Answers to questions about the COVID-19 vaccines.

I continue to get questions about the COVID-19 vaccines and how individuals should approach their own vaccination. Today, I will comment on several questions that have general impact on individuals seeking COVID-19 vaccines. This does not substitute for your doctor’s specific advice. So, if you have any complexity to this situation I would suggest you contact your health care provider.

I also refer you to an excellent review article on the COVID-19 vaccine landscape by Tom Frieden, a former head of the CDC.

1) Which vaccine would be best for me?

If you have no medical issues and have normal immunity, the best vaccine is the one that you can obtain the soonest. Both the Pfizer and Moderna vaccines look equally efficacious, so there is no real medical preference between them. The availability of other vaccines now in clinical trial may be much later next year, so if either of the mRNA vaccines is available to you, I would take it immediately.

2) Can I take one dose from one type of vaccine another dose from the other vaccine? 

Practically speaking, you would probably be prohibited from switching vaccines between doses. In addition, there’s been no testing for efficacy or side effects Using a cross-vaccination approach. Theoretically, since these vaccines are somewhat similar this might work, but would appear to have no advantage over two doses of the same vaccine.

3) I am considering participating in a COVID-19 vaccine trial. Should I just forget about doing it and get one of the approved vaccines? 

If you are healthy and have no urgency in obtaining the vaccine (you are not elderly, or an at risk health care worker) it would certainly aid society if you participated in the clinical trial. Most vaccine developers have promised that participants in the clinical trial even in the placebo group would eventually get the vaccine. This may actually be faster than waiting for one of the two approved vaccines depending on your prioritization grouping.    

4) I had COVID-19. Do I need the vaccine?

This is a difficult question to answer. If you had definitive COVID-19 and currently have antibody to SARS-CoV-2, you likely have protective immunity to reinfection. Data is supporting the concept that this immunity would be at least as good as what is achieved with the vaccine.  In addition, the vaccines have not been specifically tested in individuals with COVID-19 immunity although they may have been part of the initial clinical trials. 

Therefore, while there is no contraindication to your getting the vaccine, it would not seem to be an immediate necessity, and you might be better off waiting to see if there is any unusual outcome when these vaccines are specifically tested in people who have prior infection with COVID-19.                             

5) Why is it taking so long for the FDA to review these vaccines? They have had the data packets for two weeks, and the meeting on the first vaccine is not until December 10^th.

The FDA is being very careful about the review of these vaccines given the fact that they are based on totally new technology for a new disease. In particular, they are trying to screen for any unusual adverse event in the 40,000 participants in the Pfizer trial and 30,000 participants in the Moderna trial. The data package from these vaccine trials runs thousands of pages and must be distributed to the many parts of the FDA involved in the review as well as the External Advisory Board. Given these considerations, a three-week review process seems reasonable even though other countries appear to be moving faster.

6) I have problems with my immune system. Should I still take one of these vaccines?   

This again is a complex question to answer and should be primarily handled by your own physician. The one thing I would say is that you should not dismiss out of hand taking one of these vaccines if you have immune problems. Neither of the RNA vaccines contains live organisms or other components that would be entirely contraindicated for individuals with immune issues. Everyone should consider the risk-benefit ration with their physician.

Many people with immune problems may still respond to COVID-19 vaccines in some way and at least get partial protection against COVID-19. This may be very important in protecting individuals with immune problems who otherwise would be at great risk from being infected. Individuals with autoimmune diseases may also be eligible for this vaccine, but it is also a difficult question requiring input from your doctor. These vaccines activate the innate immune system and cause inflammation. That might make some autoimmune diseases worse. Despite this, the risk from COVID-19 to an individual with an autoimmune disease may outweigh any risk from the vaccine and therefore the vaccine would be appropriate.     

7) When are the vaccines available for me?

It is probably easiest to see where you stand in the priority system established by the CDC. If you are not in one of the specific priority groups, it will likely be in the April-June timeframe for the first vaccines. People need to look carefully, since educators and other essential workers are elevated in priority, possibly putting a person in a higher priority group. Youngsters and students likely won’t get the vaccine until next summer as child trials are just beginning.

If more vaccines are approved beyond the first two, there may be more rapid access to vaccines for everyone.

8) How do I sign up for a vaccine?

This depends on your prioritization group and profession. If you are a health care provider, your worksite should be the first place to go. Assisted living centers will also be providing these vaccines with help from CVS/Walgreens. Educators should contact their school administration. Beyond that, contact your physician to get prioritized for your health care organization’s vaccine supply. You should do this particularly if you are over 65 or have a disease that puts you at risk.