state. Depending on the proposals put together by your state’s health department, there may only be one type of vaccine available in your area, especially in the early phases of distribution when doses are limited.
We’ll learn more about how the different vaccines compare in the coming months. But in clinical trials, the shots made by Pfizer-BioNTech and Moderna (the only two authorized by the FDA so far) both appear to be almost 95% effective at preventing disease after two doses. AstraZeneca’s shot, which is not yet authorized in the U.S., looks to be about 70% effective on average.
Can pregnant people get the vaccine?
Yes—but initial COVID-19 vaccine trials enrolled non-pregnant adults, so “there are no data on the safety and efficacy of COVID-19 vaccines [among people who are pregnant or breastfeeding] to inform vaccine recommendations,” the U.S. CDC says. Some manufacturers have said they plan to study their shots in pregnant people after their initial trials are completed.
As of now, it’s essentially up to each individual to decide what to do. Some may decide it’s worth it to get vaccinated, given that studies have shown pregnant people are at risk of severe disease or pregnancy complications if they get sick with COVID-19. “Women who are pregnant and/or lactating should not be excluded from what are identified as high priority populations for the COVID-19 vaccine allocation strategy,” the chair of the American College of Obstetricians and Gynecologists said in an October statement.
Can kids get the vaccine?
When the U.S. Food and Drug Administration granted emergency-use authorization to Pfizer-BioNTech’s vaccine, it did so only for people ages 16 and older; Moderna’s shot was authorized only in people 18 and older. That means, at least for now, that younger children cannot get a COVID-19 vaccine in the U.S.
Initial clinical trials studied COVID-19 vaccine candidates only in adults. Pfizer and Moderna have started enrolling children as young as 12 for their studies, but Shen says it will likely take manufacturers a while to amass enough data for health officials to recommend a vaccine for younger kids.
“Once [data are] collected and analyzed, you could imagine a staggered rollout that would go to older children first, down to age 12, and then down to a lower age group,” Shen says, but it’s not clear when that would happen.
Until then, parents will have to help their kids—who have fortunately been mostly spared the worst of COVID-19’s effects—take non-vaccine precautions, such as masking and social distancing.
Will I be protected if I only get one dose?
Not fully. Almost all of the COVID-19 vaccines authorized or in development are designed to be given in two separate doses, a few weeks apart. (The exception is the single-dose vaccine made by Johnson & Johnson, which, after reducing the size of its Phase 3 trial in December, expects to have preliminary data available in January 2021.) The first dose kick-starts your body’s immune system, and the second significantly strengthens your immune response. To reap the full benefits, you need both.
But a growing group of experts argue that it would be beneficial for more people to get a single vaccine dose, rather than half as many people getting both shots. Dr. Moncef Slaoui, a top Operation Warp Speed official, also said in a January interview with CBS News that officials are considering the idea of giving smaller doses of the Moderna vaccine, so current supplies go further.
It’s not clear when, or even if, such ideas would be implemented.
Can I get a first dose of one vaccine, and a second dose of another?
Most guidance so far says you must get two doses of the same shot, and Perlman agrees that’s “ideal.”
Perlman says the FDA’s vaccine advisory committee has discussed the possibility of mixing doses, since most of the vaccines target the same protein within the body, even though they do so using different technologies. So far, however, each vaccine has only been studied independently, so experts are calling for everyone to get two doses of the same shot.
In the U.K., experts have said it may be necessary to mix and match doses on “extremely rare occasions,” but maintain that ideally both doses should come from the same manufacturer.
How will I keep track of which vaccine I got and when?
When you get your first dose, you should get a card on which your health care provider will mark the date and brand of the shot. The card will also say when you’re due for your second dose.
If you lose your card, don’t panic. CNN reports that many states will also keep searchable records of patients’ immunization statuses. Some providers may also use voluntary text message reminder programs to prompt patients to come in for their second dose.
Once I get vaccinated, can I go back to normal life?
Not right away. It’s crucial to understand that these vaccines prevent you from getting sick with COVID-19, but they don’t necessarily prevent you from getting infected.
There have been some promising signs that COVID-19 vaccines may prevent infections, as well as symptoms of the disease. Preliminary data from Moderna’s trial, for example, suggest there were about two-thirds fewer positive test results among people who got a single dose of its shot versus the placebo, but more research is required to conclude anything. There’s even less certainty about how well the Pfizer-BioNTech vaccine protects against infection. That means it’s possible that, even if you’re vaccinated and never experience symptoms, you could potentially still carry and spread the virus. Plus, no vaccine is 100% effective.
Especially in the early days of rollout, when many people haven’t yet been vaccinated, it will be important to keep wearing masks and practicing social distancing to avoid putting unprotected people at risk of serious disease, Shen says.
That won’t last forever, but it will take a while for coverage to be widespread enough to drop other precautions. Shen says it’s impossible to predict exactly when you can put your masks in storage. It depends how quickly people get vaccinated, which will be dictated by both the logistics of distribution and the public’s willingness to get their shots.
If my loved one has been vaccinated already, is it safe for me to go visit?
Your grandparents (and probably some other relatives) will likely get vaccinated before you do. Once a loved one has received both vaccine doses, you can feel more confident that a visit won’t get them sick—but you should still wear a mask and practice social distancing, Shen says.
