The COVID vaccine will be ready for children, pregnant women and other subsets at different times.
As we approach the one year mark of the COVID pandemic and witness record-breaking surges of infections throughout the country, news of the COVID vaccine availability is beyond welcome.
When the vaccine first became available, UK ICU physician, Dr. Matthew Morgan, described it best when he compared the period of time to the duration of a full-term pregnancy. "You know, it's been an odd mood in many ways. It's kind of a combination of feeling proud, hopeful, but also realistic. And I say proud because it was 38 weeks to the day that we admitted the first critically ill patient with COVID to our ICU. And it's remarkable to think that in less than the duration of a pregnancy, 38 weeks, we now have gone from that to actually having a vaccine. And that's a remarkable achievement for science, for medicine and humanity, really."
On December 8th, the first-ever patient received the vaccine in the United Kingdom—and it happened in the US on December 15th. The FDA's Vaccine and Related Biological Products Advisory Committee formally recommended that the FDA approve use of the vaccine on December 10th, and confirmed Pfizer's claim that the COVID vaccine is 95% effective starting at least 7 days after the second dose is administered. In other exciting news, the vaccine may offer significant protection after just one dose, though these claims need to be substantiated by more research.
People are warming to the idea of getting the COVID vaccine, as well. The Pew Research Center reported that 60% of Americans will definitely or probably get the vaccine when it's available to them; this us up from 51% in September. This includes former Presidents Barack Obama, George W. Bush and Bill Clinton who have volunteered to receive the vaccine on camera to help inspire confidence in its safety.
But with the hope and celebration, come even more questions. And we get it. COVID is still so new to us—the vaccine is even newer. Your provider and local officials will be able to provide you with the best, personalized information for you and your family, so they should always be your first stop.
Here is what we know about the COVID vaccine so far:
How does the COVID vaccine work?
The COVID vaccine is a newer type of vaccine, called an mRNA vaccine. The Centers for Disease Control (CDC) explains, "To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, they teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies."
You can read a detailed (and fascinating) description of how they do this here. But it is important to address two points of concern that are on many people's minds right now:
- The COVID vaccine does not transmit the COVID virus. No live virus is injected into the body.
- The COVID vaccine does not change human DNA. The mRNA does not even enter the cells' nucleus (where the DNA is).
When will the COVID vaccine be available to adults?
The CDC has stated that they believe that all adults will be able to receive the COVID vaccine in 2021, though vaccine rollout plans have been slower than expected. The order in which adults may be eligible to receive the vaccine will depend on several factors, however; these are outlined below.
The New York Times has just released a very cool tool to help you see when you might be able to get the vaccine. (Please note: It's not official in any way, so don't start making plans based on what it says. It's more just an interesting way to play around with the data.)
Who will get the COVID vaccine first?
The CDC recommends that healthcare workers and the residents and workers of nursing homes be the first to receive the COVID vaccine. This recommendation comes from a panel of experts called the Advisory Committee on Immunization Practices (ACIP), who examined the pandemic data and determined who is most at risk—and therefore who would benefit from the vaccine the most.
This recommendation is handed to the states, but from there, each state can make its own decision; most expect the states to follow these guidelines. Unfortunately, there may not be enough of the vaccine for every healthcare worker and nursing home resident and worker to receive one in the first round, so states will likely need to make decisions about who gets first dibs. It may be that they sort them by risk, either by exposure (who is coming into closest contact with the virus) or personal risk factors (age, etc.).
The committee will continue to meet and assess which subset of the population the vaccine should go to next.
The New York Times reports that the CDC has suggested that essential workers will likely be next. This includes people that work in "work in food and agriculture, manufacturing, law enforcement, education, transportation, corrections, emergency response" and more.
After essential workers may come vulnerable populations such as the elderly.
As each batch of vaccines becomes available, experts will assess the most current data and make the best recommendations they can.
When will the COVID vaccine be available to children?
Experts believe that the first COVID vaccines for children won't be available until at least the fall of 2021. Current trials have not included young children yet, though Pfizer has started to include children aged 12 and older, so while scientists are optimistic about their safety in children, we don't yet have the evidence to support it.
The FDA's December 8th briefing stated that "there are currently insufficient data to make conclusions about the safety of the vaccine in subpopulations such as children less than 16 years of age, pregnant and lactating individuals, and immunocompromised individuals."
