Questions to Ask Your Doctor About the COVID-19 Vaccine

About 1 in 1,000 Americans has died of COVID-19 to date, and many more have become severely ill. Now, two new COVID-19 vaccines are being distributed throughout the nation in a phased approach.

With the pandemic still raging, the decision whether to be vaccinated against COVID-19 is clear, says Dr. Tom Frieden, president and CEO of Resolve to Save Lives, an initiative of Vital Strategies. For most people, he says, the benefits of receiving the COVID-19 vaccine far outweigh the risks.

“Getting the vaccine is going to protect yourself and your family,” says Frieden, former director of the Centers for Disease Control and Prevention. When it comes to discussing the vaccine with your doctor, he adds, “The main question I hope people will be asking is: ‘How can I get this? Where can I get my vaccine as soon as possible?'”

Below, infectious disease and vaccine experts suggest what to ask your doctor (and also offer some answers) to become better informed about COVID-19 vaccination.

[Read: Vaccine Study Volunteers: Taking Their Shot to Beat COVID-19.]

Effectiveness and Safety

How effective is the vaccine?

“These are highly efficacious vaccines,” says Dr. Kathleen Neuzil, a professor in vaccinology and director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine. “They work, and they work very well.” Vaccines can keep you from getting sick and potentially be lifesaving. “They definitely protect extremely well against severe disease — which is most important as our hospitals remain full and as we continue to set records for mortality during this pandemic,” she says.

How safe is the vaccine?

The COVID-19 vaccine is considered very safe. “Even though this vaccine was developed rapidly, no corners were cut in checking for how effective it is or how safe it is,” Frieden says. “Now, with millions of people vaccinated, there have yet to be any serious long-term, adverse effects identified.”

What are my chances of having a severe allergic reaction?

With the first rollout of COVID-19 vaccines in the U.S., after receiving the Pfizer vaccine, 21 people had anaphylaxis — severe, life-threatening reactions that occur in rare cases after vaccination — between Dec. 14 and Dec. 23, according to the Jan. 6 issue of the Morbidity and Mortality Weekly Report. Among the nearly 1.9 million first doses given of the Pfizer vaccines, that means anaphylaxis occurred at a rate of about 11 cases per million doses, according to the MMWR.

In the majority of cases, people had a history of severe allergic reactions to a previous vaccine. Most of the reactions occurred within 15 minutes of the injection, and everyone recovered, according to a Jan. 6 press briefing and update hosted by the CDC.

As of Jan. 5 overall, 29 people of the more than 5.3 million who received either a Pfizer or Moderna COVID-19 vaccination had a confirmed case of an anaphylactic reaction, putting the rate at about 5.5 cases per 1 million doses. An MMWR report focused on the Moderna vaccine (which was launched later) will be published when more data is available.

How can I safely receive the COVID-19 vaccine if I’ve had allergic reactions to other vaccines?

Whether you get your COVID-19 vaccine at a pharmacy or your doctor’s office, you want to get your vaccine where they can treat anaphylaxis, although it’s rare, says Dr. Tom Kenyon, chief health officer for Project HOPE and a former director of the CDC’s Center for Global Health. “So you need to be where there is a trained nurse or doctor, plus medications and equipment needed to treat such a reaction,” he says. Epinephrine injections are the first line of treatment for an anaphylactic reaction.

“Certainly, for people with a history of allergic reactions, it would be good for them to talk with their doctor so they can clearly understand the risk and perhaps the best place to get vaccinated,” Neuzil says. “Perhaps they would feel more comfortable in a medical setting.”

If you experienced an immediate allergic reaction — even if not severe — when receiving the first dose of the COVID-19 vaccine, you should not get the second dose, the CDC warns. Immediate allergic reactions may include hives, swelling and wheezing or respiratory distress within four hours after getting vaccinated.

[See: Fear, Courage, Grit: Meet More Than 50 ‘Hospital Heroes’ in Pictures.]

Is it possible to get COVID-19 from the vaccine?

“Absolutely not,” Frieden says. “You could never get COVID from the COVID vaccine.” Both the Moderna and Pfizer-BioNTech versions use mRNA technology to “teach” your body how to recognize and make an immune response against the coronavirus, he explains. The mRNA technology is “stunningly effective,” he adds. “Essentially, it’s like an email sent to your immune system that shows it a picture of what the COVID virus looks like, and gives it a recipe for how to kill the virus where it comes.” Then, he says, like a deleted email, the message disappears without leaving a trace.

