When Can You Get the COVID-19 Vaccine?

Nurse, teacher, retiree, kid. As rollout begins in the U.S., check to see where you fall on the vax priority list.

by Sarah Ellis Health Writer

Spring is here, and so are the long-awaited COVID-19 vaccines—well, sort of. Rollout isn't going perfectly in every state, but as of April 12, more than 180 million doses of the vaccine have been administered across the U.S. If everything goes as planned, all Americans who are 18 and over will be eligible to receive their first dose by April 19.

Back in December, the FDA granted emergency-use approval to both Pfizer’s and Moderna's vaccine candidates, giving them the official green light for distribution in the U.S. Both vaccines deploy a new scientific approach, the use of messenger RNA, or mRNA. A third vax candidate by Johnson & Johnson was approved on February 27, 2021. This vaccine uses a different type of technology from Pfizer's and Moderna's shots; it’s an adenovirus viral vector vaccine, delivered in a single shot (meaning your appointment process is one-and-done. Yay!). But quick update: On April 13, the CDC and FDA released a joint statement calling for a "pause" in the use of the Johnson & Johnson vaccine while officials review six reported U.S. cases of blood-clotting following receipt of the vaccine.

Several other COVID vaccines are being used in other countries but aren't yet available here in the U.S. AstraZeneca's two-dose, viral-vector vaccine was approved in the UK in January and has been widely distributed across the European Union. But it has faced some significant roadblocks: On March 25, the company announced that its vaccine is 76% effective at preventing COVID-19 after initially stating the vaccine to be 79% effective. Efficacy was officially tweaked to show slightly lower (but still strong) numbers after AZ was accused by U.S. medical officials of manipulating data to make the vaccine look more effective.

More concerning, AstraZeneca's vaccine appears not to offer adequate protection against the newly identified COVID strain first detected in South Africa (B.1.351). On February 7, the South African government announced it was suspending rollout of the AstraZeneca vaccine while this concern is studied in more detail. In addition, in mid-March several European countries suspended use of the AstraZeneca shot after documenting 37 cases of dangerous blot clots out of the 17 million shots administered in the UK and EU. They have since resumed distribution of this vaccine after assessing that it was safe for widepread use.

With close to a quarter of all adults already fully vaxxed in the U.S., there's finally some light at the end of a pretty dark tunnel. And now that Pfizer-BioNTech has filed for emergency-use authorization for its vaccine in kids ages 12 to 15 (with the CDC currently reviewing the decision) there's more hope to be had.

Even so, “it's going to take a while to digest everything that has happened, but we will never think about pathogens and viruses the same way,” says Thomas Hope, Ph.D., professor of cell and developmental biology at Northwestern University Feinberg School of Medicine in Chicago.

And we're not out of the woods yet. Just because all American adults will be eligible by April 19 doesn't mean they'll actually be able to get a vax appointment by that date. The Biden administration has purchased 800 million total vaccine doses thus far: 300 million from Pfizer, 300 million from Moderna, and 200 from J & J (now on pause). All are set to be distributed by mid-summer, meaning that hypothetically there will be enough for all eligible Americans (kids age 11 and under are still being studied, and TBD on when the vaccines will be approved and available for kids ages 12 to 15), with some extra doses that Biden plans to distribute out to other countries.

Appointments can be tough to land in some states, so it has yet to be seen how smoothly this process will go. Still, we're keeping our fingers crossed!

Based on allocation recommendations from the CDC’s Advisory Committee on Immunization Practices, the National Academies of Sciences, Engineering, & Medicine, and the rollout process so far, experts can estimate the order in which people will have access to the vaccine.

See where you fall on the priority list:

  • Front-line Healthcare Workers

In the early days of vaccination, healthcare workers became the first group to get access. Considering their constant proximity to infected people, it makes a lot of sense. “We know that multiple exposures equate to a higher risk, thus healthcare workers are at the highest risk for contracting the virus,” says Rashid Chotani, M.D., medical director and senior scientist at Innovative Emergency Management (IEM) in Morrisville, NC. “We want all the healthcare workers safe and healthy so they can take care of the sick.”

  • Elderly Adults Living in Long-term Care Facilities

That brings us to the second group at highest priority—those living in nursing homes or other long-term care facilities. “That captures a population that has a lot of comorbidities, is elderly, and checks all the boxes for those at highest risk for severe consequences,” Hope says.

