Last updated: December 17, 2020
The COVID vaccine rollout is the largest mass-immunization effort in US history — and it’s a lot to keep track of. Between finding your place in line and knowing which vaccines are undergoing testing/getting approved/sitting in pharmacy coolers, the info can be overwhelming. So let’s start with the Big Questions. Here’s a breakdown of what you need to know about the COVID vaccine (and then some):
When can I get the COVID vaccine?
Public health officials have said everyone who wants the vaccine should be able to get it by May or June, and some experts believe it could be sooner. At a high level, the order of priority is the same across the country:
Healthcare workers and nursing home residents (being vaccinated now)
High-risk adults with underlying health conditions and people over 65
The general population (all other adults)
But the specifics will vary by state. Governors are largely in charge of distribution decisions, with support from local governments. That means each state determines the exact order of priority for subgroups within broad categories like “essential workers.” Additional factors, like geography, might come into play too. In allocating limited vaccines, New York State will consider where early vaccination will have the greatest impact, likely prioritizing areas that have the highest COVID rates and/or have historically suffered a heavy burden from disease.
How will I know when it’s my turn, and where will I get vaccinated?
State and local officials will communicate with the public at each step of the distribution process. Health systems and other medical facilities may perform outreach too. Distribution plans for every state are also available online. And many states have COVID vaccine websites, where you’ll find not only distribution plans, but also news updates and other useful resources.
In this early phase of the rollout, hospitals and large pharmacy chains, like CVS and Walgreens, are administering a lot of the shots. Public health departments will likely set up approved vaccination sites soon too. Once the vaccine is ready for the general public, it will probably be available many places — doctors’ offices, local clinics, most pharmacies.
Several states, including Maryland, Massachusetts and North Dakota, plan to use a digital system called PrepMod to help people find nearby vaccination sites and schedule appointments to get the vaccine, and also to remind them when it’s time for their second doses.
How is the vaccine administered?
The Pfizer vaccine requires two injections into the muscle, administered three weeks apart. The Moderna vaccine (likely to be approved this week) also requires two shots, but they’re administered four weeks apart.
Do I really need the second shot?
Yes, it’s strongly recommended, says Dr. Chad Sanborn, a pediatric infectious disease specialist at KIDZ Medical Services in West Palm Beach, Florida. Pfizer’s two-dose regimen emerged as the safest option and the best way to produce antibodies in clinical trials, he says, compared to other doses and intervals. Based on early data, one dose of the Pfizer vaccine is estimated to be 52.4 percent effective at preventing COVID illness. After two doses, it’s 95 percent effective.
Basically, skipping your second shot could undermine the vaccine’s ability to protect you from COVID. In fact, the government is paying vaccination providers more money to administer second doses, to incentivize them to make sure patients come back.
Once you get both doses, it takes about a week for the vaccine to work like it’s supposed to.
Is the vaccine actually free?
Yes, the federal government says it’s footing the bill. The COVID vaccine will be free through 2021 for anyone who wants it — no matter where you get vaccinated or what type of insurance you have (or don’t have).
Now for the fine print: Most private insurance plans have to cover the full cost of vaccination. If patients don’t have insurance, vaccine providers are supposed to bill the CARES Act Provider Relief Fund. But there are issues the federal guidance doesn’t address. For instance, could patients still be charged visit fees (by doctors) or facility fees (by hospitals)? Will vaccination be fully covered for patients with nonqualified short-term health plans (i.e., skimpy plans that aren’t subject to ACA requirements)? And what happens if the relief fund runs out before the rollout is done? Will it be replenished? Hopefully, we’ll get clearer answers to these questions as the vaccine becomes available to more people.
The bottom line is that you’re not responsible to pay for the COVID vaccine. Keep an eye out for sneaky bills and be straightforward with your doctor about any cost concerns. But don’t let money be a barrier to getting your shot(s).
How many COVID vaccines have been developed? Which ones do I need to know about now?
About 60 COVID vaccines have been developed globally, and they’re all at different stages of clinical testing and approval. In the US, the Pfizer/BioNTech vaccine is already being administered, after being approved for emergency use December 10. Close behind is the Moderna vaccine, which is expected to be approved this week. Emergency use authorization, which is different from full FDA approval, allows an experimental vaccine to be used if the evidence of its potential benefits outweighs its risks. Full approval requires six months of data, which is being collected during this rollout.
Traditionally, vaccines are made from the same viruses they’re designed to prevent. Injecting a tiny, weakened piece of live virus into the body triggers a protective immune response. None of the COVID vaccines were made the traditional way.
Both the Pfizer and Moderna vaccines are mRNA vaccines. They work by teaching the body’s cells how to create a coronavirus protein, triggering an immune response. The gene technology behind mRNA vaccines is pretty new; this is the first time they’re being used for mass vaccination, says Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth.
