Experts address vaccination and children, safety, side effects, boosters, variants and long COVID.
Authors: Lisa Esposito
The COVID-19 vaccine has been publicly available in the U.S. since December 2020. Since then, vaccination has eased the pandemic by preventing infections, reducing severe disease and saving lives. More is known about vaccine effectiveness, safety and side effects, which tend to be mild for most people.
Still, vaccination guidelines keep changing. Previously, three vaccines were recommended for use in the U.S., now it’s down to two. Children are receiving the vaccine at increasingly younger ages. Boosters mean that being fully vaccinated is an ongoing process. Evolving COVID-19 variants might challenge the makeup of current vaccines.
With all this flux and uncertainty, here are questions to ask your doctor about the COVID-19 vaccine.
Availability/Eligibility for the COVID-19 Vaccine and Boosters
Where can I get the COVID vaccine?
You can be vaccinated at multiple sites including your doctor’s office, clinics, participating pharmacies and your local health department, which can also point you to other vaccination sites in your area. The Centers for Disease Control and Prevention has made a vaccine finder available, and you can narrow your search by zip code and vaccine or booster type.
Do people have fairly equal access to COVID-19 vaccination (and treatment) in the U.S.?
“Yes, but – and it’s a big but here – money is about to run out,” says Dr. Tom Frieden, president and CEO of Resolve to Save Lives, an initiative of Vital Strategies, and a former director of the Centers for Disease Control and Prevention. “And it’s not clear what will happen once money runs out. On the one hand, insurers are going to need to cover all the vaccinations and treatments with no copayments and no annoying preauthorization … so insurers need to do their job.”
However, a huge question is what will happen to people without adequate insurance coverage. “Keeping vaccines and treatment access available for those who are uninsured or underinsured is extremely important, and I don’t know how that’s going to be done,” says Frieden, who is a senior fellow for global health at the Council on Foreign Relations. “Because currently it’s been done with funding that Congress provided, and Congress declined to renew that funding. So that issue will come up with increasing urgency in the coming weeks and months.”
Who is eligible for COVID-19 vaccination in the U.S.?
Full Food and Drug Administration Approval
Two vaccines are currently offered and recommended in the U.S. Initially allowed under emergency use authorization, or EUA, by the FDA as a public health measure, they are now fully approved:
- The Pfizer vaccine, given as a two-dose primary series, received full FDA approval in August 2021. It uses mRNA technology to stimulate an immune response against the coronavirus for adolescents and adults ages 16 and older. It is now marketed as Comirnaty.
- The Moderna vaccine, given as a two-dose primary series, received full FDA approval in January 2022 for adults ages 18 and older. Also an mRNA vaccine, it’s now marketed at Spikevax.
Emergency Use Authorization
The Pfizer vaccine is allowed under EUA for these populations:
- The Pfizer vaccine is approved as a first booster in adults, a second booster dose in adults over 50 and a second booster for individuals ages 12 and older who are immunocompromised.
- Also through EUA, it’s authorized as a two-dose primary series for individual ages 5 and older, and as a third primary series dose for people in that age range who are immunocompromised.
- On May 17, 2022, the FDA expanded eligibility for the Pfizer vaccine booster dose to children ages 5 to 11 years, at least five months after completing a primary series.
The Moderna vaccine is allowed under EUA for these populations:
- The Moderna vaccine is authorized for a two-dose primary series for adults, with a third primary series dose for those who are immunocompromised through EUA.
- It’s authorized as a first booster dose for adults at least five months after completing a primary series of the Moderna vaccine or another authorized/approved COVID-19 vaccine.
- A second booster dose is authorized for adults 50 and older at least four months after the first booster dose, and as a second booster dose for adults 18 and older who are immunocompromised.
What about the Johnson & Johnson/Janssen vaccine?
The J&J vaccine works differently, using previously existing viral vector technology. On May 5, 2022, the FDA limited the authorized use of the J&J vaccine because of the risk of blood clots.
“It’s a very rare but devastating side effect,” Frieden says. “Basically, other than in people who for one reason or another cannot or will not get another vaccine, J&J is not likely to be used in the U.S.”
What if I originally received the J&J vaccine – is it OK to get a different booster?