Availability

How is COVID-19 vaccination prioritized while supply catches up with demand?

Health care personnel and long-term care facility residents are top priority, or Phase 1a, to be offered the vaccine, according to recommendations from the CDC’s Advisory Commission on Immunization Practices.

Non-health care essential workers such as first responders, U.S. Postal Service workers, workers in manufacturing, grocery stores and public transit, educators and child care workers fall under Phase 1b, as do people ages 75 and older.

All other essential workers, like those in food services or construction, people ages 65 to 74, and people ages 16 to 64 with underlying medical conditions that increase the risk for COVID-19 are designated Phase 1c. All others over age 16 fall under Phase 2 recommendations for vaccination.

However, states are not required to adopt these guidelines, Kenyon says. States and jurisdictions decide who receives the vaccines.

Vaccine priorities are a moving target, so keep an eye out for changes. On Jan. 12, the U.S. Department of Health and Human Services announced new allocation guidelines for states to make coronavirus vaccines available to all people ages 65 and older, and to anyone with an underlying condition.

How do I know when I qualify to receive the vaccine?

“You need to go to your state health department website or even your local county website to see what the plan is,” Kenyon says. With the decentralized U.S. health care system, he notes, “You’re seeing some modifications of the vaccine priority groups in different states. For example, Florida and Texas, instead of starting with a cutoff of 75 and older, are starting with a cutoff of 65 and older.” Also, guidelines for what constitutes essential workers may vary.

Does it make a difference which vaccine is available to me?

As a health consumer, you likely won’t have a choice whether you’ll receive the Moderna or Pfizer vaccine — you’ll get whatever’s available in your area. Does it matter which version you get? “Probably not,” Frieden says. With effectiveness for both vaccines ranging roughly between 90% and 95%, difference are “statistically insignificant,” he says.

Can my children be vaccinated?

Only if they’re at least 16 or 17. The Pfizer vaccine is approved for ages 16 and older. The Moderna vaccine is approved for adults only: ages 18 and older. The difference is due to how much clinical trial data is currently available.

“The Pfizer-BioNTech vaccine was tested down to 16 years of age and did receive emergency use approval,” Neuzil explains. “Both of those vaccines are currently in testing in 12 and over, and in the next few months we may be able to offer vaccines to more adolescents. At which point — which is the general way we move in pediatrics, called ‘age de-escalation’ — we will continue to go down in age, monitoring closely for safety. So the next group you will likely hear about will be the 12-and-older adolescent group.”

Vaccine Experience

How many injections will I get?

Both the Pfizer and Moderna vaccines are given in a two-injection series. For Pfizer, the doses are administered three weeks apart. For Moderna, the doses are administered four weeks apart. Each injection is given into the deltoid muscle of the upper arm.

Other vaccines are being developed and in various phases of clinical trials. There is a study underway of the Janssen-Johnson & Johnson vaccine that’s a single dose in one of the regimens, Frieden notes. But it’s not yet known whether that single dose is protective, he adds.

What are common vaccine side effects?

For both vaccines, arm pain is a common local reaction, typically worse after the second dose, Neuzil says. (Arm pain is a common side effect of vaccination in general, not just with the COVID vaccine.) “Then, a smaller percentage of people get some systemic reactions that are generally self-limited to a day, sometimes two days.” Fatigue, chills, headache, muscle or joint pain and fever are the most commonly reported side effects, according the Food and Drug Administration.

What can I do to minimize vaccine after-effects?

Consider asking to have the vaccine given in your nondominant arm, so you’re not bothered as much by tenderness while going about routine activities, Neuzil suggests.

At home, have over-the-counter medication on hand so you can treat muscle soreness, fever or other common vaccine side effects. “People just need to be prepared with ibuprofen or acetaminophen,” Neuzil says. “There’s nothing wrong with taking it and there’s no reason to wait and suffer.”

When will immunity to COVID-19 develop?

Full protection from COVID-19 comes about seven to 10 days after the second dose, Neuzil says. However, “We’re seeing really good protection starting just about two weeks after the first dose,” she adds. “The concern is that we don’t know how long it will last with just one dose. So that emphasis on the second dose is important.”