The COVID-19 vaccines available now have only been confirmed to protect against illness, not to block infection entirely. So if you went to visit grandma while unknowingly carrying the virus, she could potentially still pick it up and transmit it to others, even if she herself didn’t get sick. (She could also potentially infect you.) Until most of the population has been vaccinated, it’s safest to keep up with the precautions you’ve been taking all year.
How do we know these vaccines were developed safely?
Just like any vaccine, those authorized for emergency use against COVID-19 have gone through a rigorous review process by the U.S. Food and Drug Administration, which receives input from its expert vaccine advisory committee. If anything, Shen says, the FDA has given COVID-19 vaccine developers more stringent guidelines than usual. “They have told industry, ‘We need at least 30,000 individuals in a Phase 3 trial,’ and they usually don’t give a number,” she explains.
The FDA has also asked each manufacturer to track study participants for two months after they get fully vaccinated, to help ensure the vaccines do not come with serious side effects. The agency also said up front that it will not approve any vaccine less than 50% effective at preventing COVID-19, Shen says. (Pfizer, Moderna and AstraZeneca have so far reported that their vaccines are significantly more effective than that.)
The speed of vaccine development shouldn’t be cause for concern. It’s true that COVID-19 vaccines were developed much faster than typical shots, but that’s in part because pharmaceutical companies had massive amounts of government funding and manufacturing support—and because many other research efforts have been put on hold to facilitate vaccine development.
Can I get the shot if I have allergies?
A small percentage of the 4.8 million people vaccinated in the U.S. as of Jan. 5 have reported allergic reactions to COVID-19 vaccines. (Out of the 1.8 million people who got first doses of the Pfizer-BioNTech shot from Dec. 14 to 23, 21 had allergic reactions, according to the CDC.) Researchers from the U.S. National Institutes of Health are working to determine which component of the shots causes people to react badly. Some scientists theorize it could be a compound called polyethylene glycol, which is found in both Pfizer and Moderna’s vaccines.
For now, the CDC recommends that anyone with a known allergy to an ingredient in COVID-19 vaccines not get vaccinated. People who have experienced allergic reactions after getting other vaccines should consult their doctors prior to vaccination, and alert providers at the vaccination site so they can be monitored for about 30 minutes after getting the shot.
People with other types of allergies—such as to foods, animals or oral medications—can get the shot.
What are the vaccines’ side effects?
Each of the COVID-19 vaccine candidates was developed a bit differently, so they’ll each come with a unique set of potential side effects.
If I already had COVID-19, do I need a vaccine?
There has been some speculation about whether people who have had COVID-19—and thus have likely developed antibodies, proteins produced by the body to fight infection—will be barred from getting the shot in initial waves, since they presumably already have some level of protection against the virus.
One paper posted online in December (which was not yet peer-reviewed) suggested it could be beneficial for COVID-19 survivors to wait to get vaccinated until those who have not had the virus get their shots, so that everyone has some amount of protection. The CDC’s vaccine advisory committee also suggested that if vaccine supplies run low among health care workers, those who have had COVID-19 within the past 90 days could wait to get vaccinated to free up doses for those without antibodies.
But it’s not clear yet how COVID-19 infection status will affect the general public’s access to vaccines—especially since many people who had mild cases of the virus may not even know it or have proof of being sick.
Alex Azar, the secretary of the U.S. Department of Health and Human Services, on Dec. 7 told NBC News that it’s an issue still under discussion. “I’m not saying [survivors will be] included or excluded” from vaccination, Azar said.
If COVID-19 survivors are not actively excluded from vaccine plans, experts have pretty clear guidance: “If you can get a vaccine, you should,” Shen says. While natural antibodies likely provide some level of immunity against the virus, it’s not yet clear how well they work or how long they last. A vaccine is a surer bet for protection.
Will I need a COVID-19 vaccine every year?
It’s too soon to tell. Following up with people who have gotten the vaccines will help answer that question over time. They may end up being annual shots, like the flu vaccine; long-lasting shots that require occasional boosters, like the tetanus vaccine; or, possibly, lifetime-long immunizations.
Can my employer require me to get a COVID-19 vaccine?
They probably can, but most probably won’t, says Stacy Hawkins, an employment law expert at Rutgers Law School.
There is legal precedent for private employers requiring certain vaccinations—many health care facilities, for example, require staff members to get annual flu shots. That’s legal, as long as the employer offers accommodations for people with disabilities or religious objections, Hawkins says.
That said, Hawkins thinks most employers will encourage or incentivize COVID-19 vaccination, rather than flat-out requiring it as a condition for returning to or continuing in-person work. For one thing, COVID-19 vaccines have been granted emergency-use authorization, as opposed to full FDA approval. Typically, people have more legal leeway to refuse a product authorized under emergency use.
Hawkins adds that a mandatory vaccine policy can get businesses into tricky liability scenarios. Take a retail business. Employees who must report for in-person work, such as cashiers and stockroom employees, would face more immediate consequences from refusing a mandatory vaccine policy than would upper managerial staffers who could presumably work from home. It gets even stickier if one group of employees is predominantly of color, while the other is predominantly white, she says.
“Under federal workplace anti-discrimination law, even policies that are neutral on their face, like a mandatory vaccine policy, but that have a racially discriminatory impact, may give rise to employer liability,” Hawkins explains.
Do I need a COVID-19 shot and a flu shot?
Yes. Different viruses cause the seasonal flu and COVID-19. And since it is possible to get both viruses in one season, doctors recommend you get both shots.
(compiled and written by TIME health reporter Jamie Ducharme)