Yes, it’s fine to mix and match. “In fact, there’s evidence that what is called ‘heterologous boosting’ often provides some additional protection,” Frieden says, beyond the protection already afforded by getting a booster. “There’s also some evidence that the Moderna booster, which is a little bit higher-dose than Pfizer’s booster, may be a little more effective. But either of them works very well.”
Effectiveness of the COVID-19 Vaccine
An estimated 2.2 million deaths, 17 million hospitalizations and more than 66 million additional infections were prevented by the U.S. COVID-19 vaccination program, according to a March 2022 Commonwealth Fund update.
“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.
What are some key benefits of COVID-19 vaccination?
Being vaccinated against COVID-19 offers these benefits:
- Greatly reduces the risk of COVID-19 infection.
- Greatly reduces the risk of hospitalization, serious illness or death from COVID-19.
- Offers protection against the omicron variant and subvariants, particularly with boosters.
- By preventing COVID-19 infection, it may reduce the risk of developing long COVID.
- Contributes to herd immunity, which helps protect people who can’t be vaccinated.
Safety/Side Effects of the COVID-19 Vaccine
Is the COVID-19 vaccine safe?
Nearly 585 million doses of the COVID-19 vaccine have been given in the U.S. since the pandemic began through late May 2022, according to the CDC. The vaccines were evaluated in tens of thousands of clinical trial participants, the CDC notes, and meet the FDA’s scientific standards for safety, effectiveness and manufacturing quality to support their authorization.
What are common COVID 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.”
According to the FDA, commonly reported side effects are:
- Muscle or joint pain.
- Nausea and vomiting.
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.”
What serious vaccination complications have occurred?
The CDC lists four rare but serious safety problems related to COVID-19 vaccination:
- A relatively small number of people – about five cases per 1 million doses delivered – have suffered anaphylaxis as a severe allergic reaction to the vaccine.
- Blood clots with low platelets, called thrombosis with thrombocytopenia, is a rare side effect that has happened after receiving the J&J vaccine, which is no longer typically used.
- Myocarditis and pericarditis – inflammation of the heart and the heart lining – is a rare side effect in young adults and adolescents.
- Guillain-Barre syndrome, a rare disorder in which the body’s immune system damages certain nerve cells, causes muscle weakness and in some cases, paralysis. GBS has primarily been reported as a vaccine side effect in men ages 50 and older.
Severe allergic reactions including anaphylaxis can occur after any type of vaccination, the CDC website points out. And COVID-19 vaccination benefits outweigh the risks, the CDC emphasizes.
Repeat Infections, Breakthrough Infections and Long COVID With the Vaccine
Can fully vaccinated people get breakthrough COVID-19 and long COVID?
Yes, although infection is less common after vaccination and booster doses, and resulting symptoms tend to be milder and less likely to result in hospitalization or death. Vaccinated people with even mild breakthrough COVID-19 infections can experience lingering symptoms that affect organs such as the heart, lung and brains, according to a study released May 25.
Vaccination reduced the risk of getting long COVID by 15%, according to the study of more than 13 million veterans published in the journal Nature Medicine. However, vaccines were most effective at preventing the worst long COVID complications – reducing lung disorders by 49% and blood-clotting disorders by 56% in vaccinated veterans.
Why is it important to stay up to date with COVID-19 booster shots?
“We continue to be really impressed about how well the vaccines protect against severe illness, hospitalization or death,” Frieden says. “These are remarkably effective vaccines. At the same time, it’s become increasingly clear that there is a waning of the immunity – and that’s why boosting is important.” Although there may eventually be even better, longer-acting, more widely protective vaccines, “we don’t have them yet,” he says. “So we need to get protected now against the variants that are circulating now or may soon be circulating.”
Does having had COVID-19 give you some protection against future infection?
“You do have some protection, but not nearly as much as if you get a vaccination,” Frieden says. “And it’s not enough to think you’re super-protected and take risks.” The bottom line is: “Some people who are older, although they are protected by prior infections, still get very severely ill. And that’s why we still have hundreds of deaths a day in the U.S.”
If I’ve already had COVID-19, should I still get the vaccine or boosters?
“Absolutely,” Frieden says. “You can wait anywhere for one to three months after you’ve had COVID and then you can get your booster.”
Are vaccines effective against the omicron variants?
It appears so. Vaccination including booster doses produced high levels of virus-neutralizing antibodies that recognized both omicron BA.1 and BA.2 among participants in a recent study supported by the National Cancer Institute. However, participants who only received the initial vaccine series but no booster had far fewer neutralizing antibodies in their blood.
