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
We all needed some good news to ring in 2021—and it arrived with the long-awaited COVID-19 vaccines as last year came to a close. First, on December 11, the FDA granted emergency-use approval to Pfizer’s vaccine candidate, giving it the official green light for distribution in the U.S. less than a week after the UK became the first country in the world to make the vax available on a wide scale.
Then, on December 18, Moderna's candidate, developed in partnership with the National Institutes of Health (NIH), became the second vaccine to gain emergency-use approval by the agency. Both vaccines deploy a new scientific approach, the use of messenger RNA, or mRNA. Fast forward to January, and a third vaccine candidate by AstraZeneca has been approved in the UK (but is still waiting on FDA approval here).
As of January 8, more than 6 million people in the U.S. have received at least one dose of either Pfizer's or Moderna's vaccine, according to the Centers for Disease Control and Prevention (CDC).
It’s an emotional time for those of us (read: everyone) who have been waiting for a light at the end of a pretty dark tunnel. “It is 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.
Still, the pandemic is far from over. Hope predicts it will be months before the general public has access to the vaccine because “the bottom line is, that there’s not enough vaccine to go around.” Pfizer plans to distribute 100 million vaccines (enough for 50 million people) in the U.S. by March 2021, with an additional 100 doses delivered by the end of July.
The U.S. government has also purchased 200 million doses of Moderna’s vaccine, set to be distributed by June. Unlike Pfizer's vax, Moderna's does not require extreme-cold storage, meaning it can be shipped in smaller batches using standard refrigeration. Between those two vaccines, at the current tally there would be enough two-dose shots for two out of three Americans by this summer. Whether these figures will increase under the new Biden administration remains unclear.
Currently, the Trump administration is putting individual states in charge of rollout, so the process will look different depending on where you live. But based on allocation recommendations from the CDC’s Advisory Committee on Immunization Practices and from the National Academies of Sciences, Engineering, & Medicine, 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 these early days of vaccination (a.k.a. right now), healthcare workers are 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. “Moreover, with the explosion of the pandemic during [this] winter, 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, are phasing in adults aged 75+ first) living independently are next in line. In many states, this group is already lining up to get the shot.
Plenty of people, from USPS workers to K-12 teachers, are putting themselves at risk every day to keep our society functioning. Those people will likely be eligible for the vaccine soon, although it’s unclear who, specifically, will get first dibs in this group. Hope guesses priority will be given 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. (Note: It will probably be early spring by this point.)
Adults (16 and Over) at Average Risk
Finally, the hope is that all adults at average risk can get vaccinated by the summer of 2021. This seems more likely now that multiple vaccines are available to increase the supply. Dr. Chotani notes that three additional vaccine candidates—AstraZeneca, Johnson & Johnson, and Novavax—are in line for FDA approval and may receive it by March 2021. “In order to develop herd immunity, 70% of the population must either get vaccine-induced or natural immunity,” he 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 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 few months.
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 after the FDA gave them the OK to do so. Moderna also recently announced it is starting trials on children 12 and older. We won’t know results from these trials for a few more months.
As for children under 12, there are no trials currently in progress that include them. On November 17, the American Academy of Pediatrics penned an open letter urging vaccine manufacturers to include children in their research as soon as possible to jump-start the process of making COVID vaccines available.
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 Moderna's vax.)
People With Severe Allergies to Ingredients in the Vaccine
In a fact sheet for vaccine recipients, Pfizer says that those who have had an anaphylactic (a.k.a. a severe, potentially life-threatening allergic) reaction to a previous dose of the vaccine should not proceed with a second dose. Those with known allergies to any ingredients in the vaccine 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
Dibasic sodium phosphate dihydrate
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. The CDC has yet to confirm the number of reactions to the Moderna vaccine. But thousands of people enrolled in clinical trials were fine. Talk to your doctor if you’re concerned.
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 may opt to receive the COVID vaccine if they wish—but because this group was excluded from clinical trials, some experts have concerns about the lack of data on pregnancy and the new COVID vaccine candidates. In October, the American College of Obstetrics & Gynecology wrote a letter to the Centers for Disease Control and Prevention (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 and Moderna release data on pregnant women as soon as it becomes available. For now, it’s up to each woman and her doctor to decide whether to get the vaccine.
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 any 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 will the process take?
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 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 not one but two effective and officially approved COVID-19 vaccines in under a year (with a third on the way) is a magnificent feat of science. We can’t wait until each one of us gets our turn.
- FDA EUA Pfizer Vaccine: Food & Drug Administration. (2020). “FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine.” fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19
- FDA Approval Letter: Food & Drug Administration. (2020). “Pfizer-BioNTech COVID-19 Vaccine EUA Letter of Authorization.” fda.gov/media/144412/download
- Pfizer COVID Vaccine Fact Sheet: Food & Drug Administration. (2020). “Facts Sheet for Recipients and Caregivers.” fda.gov/media/144414/download
- Moderna Purchase: U.S. Department of Health & Human Services. (2020). “Trump Administration purchases additional 100 million doses of COVID-19 investigational vaccine from Moderna.” hhs.gov/about/news/2020/12/11/trump-administration-purchases-additional-100-million-doses-covid-19-investigational-vaccine-moderna.html
- CDC Allocation Recommendations: Centers for Disease Control and Prevention. (2020). “Recommendation for Allocating Initial Supplies of COVID-19 Vaccine.” cdc.gov/vaccines/acip/index.html
- National Academies Allocation Recommendations: National Academies of Science, Medicine & Engineering. (2020). “Framework for Equitable Allocation of COVID-19 Vaccine.” nap.edu/read/25917/chapter/1
- Pfizer Clinical Trials in Children: Pfizer. (2020). “Our Progress In Developing An Investigational COVID-19 Vaccine.” pfizer.com/science/coronavirus/vaccine
- AAP Statement: American Academy of Pediatrics. (2020). “COVID Vaccine Trials Should Begin Including Children Now, Says American Academy of Pediatrics.” aap.org/en/news-room/news-releases/aap/2020/covid-vaccine-trials-should-begin-including-children-now-says-american-academy-of-pediatrics/
- ACOG Statement: American College of Obstetrics & Gynecology. (2020). “Advisory Committee on Immunization Practices; Notice of Meeting; Establishment of a Public Docket; Request for Comments.” acog.org/clinical-information/physician-faqs/~/-/media/ba82df62bd0149f0a1019a6662038fc5.ashx
- CDC COVID Vaccine FAQ: Centers for Disease Control and Prevention. (2020.) “Frequently Asked Questions about COVID-19 Vaccination.” cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
- Number of People Vaccinated: Centers for Disease Control and Prevention. (2021.) “COVID-19 Vaccines.” cdc.gov/coronavirus/2019-ncov/vaccines/index.html
- Additional Pfizer Doses: U.S. Department of Health & Human Services. (2020.) “Trump Administration purchases additional 100 million doses of COVID-19 investigational vaccine from Pfizer.” hhs.gov/about/news/2020/12/23/trump-administration-purchases-additional-100-million-doses-covid-19-investigational-vaccine-pfizer.html
- Additional Moderna Doses: U.S. Department of Health & Human Services. (2020.) “Trump Administration purchases additional 100 million doses of COVID-19 investigational vaccine from Moderna.” hhs.gov/about/news/2020/12/11/trump-administration-purchases-additional-100-million-doses-covid-19-investigational-vaccine-moderna.html
- CDC Report of Allergic Reactions: Centers for Disease Control and Prevention. (2021.) “Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020.” cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm