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Experts say the COVID-19 vaccine is safe for most people of all ages. Matthew Horwood/Getty Images
  • Experts say the COVID-19 vaccine is safe for most people.
  • There are no known safety issues for pregnant people, those who are breastfeeding, or people who’ve tested positive for COVID-19 in the past, according to experts.
  • They note that people who’ve had severe allergic reactions to any ingredients in the vaccine should not get it.
  • People who have autoimmune or other conditions should check with their doctor before getting the vaccine, experts say.

The initial wave of COVID-19 vaccine doses are being administered across the United States.

The Food and Drug Administration (FDA) issued an emergency use authorization for the Pfizer-BioNtech and Moderna COVID-19 vaccines. Both vaccines are made up of 2 doses given intramuscularly.

The Pfizer vaccine is given 21 days apart, while the Moderna vaccine is administered 28 days apart.

Here’s what you need to know about who’s getting vaccinated first and who can safely get the COVID-19 inoculation.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, said both the Moderna and Pfizer vaccines are safe.

“Scientifically, these vaccines have been rigorously examined by now two external, tough committees, people not associated with the companies or the government,” Schaffner told Healthline. “And they have passed both committees with flying colors.”

Dr. Anne Liu, an infectious disease physician at Stanford Health Care in California, said there’s no reason to worry about any potential long-term side effects from the vaccination.

“People who are worried about long-term side effects may somewhat misunderstand how vaccines work. This is not something that stays in your body very long, and the immune response that is generated is fairly quick and should settle down fairly quickly over several weeks,” Liu told Healthline.

“It’s not like medications that can accumulate in your body. It’s not something that changes anything about your makeup so you can have effects from it later on,” she said.

Experts said there’s no real difference in terms of safety or efficacy between the Moderna and Pfizer vaccines.

“To my assessment, they look very similar both in terms of safety and in terms of effectiveness, so I’m not recommending any preference for one over another,” Dr. Dean Blumberg, chief of pediatric infectious diseases at the University of California Davis, told Healthline.

For the large majority of people, the COVID-19 vaccine is safe.

But there are some groups who may need to take into account additional considerations when deciding whether to get the COVID-19 vaccine. These include:

  • people with allergies
  • people who are pregnant or breastfeeding
  • people who’ve tested positive for COVID-19
  • people with underlying medical conditions
  • children and adolescents

The Centers for Disease Control and Prevention (CDC) has received early reports that some people have experienced severe allergic reactions after getting the COVID-19 vaccine.

“There have been a few patients who have had allergic reactions and […] that is always very concerning. It doesn’t appear to be very common but, of course, anaphylaxis is very scary and it is life threatening, so it is a concern,” Blumberg told Healthline.

The CDC advises that people who’ve had a severe allergic reaction to any of the ingredients in the COVID-19 vaccine to not get inoculated.

People who’ve had a severe allergic reaction to other types of vaccines or injectable therapies should talk with their doctor about what would be best.

Those with a history of severe allergic reactions that aren’t related to vaccinations (food, venom, pets, latex) can still get vaccinated.

If a person has a severe allergic reaction to the first shot of the COVID-19 vaccine, the CDC advises them not to get the second shot.

Those without a history of severe allergic reactions will be observed for 15 minutes following vaccination. The CDC advises those with a history of severe allergic reactions to be observed for double that amount of time.

“If you do have a history of noteworthy allergic reactions in the past, we’re going to watch you for a half hour after you receive the vaccine, so I think things are in hand,” Schaffner said.

There’s no data on the safety of the COVID-19 vaccine in pregnant people, as they were excluded from the clinical trials.

“Based on current knowledge, experts believe that mRNA vaccines are unlikely to pose a risk to the pregnant person or the fetus,” the CDC said. “If pregnant people are part of a group that is recommended to receive a COVID-19 vaccine (e.g., healthcare personnel), they may choose to be vaccinated.”

That advice differs from the United Kingdom’s health regulatory body, which advised against vaccination during pregnancy.

Schaffner said that isn’t a reason for pregnant people in the United States to be concerned.

“[It’s] quite appropriate to have difference of opinion because it has not been studied. I think our colleagues in the U.K. would agree there is no theoretical reason to anticipate adverse events either to the mother or to the fetus and that was enough to let the U.S. go ahead and give the green light,” he said.

“One of the things that motivated people in the U.S. were the following two numbers,” Schaffner added. “Given that we are beginning to immunize healthcare workers it was noted that something like 72 to 74 percent of all healthcare workers are women, and in addition it was estimated in the United States there are… 330,000 pregnant healthcare workers.”

“So if we are trying to vaccinate the healthcare workforce we had to resolve that issue,” he said. “Since the American College of Obstetricians and Gynecologists got together a huge expert committee to study this and they gave it the green light, so did the Advisory Committee on Immunization Practices (ACIP).”

Blumberg said the potential benefits outweigh the risks.

“We know that those who are pregnant have an increased risk of severe illness with COVID-19 and also might be at increased risk of adverse pregnancy outcomes,” he said. “Even though there’s not much data… we know that the vaccine protects, and knowing the increased risk of bad outcomes with COVID-19 during pregnancy, to me it’s clear the benefits of vaccination outweighs the theoretical risks.”

There’s no data on the safety of the vaccine in lactating people or the effect of the COVID-19 vaccine on breastfed infants, but the CDC advises the vaccine is not thought to be a risk to infants who are breastfed.

“A lactating person who is part of a group recommended to receive a COVID-19 vaccine (e.g., healthcare personnel) may choose to be vaccinated,” the CDC said.

Clinical trials suggest the vaccine is safe for people who’ve already been infected with COVID-19.