Children and the COVID-19 Vaccine
How important is it for eligible children to be vaccinated?
“What we’ve learned about vaccines is that they seem to help prevent you from getting COVID, but more importantly, they help prevent you from having severe disease from it,” says Dr. Jonathan M. Miller, chief of pediatric primary care at Nemours Children’s Hospital–Delaware. “Ensuring that your kid is up to date and boosted for the COVID vaccine is the best thing you can do to protect them against this unpredictable virus.”
Should young kids receive COVID-19 boosters?
Yes. On May 19, the CDC expanded eligibility of COVID-19 boosters to everyone ages 5 years and older. Specifically, children ages 5 to 11 should receive a booster shot five months after their initial Pfizer vaccine series.
Could younger children eventually receive COVID-19 vaccination?
On May 23, Pfizer announced that its vaccine demonstrated a strong immune response, high effectiveness and was safe and well-tolerated in children from 6 months old to under 5 years. In April, Moderna requested authorization for its two-dose vaccine for children younger than 6 years old. “We are patiently – and in the pediatric world, eagerly – awaiting the FDA’s review of the vaccine for 6 months and up in June,” Miller says.
Is it OK for kids to get the COVID-19 vaccine along with other vaccines?
“The answer to that is yes,” Miller says. “In fact, we recommend that if your child is due for any of the other vaccines, you get it done when you’re there for that COVID vaccine. And that goes also for the flu vaccine.”
Unfortunately, both COVID-19 and the flu are currently a problem, with a later-than-usual flu season. Kids can get both vaccines simultaneously, Miller emphasizes: “I strongly recommend that you do them both because those are viruses that your kid is definitely susceptible to now that they are spreading through the community.”
How concerning are side effects in vaccinated kids?
“For what I think is no longer a strong or evidence-based reason, people are still worried about side effects of this vaccine,” Miller says. “It definitely causes fever, and sometimes headache or a sore arm, but there’s no serious, long-term side effect of this vaccine.”
Parents express concerns about vaccination effects in younger children, in particular, he notes. However, a more significant, although rare side effect can be seen in older adolescents.
“The most serious effect we’ve seen has been some heart inflammation, particularly in teenagers, but it’s pretty rare and it goes away pretty quickly,” Miller says. “It’s not something that’s long term – it sort of comes and goes in the time frame that you get side effects from the vaccine. While that sounds scary, the heart manifestations of getting COVID are so much more frequent and more severe than this mild and rare side effect of the vaccine that I would still strongly recommend the vaccine rather than taking your chance with COVID.”
What about long COVID, kids and vaccination?
“We are seeing kids with long COVID,” Miller says. “Usually these are adolescents who are getting long COVID, but it’s happening.” While data on vaccination and long COVID is limited, he says, the vaccine helps prevent people from getting the virus, and the virus is what causes long COVID. Therefore, it follows that getting the vaccine at least reduces the risk of getting long COVID.
When it comes to kids and long COVID, he says: “It’s frustrating. It impacts school, it impacts the family and it’s preventable.”
What else should parents understand about vaccination?
“This virus has really shown us a pattern in the past couple years,” Miller says. “Every three to six months, there’s a new variant – and it’s different and unpredictable.”
For instance, he says, “There was no way for us to predict that COVID was going to cause an inflammatory disease or long COVID. These are things that are unique to COVID and each variant has a different spin.”
It’s not the time for complacency. “If I feel that the current variant out there is milder than the one that came before it, the data might show that there’s some truth to that,” Miller says. “But the next variant might be much worse and it might impact kids far worse.” That, he says, makes vaccination all the more crucial for kids.
Should I have the vaccine if I’m pregnant?
Vaccination is strongly recommended for pregnant individuals by the American College of Obstetricians and Gynecologists. Vaccination can occur in any trimester, preferably as soon possible, ACOG advises. In addition, pregnant and recently pregnant people (up to six weeks postpartum), should receive a booster dose of COVID-19 after their initial vaccine series.
Does vaccination have specific pregnancy risks?
None of the authorized COVID-19 vaccines causes infertility or spontaneous abortion (miscarriage), according the ACOG website: “There is no evidence of adverse maternal or fetal effects from vaccinating pregnant individuals with the COVID-19 vaccine, and a growing body of data demonstrates the safety of such use.”