What happens if the second vaccine in the series is delayed?

With vaccine supply and distribution issues still rampant, there could be a possibility that your second dose might not be accessible when you’re due to receive it. “Should your second dose be delayed, absolutely you should get that second dose (when it’s available),” Neuzil says. “If you’re a week late or two weeks late for reasons you can’t control, that’s OK. It’s more important to get the second dose than to get the second dose on time. And there’s no recommendation that you would need to start over.”

Ongoing Precautions

Could I still spread the coronavirus to others even if I’ve had the vaccine?

The jury is still out. “There’s still much to be learned about this vaccine,” Kenyon says. “Are we sure it’s going to prevent transmission? That isn’t yet confirmed. There’s early evidence, at least for the Moderna vaccine, that it probably does. But you can still, potentially, be vaccinated and acquire COVID-19 asymptomatically and spread it to others. We don’t know yet.” Therefore, it’s important to continue to wear masks and practice social distancing even after you are vaccinated, in order to protect others.

Will being vaccinated allow me to travel internationally?

“It’s very likely for international travel that you’ll be required to show a vaccine certificate to be able to travel,” Kenyon says. “Either the airlines or the country you’re traveling to.” Such a scenario is already in place for yellow fever when traveling to certain parts of the world, he adds. “So, it’s not unprecedented.”

How long will my immunity to COVID-19 last?

It’s too soon to tell. “We don’t know the durability of the immunity,” Kenyon says. “We won’t know until we’ve had enough time, experience and ongoing research to document that. We’ve learned from other vaccines that you have to have a booster.” For instance, that’s the case with whooping cough (pertussis) and measles vaccines, among others, he notes. “So you might get the COVID vaccine this year — but what about next year?”

Why else should I keep wearing a mask?

You still need to wear a mask after you’ve been vaccinated for several reasons, Frieden says. “One: How are we supposed to know who’s been vaccinated and who hasn’t?” he points out. “Two: Even if it’s 95% effective, that means it’s 5% not effective. Three: Even if you’ve been vaccinated, even if you don’t get sick, we don’t yet know if you might not sometimes be able to get the virus and spread it to others. So masks remain in, even with vaccines, for the foreseeable future.” An important mask bonus: “They really prevent flu,” says the former CDC head. “We’re (essentially) not having a flu season this year.”

[SEE: What to Say to Friends or Family Members Who Hesitate to Wear a Mask.]

Individual Medical Issues

Considering my medical condition, should I receive the vaccine?

Having an underlying conditions such as diabetes, obesity, high blood pressure, chronic obstructive pulmonary disease, heart disease and kidney disease puts you at higher risk for having severe COVID-19. That puts you in a higher priority category (1c) for recommendations to receive the vaccine.

However, some conditions require particular caution when deciding on vaccination. “There are people with certain conditions who need to talk with their doctors more than others,” Kenyon says. That includes people who are immunocompromised, he says, such as those with organ transplants. Women who are pregnant or contemplating pregnancy should talk with their doctors, he says: “That’s an area where we don’t have enough data.”

Should I have the vaccine if I’m pregnant?

Pregnancy or breastfeeding is not a reason to withhold the vaccine from women. “Pregnancy isn’t a contraindication, Neuzil says. “That would be a good individual conversation between the pregnant woman and her physician.” The American College of Obstetrics and Gynecology recommends that women, particularly those in high-risk categories for COVID-19, such as diabetes or obesity, consider vaccination through shared decision-making with their clinician.

Are rumors of female infertility related to the COVID-19 vaccine true?

“There are a lot of rumors out there,” Neuzil says. “Female infertility is one of the latest that we’re hearing. There is absolutely no basis to that rumor. And, in fact, both of these companies have done what are called DART studies — developmental and reproductive toxicity studies that are required to be done in animals. And they were absolutely normal: no safety concerns.”

Resources

Where can I find reliable information on COVID-19 and vaccines?

For consumer-friendly facts on COVID-19 in general, cdc.gov offers a wealth of information. To get the latest status on vaccination in your area, reach out to your state or county health department. The National Governors Association provides links to updated vaccine information for U.S. states and territories on its website.

More from U.S. News

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Questions to Ask Your Doctor About the COVID-19 Vaccine originally appeared on usnews.com

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