Which COVID-19 Vaccine Is Best in 2024?

Chart comparison

The following summary shows the latest vaccination guidelines for the three currently approved COVID-19 vaccines in the United States. Data is based on the 2023 to 2024 guidelines by the Centers for Disease Control and Prevention (CDC).

Note that the 2024 to 2025 guidelines are expected to come out in the fall of 2024 and may differ.

Learn more: How the different types of COVID-19 vaccines work

Which vaccine is the most effective against COVID for adults?

When COVID-19 vaccines were first introduced, the general rule of thumb was that the best vaccine was the one that you could get now.

However, at the beginning of 2022, the CDC updated its vaccine recommendations to state that the two mRNA vaccines — Pfizer and Moderna — were preferred over the Johnson & Johnson (J&J) vaccine.

The J&J vaccine has since been discontinued. In 2023, the Food and Drug Administration (FDA) authorized a protein subunit vaccine called Novavax.

Today, the CDC recommends any of these three COVID-19 vaccines if you follow the recommended dosing and schedule.

So, which is better?

mRNA vaccines: Is Pfizer or Moderna better?

MRNA vaccines tell your body how to make the necessary protein to fight a virus.

Clinical trials for the two mRNA vaccines found that both Pfizer and Moderna were safe and had similar effectiveness: 95% for Pfizer and 94.1% for Moderna.

The similar effectiveness of these vaccines also extends into a real-world setting.

A 2022 study examined vaccine effectiveness in U.S. veterans vaccinated between January and May 2021. While the two vaccines were comparable, the Moderna vaccine prevented symptomatic infection and hospitalization slightly more effectively than the Pfizer vaccine.

Note that the effectiveness between the Pfizer and Moderna vaccines might vary depending on the coronavirus variant.

For example, a 2022 study of the Pfizer vaccine against the Omicron variant found that vaccine effectiveness was 67.2% in the 2 to 4 weeks after a booster but declined to 45.7% after 10 or more weeks.

Another 2022 study of the Moderna vaccine against the Omicron variant found that vaccine effectiveness was 71.6% in the 14 to 60 days after a booster but declined to 47.4% after 60 days.

That said, the FDA now approves updated versions of these vaccines annually to target newer virus variants.

Protein subunit vaccine: Is Novavax better than the mRNA vaccines?

Protein subunit vaccines are a direct injection of a modified protein that stimulates the immune system to make antibodies and T cells to fight a virus.

A 2023 study compared the effectiveness of mRNA and protein subunit vaccines. Researchers found that all the newer vaccines are at least 90% effective regardless of how they work.

However, a 2023 study suggests that Novavax may cause fewer side effects than mRNA vaccines.

Some research suggests that mixing mRNA and protein subunit vaccines might result in a better immune response and, therefore, better protectiveness. For example, a 2023 animal study in mice examined mixing mRNA and protein subunit vaccines against influenza strains and found good effectiveness.

However, the CDC only recommends mixing vaccines in specific circumstances:

• the preferred vaccine is unavailable
• there’s no information on the previous dose
• you would otherwise not receive a recommended vaccine dose
• you cannot complete the original vaccination series because you had an adverse reaction

Which COVID-19 vaccine is best for children?

As with adults, there isn’t a clear answer as to which vaccine is better for your child.

The CDC recommends that everyone 5 years old and older be vaccinated against COVID-19. Currently, the Pfizer and Modera vaccines are recommended for children over 6 months old, whereas Novavax is intended for only those over 12 years old.

Research shows that the Moderna and Pfizer vaccines are generally safe for children. Lower doses have been deemed safe for children ages 6 months to 5 years.

While children have a higher chance of developing myocarditis related to mRNA vaccines, this risk is now considered low. It’s also lower than the risk of getting the condition from COVID-19 itself for most age groups. Extending the time between doses to 8 weeks helps improve immune response and reduce this risk.

A 2023 clinical study also found that Novavax caused mostly mild adolescent reactions. Reactions were only slightly stronger after the second dose. The efficacy was 79.5%.

However, since Novavax is relatively new, this clinical trial is still ongoing, and the data may change.

Which vaccine is best for seniors?

One 2023 study in Australia found that COVID-19 vaccines were highly effective in preventing deaths among older Australians during the peak of the Omicron variant outbreak in 2022. However, after 6 months of receiving the booster, effectiveness dropped to around 50%.

This highlights the importance of getting additional boosters in this age group, especially those released to target newer virus variants.

Multiple studies confirm the effectiveness of vaccination in older adults.

When it comes to which is best, a 2023 study comparing Pfizer and Moderna vaccines in older adults found that the Moderna vaccine was associated with slightly fewer side effects than Pfizer in this age group.

A 2024 study compared mRNA and protein subunit vaccines in Taiwan. Researchers found that in people over 65 years old who were given three vaccine doses, both vaccine types provided comparable protection against death. The effectiveness rates against death were:

• 86.6% for Moderna
• 85.2% for Novavax
• 83.6% for Pfizer

Therefore, which vaccine is preferable to someone in this age group might ultimately be based on personal preference.

Which COVID-19 vaccine is best for immunocompromised people?

People who are immunocompromised have an increased risk of severe illness or death due to COVID-19. This includes people who:

• are taking immunosuppressant drugs
• are receiving cancer treatment
• have received an organ or stem cell transplant
• are living with HIV
• have an inherited immunodeficiency syndrome

As with adults and children, the CDC now recommends any of the three vaccine options for immunocompromised people so long as the specific recommendations on age and number of doses are followed.

A 2021 study examined the effectiveness of two mRNA vaccine doses in immunocompromised people. It found that the Pfizer vaccine was 71% effective, and the Moderna vaccine was 81% effective. However, this difference isn’t considered statistically significant.

That said, a 2022 meta-analysis of 82 studies found that antibody response rates in immunocompromised people may be lower than in those who are not immunocompromised. This means immunocompromised people usually need more doses to develop enough antibodies against the coronavirus.

However, this study did not examine the Novavax vaccine.

A 2022 review article also states that an additional dose may raise antibody response rates from 41% to 67%. However, researchers also note there may be significant variation between different groups of immunocompromised people.

A 2023 randomized placebo trial with adults 18 to 84 years old found that Novavax was generally 82.7% effective. Its efficacy was 100% for severe disease. That said, the study didn’t examine efficacy in immunocompromised participants.

Vaccine schedule for immunocompromised individuals

The COVID-19 vaccine schedule for immunocompromised people differs slightly from the schedule for the larger population. The table below shows the CDC’s current vaccine recommendations for immunocompromised individuals.

Guidelines for getting vaccinated and staying up to date

To be protected from COVID-19, it’s important to stay current on your COVID-19 vaccines. But what exactly does this mean?

According to the CDC, you’re up to date on your COVID-19 vaccines when you’ve received both your primary vaccine series and your booster dose.

If you’ve received only your primary vaccine series, you are considered fully vaccinated but not current.

Note that if you have a compromised immune system, your doctor may also recommend taking pemivibart (Pemgarda).

The FDA recently authorized this monoclonal antibody medication in 2024 to help people who may not be able to build enough of an immune response from a vaccine.

Takeaway

Overall, receiving any of the currently available COVID-19 vaccines is better than not getting vaccinated. This is because all of the COVID-19 vaccines are safe and effective at protecting you from serious illness and death due to COVID-19.

What brand and type of vaccine you prefer largely depends on your age and preferences. Be sure to talk with your doctor if you have any questions or concerns about COVID-19 vaccination.

Read this article in Spanish.