In the medical community, we often say that kids are not just little adults. This means you can't simply reduce the dose of a medication or vaccination and give it to a child. There are specific considerations that need to be accounted for in children.
This feels disheartening—but know that children are very much at the forefront of the vaccine developers' minds. According to the New York Times, children are being recruited into studies, and hopefully, they will start soon. When enough data is available to prove that they are safe, a similar process of FDA approval will begin and then vaccination can start.
The American Academy of Pediatrics (AAP) is calling for COVID vaccine trials to begin including children. AAP President Sally Goza, MD, FAAP, wrote, "If we do not add children to these research trials very soon, there will be a significant delay in when children are able to access potentially life-saving vaccines. This is unconscionable."
Goza cites not only the impact of the virus itself but the significant tangential ways children have been affected by the pandemic, as well. "More than 1 million children have been infected with this virus since the beginning of the pandemic, and children have suffered in numerous other ways. This includes disruptions to their education, harms to their mental and emotional health, and greatly diminished access to critical medical services. It is unjust to allow them to take on these burdens, but not give them the opportunity to benefit from a vaccine."
Yvonne A. Maldonado, MD, FAAP, and chair of the AAP Committee on Infectious Diseases, concurs, stating that "in order for parents to be comfortable giving these vaccines to their children, we must have studies showing they are safe and effective in children as well. This research takes time. If this does not begin soon, it will be less likely a vaccine will be available for children before the next school year."
Until kids can receive the COVID vaccine the pandemic will continue to exist.
When will the COVID vaccine be available to pregnant people?
Pregnant people have not yet been included in COVID vaccine trials—but some are getting vaccinated. As noted above, the FDA can not yet recommend the vaccine as safe for pregnant people.
Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics, explained that the first round of vaccine testing should not include pregnant people, to ensure that the vaccine is safe and to make sure that it works (provides the desired immunity to the virus).
Now, it is possible that some of the people involved in the current studies have or will become pregnant over the course of the study—that will provide some information, certainly, but likely not enough to warrant generalized statements of safety. To get the level of data we need, researchers need to conduct studies that are designed to focus on large groups of pregnant people from the outset.
It's likely that in the coming months, scientists will be weighing the risks of the severity of the COVID virus in pregnant people with the risks of a vaccine that hasn't been through full testing. In other words, it is possible that the consequences of getting COVID-19 while pregnant are deemed worse than the risk of the vaccine—if this is the case, providers may start recommending the vaccine to more pregnant people.
Ruth Karron, director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at the Bloomberg School, said in December, "By next year, we will hopefully have a clearer picture on both sides of the equation. If the virus presents a major risk to pregnant [people], then it's possible that pregnant [people] might be offered a vaccine sooner."
Pregnant people are currently being vaccinated, so the option may be available if you are interested.
Should pregnant people get the COVID vaccine?
Right now, there is not a one-size-fits-all approach.
Sean Esplin, MD, Sr. Medical Director of Women's Health at Intermountain Healthcare told Motherly, "If you're pregnant, the best thing is to get more information so you can evaluate the risks and benefits of getting or not getting the COVID-19 vaccine. People are worried because we don't have a lot of experience and data about pregnant [people] and the type of vaccine being used for the COVID-19 vaccine. Pregnant [people] want to be careful and might be nervous about the vaccine."
On January 27th, the World Health Organization announced that the vaccine was not recommended for pregnant people, unless they have a high risk of exposure—but then reversed course on the 29th, aligning with ACOG and SMFM. Dr. Esplin explained that "in response to the WHO recommendation, ACOG and SMFM issued a joint statement yesterday affirming their guidance that both COVID-19 vaccines currently authorized in the U.S. should not be withheld from pregnant individuals who choose to receive the vaccine." Many are glad to see the swift action WHO took in reconsidering their guidance.
Dr. Esplin continued that, "national organizations such as the American College of Obstetrics and Gynecology, the U.S. Centers for Disease Control (CDC) and the Society for Maternal Fetal Medicine recommend that each person consider their own potential risk factors and discuss them with their OB provider. They agree that in most cases there is no reason for pregnant [people] to not receive the vaccine."