  • Elderly Adults Living at Home

Dr. Chotani estimates that elderly adults (aged 65+, although some states, including New York, phased in adults aged 75+ first) living independently are next in line. In most states, this group has already lined up to get the shot.

  • Essential Workers

Plenty of people, from USPS workers to K-12 teachers, are putting themselves at risk every day to keep our society functioning. Those people are already eligible in many states, although the specifics of who goes first really depend on where you live. Some states have given priority to “older individuals and individuals with comorbidities” who work outside the home.

  • Those With Pre-existing Health Conditions

Dr. Chotani says people of any age who have pre-existing medical conditions that put them at high risk for COVID complications come next. Most states are already allowing these high-risk groups to get vaccinated.

  • Adults (16 and Over) at Average Risk

Finally, the hope is that all eligible Americans at average risk can get vaccinated by the summer of 2021. A growing number of states have already opened up the vaccine to everyone 16 and up. “In order to develop herd immunity, 70% of the population must either get vaccine-induced or natural immunity,” Dr. Chotani says. “It will not make any difference which vaccine is available—the objective is to have 70% herd immunity to significantly decrease the spread of the disease.”

For now, there are still several groups of people who still aren’t eligible to receive the COVID-19 vaccine. We won’t know where they fall in the rollout (or if they’ll get vaccinated at all) for another month or two.

Those who can't or shouldn't get the vaccine yet include:

  • Children Under 16

Children are generally considered to be at lower risk of COVID complications than adults, barring any serious comorbidities, so they are not the first priority to get the shot. But they’ll still need to be vaccinated for their safety and to prevent them spreading the virus to family members or teachers. (School-age kids, especially younger school-aged children, have been shown to transmit COVID to adults, even when they have few or no noticeable symptoms.) It is standard procedure not to test vaccines in children until the shots have been shown to be safe and effective in thousands of adults first. As such, Pfizer didn’t initially enroll children in the vaccine trials; they only started testing the vax on children 12 and older in October 2020 after the FDA gave them the OK to do so. On March 31, Pfizer-BioNTech announced that their vaccine was 100% effective in children ages 12 to 15, and soon after, the company requested an EUA to distribute it to this age group. The decision is currently pending FDA approval. Moderna and J & J also recently announced they are starting trials on children 12 and older.

As for children under 12, Moderna and Pfizer have recently announced plans for clinical trials to include them. Unfortunately, most experts don’t expect the vaccines to be available for children before the start of the 2021-22 school year. (It should also be noted that while Pfizer's vaccine is being offered to those 16 and older, you have to be at least 18 years of age to qualify for both Moderna's and J & J's vaccines.)

  • People With Severe Allergies to Ingredients in the Vaccine

The CDC recommends that those who have had an anaphylactic (a.k.a. a severe, potentially life-threatening allergic) reaction to their first dose of the COVID vaccine should not proceed with a second dose. Those with known allergies to any ingredients in one of the three vaccines should not be vaccinated at all, at least until more is known.

To be clear, anaphylaxis is an extreme and, as of now, highly unusual reaction to the vax, involving a drop in blood pressure, weak pulse, and difficulty breathing. This does not refer to people getting COVID-like side effects after being vaccinated. Getting a fever, headache, and/or chills that last one to three days it means your immune system is working how it’s supposed to by building immunity that will protect you from serious COVID infection (although for how long remains a big question). “The point of the vaccine is to mimic the consequences of infection without the worst of the symptoms and other problems,” Hope says.

The Pfizer vaccine ingredients include:

  • mRNA, aka “messenger RNA,” which are molecules that give instructions to the body about how to build proteins to trigger a protective immune response

  • Lipids to help encase and protect the mRNA molecules

  • Potassium chloride

  • Monobasic potassium

  • Phosphate

  • Sodium chloride

  • Dibasic sodium phosphate dihydrate

  • Sucrose

The Moderna vaccine ingredients include:

  • mRNA, aka “messenger RNA,” which are molecules that give instructions to the body about how to build proteins to trigger a protective immune response

  • Lipids to help encase and protect the mRNA molecules

  • Tromethamine

  • Tromethamine hydrochloride

  • Acetic acid

  • Sodium acetate trihydrate

  • Sucrose

It’s important to stress how rare it is to have an allergic reaction to a vaccine like this. Here in the U.S., there have been 21 confirmed cases of anaphylaxis after receipt of Pfizer's COVID vaccine, 17 of which happened in people with a documented history of severe allergic reactions. As of late January 2021, there have been 10 confirmed cases of anaphylaxsis to the Moderna vaccine. Remember, thousands of people enrolled in clinical trials for all three approved vaccines were fine. Talk to your doctor if you’re concerned.