Vaccines from AstraZeneca/Oxford (two doses) and Johnson and Johnson (one dose) may be next out of the gate. They’re both viral vector vaccines. That means they use a different virus to transport a tiny bit of coronavirus DNA into the body. The DNA — not the other virus — prompts an immune response.
Can I choose which vaccine I get?
Maybe later, once more vaccines come to market, and if we learn that certain vaccines work better for certain populations. But for at least the next few months, just accept whichever vaccine is available, says Dr. Dean Winslow, an infectious disease physician at Stanford Healthcare in California. Vaccines are difficult to manufacture compared to, say, therapeutic drugs, and Winslow says we’ll have a limited supply until at least late spring of 2021. Fortunately, Winslow says, you can consider any vaccine approved by the FDA to be both effective and safe.
These vaccines were developed so quickly. How do we know they’re safe?
Because the FDA says they are (for people 16 and over). It’s very unlikely that anyone for whom a COVID vaccine is approved would experience a severe, adverse reaction from it, says Dr. Cassandra Pierre, an infectious disease physician at Boston Medical Center.
Part of the reason the vaccines were developed so rapidly is that scientists had a head start, building off years of vaccine research on MERS and SARS, two other coronaviruses.
Clinical testing, though expedited, has still been rigorous. Any approved vaccine has been given to tens of thousands of volunteers. The FDA also requires vaccine manufacturers to provide two months of safety data in their applications for emergency use.
What should I know about side effects?
The first thing to know is that it’s impossible to get COVID from vaccination because, among other things, the vaccines don’t contain any live virus. But as with any vaccine, you might experience side effects.
The Pfizer trial found that mild- to- moderate side effects are relatively common and more likely to develop after the second shot. They tend to last one or two days and resemble symptoms of COVID itself: Pain, swelling and redness at the injection site; fatigue; headaches; muscle and joint pain; fever; chills. While these post-shot symptoms might be unpleasant and unnerving, they aren’t dangerous. In fact, they’re a sign that your immune system is responding to the vaccine the way it’s supposed to.
Data on side effects is being tracked closely as vaccination continues to roll out. Once you get vaccinated, you can report your own side effects, however mild, using the CDCs V-safe app. The app will also send you a reminder to get your second dose.
So far, in the US, no severe side effects, aka “adverse events,” have been reported in response to the COVID vaccine. An adverse event is a longer-term, serious illness or hospitalization (or worse) following vaccination. Once vaccination ramps up, it’s possible a small number of people will have these serious reactions. But the likelihood of any given person experiencing one is very, very low.
That said, if you do have an adverse event, you should talk to a healthcare provider and report it on the Vaccine Adverse Event Reporting System.
Should I be concerned about the possibility of an allergic reaction?
So far, four healthcare workers in the UK and the US (combined) have had severe allergic reactions to the Pfizer vaccine. Three of the reactions were considered anaphylaxis, while one was less serious. All four were treated and are now fine.
It can be disconcerting to hear about even a single negative reaction to a vaccine we’re all waiting in a months-long line to get. But it’s important to remember how many tens of thousands of people have now received the Pfizer vaccine without going into anaphylaxis.
With that said, now that multiple, similar allergic reactions have been reported, experts say we may see tweaked recommendations regarding post-injection monitoring, from Pfizer and/or US health authorities. For now, the CDC advises people who’ve had severe allergic reactions to other vaccines or injectable drugs to do a vaccination risk assessment with their doctor. The CDC says these precautious aren’t necessary for people with less serious or unrelated allergies. Anyone who has a severe allergic reaction to the first dose of the Pfizer vaccine, the FDA says, should not get the second dose.
Ostrosky suggests a simple rule of thumb: If you carry around an EpiPen, hold off on vaccination for now, at least until you talk to your doctor. By the time the general public can get the vaccine, he says, we’ll probably have more specific guidance.
Certain groups of people weren’t included in COVID vaccine trials. Should they get vaccinated?
Up until now, trials have excluded people with suppressed immune systems, children under 16, pregnant and lactating women, and those with recent COVID infections. That means we don’t have strong evidence to show COVID vaccination is safe or effective for these groups. But there’s no concrete reason to believe it’s unsafe, especially since the COVID vaccines don’t contain any live virus. Efficacy is only a question mark for immunocompromised people, Sanborn says, because we don’t know if they’ll mount a strong enough immune response from the vaccine to prevent sickness.
But we’ll have data relatively soon. Upcoming vaccine studies will include pregnant women, children and immunocompromised people. And people who’ve had COVID already are being vaccinated in this rollout.
- The vaccine is not approved for children under 16.
- The FDA and CDC have not issued guidance either way for pregnant or lactating women. Experts recommend talking to a doctor about the risks and benefits of a still-experimental vaccine that offers protection against COVID.
- The CDC recommends vaccination for immunocompromised people — who may be high risk for severe COVID — unless a healthcare provider familiar with their medical condition urges otherwise.