Dr. Esplin said that it's important to "evaluate your own risk of contracting COVID-19. Talking with your OB provider can help you further evaluate your risk." He states that you are at a higher risk if you have frequent contact with people outside your home, such as a teacher or healthcare worker might be. "You are also at more risk of getting COVID-19 if you are pregnant and over age 35 or are overweight, or have other medical conditions, or smoke or [are part of the belong to BIPOC community.]" Dr. Esplin feels that vaccines might be appropriate for this higher-risk group. Patients should discuss previous reactions to vaccines with their providers first, he advises.
He also suggests that you assess the COVID-19 rates near you. "Our positivity rates in Utah are high right now. Most pregnant [individuals] in Utah communities should opt to have the vaccine when it's available."
This is because pregnant people are at higher risk when they get COVID. "They have a slightly higher risk of ending up in the ICU and having a severe case COVID-19," says Dr. Esplin. "It makes sense to protect yourself."
"My patients who are pregnant have a wide spectrum of feelings about the vaccine. Some are biased by misinformation they've heard about vaccines. For years, we've encouraged pregnant [people] to take other vaccines, such as for the flu, Tdap, etc."
Of note, Dr. Esplin shared that "there is no evidence that [those] in their first or second trimester are at higher risk if they get the vaccine." It also appears to be okay for people to get pregnant after receiving the vaccine.
When will the COVID vaccine be available to breastfeeding and chestfeeding people?
At this time, we don't know enough about its safety and effectiveness yet to make a recommendation regarding the vaccine for breast and chestfeeding people. That said, Ilona T. Goldfarb, MD, MPH of Harvard Medical School wrote that "experts believe it is most likely safe to get an mRNA COVID-19 vaccine if you're breastfeeding. Although breastfeeding people were not included in the vaccine trials, the mechanism of mRNA vaccines and experience from other vaccines suggest this is true."
Your provider can recommend it as the best option for you.
The primary concern with all medications and vaccinations in the breastfeeding, pumping and chestfeeding population is whether or not the medication or vaccination is secreted in milk—and if it is, whether it is okay for the baby to ingest it. We don't have this information yet.
What are the side effects of the COVID vaccine?
Many vaccines have mild side effects, and the COVID vaccine is predicted to be no different. Kelly Moore of the Immunization Action Coalition, who is also an external adviser for Pfizer told the Washington Post, "We talk about these vaccines as being reactogenic, which is just a big word that means the way they work, you will feel that they're working."
Moore explained the possible side effects can include:
- Soreness at the injection site
- Redness at the injection site
- Flu-like symptoms
- Body ache
In the FDA committee's December 8th briefing, they reported that severe reactions occurred in less than 5% of study participants, and this was most likely to occur after the second dose and in people younger than 55.
Just like with all medications and vaccines, if and when you and your family members do receive the vaccine, your provider will explain the risks and benefits as they apply to your specific scenario, and together you can make the best decision for you.
Should I get the COVID vaccine?
Whether you should get the vaccination will depend on a variety of factors about your overall health—your provider will help you determine the best course of action for you. But the sentiment from the medical community is likely to be a resounding, "Yes, most people should get the vaccine."
The morbidity and mortality of COVID are dramatic, as is the utter chaos of life within a pandemic. Not only do we have a personal need to be healthy, but we also have public health impetus as well. We need this pandemic to end—enough people getting the vaccine is how that's going to happen.
Should my kids get the COVID vaccine?
Your pediatrician is likely going to suggest—strongly—that your child receive the COVID vaccine. When the vaccine is deemed safe and effective, and it is available, most pediatricians and the AAP recommend getting it. As we have seen, COVID-19 can be horrific, and we need to do whatever we can to keep it out of our families.
Will the COVID vaccine stop the pandemic?
We certainly hope that the development of a COVID vaccine will allow us to one day put this pandemic behind us. Dr. Esplin told Motherly that "The COVID-19 vaccine is a critical part of how we end this pandemic. We want as many people to get the vaccine as they can." But that's going to depend on a lot of factors. According to the World Health Organization (WHO), the vaccine's effectiveness at curtailing the pandemic will depend on:
- How effective the vaccine is in varied populations (children, pregnant people, etc.)
- How quickly the vaccine can be produced and distributed.
- How many people receive the vaccine
We're going to be in this pandemic for some time to come. But these recent developments are huge, and we invite you to be cautiously optimistic as we learn more.
Stay calm, stay informed and stay well. We've got this.
This article was originally written on December 3rd and has been updated.
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