The CDC said vaccination should be delayed until the person has recovered from acute illness (if symptoms were present) and they’ve met all criteria to discontinue isolation.

However, for those who’ve received antibody therapy for COVID-19, things are slightly different.

“Those antibodies are specific against the COVID-19 virus so… we would anticipate those antibodies would interfere with the immune response stimulated by the vaccine,” Schaffner said. “The rule of thumb, based on the decay curve of those injected antibodies, has been 90 days. So if you’ve received those antibodies, wait 3 months and then get vaccinated,”

Clinical trials showed that the vaccine was similarly effective and safe among those with some underlying medical conditions as those without those conditions.

People who have underlying medical conditions can receive the vaccine safely if they have no contraindications to vaccinations.

“We don’t have data on that for immunocompromised patients or patients with HIV. But we know that immunocompromised patients and HIV infected patients are likely at increased risk for severe COVID, so they still can receive vaccine,” Blumberg said.

“It’s an individual decision for these people, and they can discuss it with their healthcare provider,” he said. “But theoretically I can’t think of a reason why this vaccine would be harmful in those populations and it may be beneficial. So, overall my assessment is the potential benefits outweigh the potential risks.”

Liu agrees.

“Given the situation that they’re at higher risk for complications and that we don’t know there’s a reason it would hurt them, even if there’s a bit of benefit… it’s reasonable to give them the vaccine as well, even though they were excluded from the studies,” she said.

But experts say it’s possible the vaccine won’t be as effective in those who are immunocompromised.

“It’s likely not to work as well in immunocompromised people as it is in healthy counterparts. But if it can’t hurt, it might help,” Schaffner said. “The downside risk appears to be very low.”

There’s no data available on the safety of the COVID-19 vaccination in people with autoimmune conditions, but the CDC said people with autoimmune conditions who have no other contraindications can still receive the vaccine.

“No imbalances were observed in the occurrence of symptoms consistent with autoimmune conditions or inflammatory disorders in clinical trial participants who received an mRNA COVID-19 vaccine compared to placebo,” the CDC said.

During the clinical trials for both the Moderna and Pfizer vaccine, there were cases of participants experiencing Bell’s palsy following vaccination.

Bell’s palsy causes temporary paralysis or weakness in facial muscles.

“The FDA does not consider these to be above the frequency expected in the general population and has not concluded that these cases were causally related to vaccination,” the CDC said.

“Post-authorization safety surveillance will be important to further assess any possible causal association,” the CDC said. “In the absence of such evidence, persons with a history of Bell’s palsy may receive an mRNA COVID-19 vaccine unless they have a contraindication to vaccination.”

There have been no cases of Guillain-Barré syndrome reported following the COVID-19 vaccination in either the Pfizer or Moderna trials.

Those who have a history of this disease can receive the COVID-19 vaccination unless they have other contraindications.

The Moderna vaccine is authorized for use in people 18 and older, and the Pfizer vaccine is authorized for use in those 16 and older.

At this time, the COVID-19 vaccine has not been studied in children, and they’re not authorized to receive the vaccination.

Trials are expected to begin shortly, with information about safety and efficacy of the vaccination in children expected to be available in mid-summer.

The CDC said that because COVID-19 vaccine supplies will initially be limited, priority for vaccination will be given to healthcare personnel and those living in long-term care facilities.

Healthcare workers

As of Jan. 3, more than 340,000 healthcare workers had been diagnosed with COVID-19, and more than 1,100 had died from the disease.

“When healthcare personnel get sick with COVID-19, they are not able to work and provide key services for patients or clients. Given the evidence of ongoing COVID-19 infections among healthcare personnel and the critical role they play in caring for others, continued protection of them at work, at home, and in the community remains a national priority,” the CDC said.

“Early vaccine access is critical to ensuring the health and safety of this essential workforce of approximately 21 million people, protecting not only them but also their patients, families, communities, and the broader health of our country,” the agency said.

Long-term care facilities

Residents of long-term care facilities are among those who are most at risk of dying from COVID-19.

As of Nov. 6, there had been more than 570,000 confirmed cases and more than 91,000 deaths related to COVID-19 among residents and employees of long-term care facilities in the United States. That accounted for 39 percent of all COVID-19 deaths in the United States.

“Making sure [long-term care facility] residents can receive COVID-19 vaccination as soon as vaccines are available will help save the lives of those who are most at risk of dying from COVID-19,” the CDC said.

“All COVID-19 vaccines were tested in clinical trials involving tens of thousands of people to make sure they meet safety standards and protect adults of different races, ethnicities, and ages, including adults over the age of 65,” the CDC said. “There were no serious safety concerns. The most common side effects were pain at the injection site, and signs and symptoms like fever and chills.”

The CDC said that after reviewing all available information the ACIP and the CDC “agreed the lifesaving benefits of COVID-19 vaccination for [long-term care facility] residents outweigh the risks of possible side effects.”

Next in line

The ACIP has made recommendations for the allocation of the COVID-19 vaccination in the United States.

The rollout of the vaccine will occur in four phases:

  • Phase 1a. Healthcare personnel and long-term care facility residents will be vaccinated. This phase has begun.
  • Phase 1b. Frontline essential workers and people over the age of 75 will be vaccinated.
  • Phase 1c. Persons between 65 and 74, people between 16 and 75 who have high-risk medical conditions, and essential workers who’ve not been recommended for vaccination in phase 1b will be vaccinated.
  • Phase 2. All remaining persons over the age of 16 who’ve not previously been recommended for vaccination will be inoculated.

The first supplies of COVID-19 vaccine were made available in mid-December, and the CDC advises all adults should be able to get vaccinated later in 2021.