Do I need to get the vaccine if I’ve already had COVID?
Yes, says Pierre. If you’ve had COVID-19, you most likely developed antibodies. But experts don’t know how effective those antibodies are or how long they last.
What they do know is that getting vaccinated confers stronger and longer-lasting protection against COVID than getting sick with COVID does.
If you’ve had COVID, Pierre says, wait 90 days after the initial onset of symptoms to begin vaccination.
Is it possible to get the COVID vaccine and still get COVID?
It’s possible but not likely. Both the Pfizer and Moderna vaccines are around 95 percent effective in preventing severe COVID illness, so there’s a small chance you could get the vaccine and still get sick. But, in that case, you’d probably have a more mild case of COVID than if you weren’t vaccinated. While 95 percent efficacy isn’t perfect, it’s very good. For comparison, a seasonal flu shot is about 40 percent effective on average (and it’s still worth getting).
What we don’t know yet is how well COVID vaccination protects people against asymptomatic infections. That means we also don’t know if someone who’s been vaccinated can become a silent carrier and unknowingly contribute to the spread of the virus.
“The important message here is that even if you’ve been vaccinated, that’s just a protection for you against severe disease,” Pierre says. “You need to continue to wear your mask and physically distance because you could still be at risk yourself and put others at risk.”
Can I opt out of vaccination?
The short answer is yes. The government can’t mandate universal COVID-19 vaccination, but unvaccinated people could encounter a range of restrictions. For example, airlines could require proof of vaccination before booking or boarding flights. And employers have the right to make vaccination a condition of employment, and to fire workers who don’t comply. The only exception, Winslow says, is if you have a medical exemption. In that case, an employer would have to make a “reasonable accommodation,” such as having you work remotely, so you could continue to do your job.
Keep in mind, the goal of this rollout is to vaccinate enough people to achieve herd immunity so that the coronavirus will stop spreading like wildfire. The percentage of a community that needs to be vaccinated to reach herd immunity is different for every virus. For the coronavirus, Winslow says, the magic number is thought to be about 60 percent. But that’s an educated guess; some experts have put it closer to 70 or 75 percent.
In order to return to our pre-pandemic lives in the near future, most people need to get the COVID vaccine.
Can I stop wearing a mask once I’m vaccinated?
For now — and until we’re explicitly told otherwise — everyone needs to keep wearing masks whether or not they’ve been vaccinated. The vaccine appears to do a great job preventing people from getting ill with COVID. But we don’t know how well it prevents people from getting infected with the virus in the first place. “While you have less of a chance of getting sick after getting vaccinated,” Sanborn says, “without masks or social distancing, you may actually have a higher chance of acquiring an asymptomatic infection and giving it to others who can’t receive [the vaccine], or haven’t been vaccinated yet.”
Sanborn says we’ll learn more in the next month or two. “There is light at the end of the tunnel — vaccines are a huge part of the way this ends, but it will take months to vaccinate enough people to be able to let down our guard some.”
Once I’m vaccinated, will I be able to do normal things again, like travel and eat inside restaurants?
Don’t expect normal life to return right away. For one thing, experts don’t know exactly how long immunity lasts. And while we do know that vaccination does a good job protecting against sickness, we don’t know if vaccinated people can contract the virus and spread it to others.
There’s been talk of immunity passports, but Pierre doesn’t foresee them becoming a thing anytime soon, mostly because we need to allow for the possibility that vaccinated people can contribute to the spread of the disease — unless we get enough data to the contrary.
Can I spend time with older family members once they’re vaccinated, even if I’m not?
Maybe — if you’re careful. Sanborn recommends waiting until they’ve been vaccinated for at least one to two weeks and wearing a mask the whole time you’re with them. They should also ask their doctor first.
In clinical trials, the Pfizer vaccine showed similar protection in the over-65 and over-75 groups as it did in younger adults. While those results are promising, Sanborn still urges caution, particularly if older family members have suppressed immune systems. It’s possible the vaccine won’t be as effective for them. Time and data will tell.
In general, Sanborn believes we need to see increased vaccination coverage and decreased COVID infection rates before we start freely gathering with the people we care about like it’s 2019. “We are still learning the kind of protection the vaccine offers in real life.”
If I have an underlying health condition, do I need to prove that I’m “high risk” in order to get vaccinated before the general public?
With the vaccination rollout underway, healthcare providers are focused on getting the vaccine to the people who need it most, including those with underlying conditions (also called comorbidities). If you have a relationship with a primary care provider, Pierre says, it’s likely that your doctor’s office or hospital, or even your insurance company, is already reviewing your record to determine if you’re a candidate for early vaccination.
Pierre suggests that anyone with a comorbidity establish a relationship with a PCP if they don’t have one already. If you fall into the high-risk category and plan to get vaccinated at a pharmacy, you might want to bring your medical records, just in case the pharmacist asks.