As for the Johnson & Johnson and AstraZeneca vaccines, these vaccines do NOT use mRNA tehnology. Instead, they inject a harmless, specific virus designed to help the body recognize the spike protein for COVID-19, using a technology that has been used before in previous vaccines. Neither of these vaccines contain polyethylene glycol (PEG), which some experts suspect may be triggering allergic responses in some people.

The J & J vaccine ingredients include:

  • adenovirus vector encoding an inactivated variant of the SARS-CoV-2 spike protein

  • Polysorbate-80

  • 2-hydroxypropyl-β-cyclodextrin

  • Citric acid monohydrate

  • Trisodium citrate dihydrate

  • Sodium chloride

  • Ethanol

Finally, there are the groups of people that experts still have questions about, but who may choose to receive the vaccine on an individual basis.

Those who should speak to their doctor before considering vaccination include:

  • Pregnant Women

Pregnant women may opt to receive the COVID vaccine if they wish—but because this group was excluded from the original clinical trials, some experts have concerns about the lack of data on pregnancy and the new COVID vaccine candidates. In October 2020, the American College of Obstetrics & Gynecology wrote a letter to the CDC urging for the inclusion of pregnant and lactating women in clinical trials, especially for the sake of pregnant healthcare workers and those with underlying health conditions. The FDA has asked that Pfizer-BioNTech and Moderna release data on pregnant women as soon as it becomes available, and Pfizer-BioNTech is currently conducting a trial of its vaccine in healthy pregnant women 18 and older. For now, it’s up to each woman and her doctor to decide whether to get the vaccine.

  • Immunocompromised People

This is another population that hasn’t been included in clinical trials—which is unfortunate, because immunocompromised people are among the highest-risk groups for serious COVID complications. Researchers hope to know more about the safety of the vaccine for this group within a few months. Because they weren’t included in the first round of studies, we don’t have much data yet on how well the vax will work, or if increased risks are involved. However, the theory is that because mRNA vaccines do not contain live or weakened virus, they should be safer than some traditional vaccines. But again, it’s not proven yet. So where does that leave you? With a need to have a conversation with your MD. Touch base with your doctor to get his or her advice on the potential risks and benefits for you, depending on your potential exposure to COVID. (In its vaccine fact sheet, Pfizer suggests talking to your doctor if you have an autoimmune disease and/or are on immunosuppressant medications.)

As for access, Brandon Brown, Ph.D., associate professor at the Center for Healthy Communities at the University of California Riverside School of Medicine, hopes the COVID vaccine will be available at no cost to the recipient. So far, that has been the case. “Health insurance should not be a factor in deciding who gets vaccine,” Brown says. COVID vaccines purchased by the U.S. government will be free, but once those run out, the manufacturer could theoretically charge consumers for vaccines they sell privately.

Brown also notes the importance of making it available to people in jails and prisons. “We must not forget about people who are incarcerated,” he says, “as they are at very high risk for COVID-19 due to their placement in close quarters and lack of resources.” Ultimately, the most important thing will be to prioritize the groups who need a vaccine most due to their likelihood of infection.

So, how long until everyone in the U.S. is vaccinated?

That’s the million-dollar question, and we still don’t have a clear answer. Dr. Chotani estimates that by winter of 2021, life will return to something closer to normal—provided the manufacturing and rollout process goes smoothly. Hope’s guess is a little sooner—maybe even by this summer.

Still, we’re taking the wins where we can get them these days. And having developed several effective and officially approved COVID-19 vaccines in a year (with more potentially on the way) is a magnificent feat of science. We can’t wait until each one of us gets our turn.

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Sarah Ellis
Meet Our Writer
Sarah Ellis

Sarah Ellis is a wellness and culture writer who covers everything from contraceptive access to chronic health conditions to fitness trends. She is originally from Nashville, Tennessee and currently resides in NYC. She has written for Elite Daily, Greatist, mindbodygreen and others. When she’s not writing, Sarah loves distance running, vegan food, and getting the most out of her library card.