How To Get On List For Covid Vaccine

Experts say all the COVID-19 vaccines available are highly effective, so don't shop around. Chet Strange/Getty Images

Experts say the three COVID-19 vaccines now in use as well as those in clinical trials are highly effective.
They urge people to get the first vaccine that's available to them rather than wait on one that might be slightly more effective than another.
Getting a vaccine that's less effective than others is still much better than having no vaccine at all, experts say.

Which COVID-19 vaccine should you get?

Whichever one you can get into your arm first, medical experts say.

When the new coronavirus, SARS-CoV-2, first emerged more than a year ago, there was no vaccine to fight COVID-19, the disease it causes.

Now there are three vaccines authorized by the Food and Drug Administration (FDA), with more in advanced stages of development.

The vaccines take different approaches to fighting COVID-19, and effectiveness varies slightly as well.

However, experts say the bottom line is that any vaccine is better than no vaccine in preventing COVID-19. And, if you do get COVID-19, a vaccine increases the chances that you'll have a mild rather than severe bout of the illness.

"Here's my attitude toward the vaccine: Get what you can and as soon as you can get it," Dr. Ramin Ahmadi, the chief medical officer for Graduate Medical Education Global LLC, told Healthline.

"Get the first one available," agreed Dr. Steven Quay, a COVID-19 researcher, author of "Stay Safe: A Physician's Guide to Survive Coronavirus," and CEO of Atossa Therapeutics Inc. "They all keep you out of the hospital and keep you from dying, and those are big things."

Dr. L. J. Tan, chief strategy officer of the Immunization Action Coalition, told Healthline that while a lot of concerns about the COVID-19 vaccines have been raised — from the reasonable to the outlandish — research has proven most of these theories to be unfounded.

For example, he said, when the FDA issued emergency use authorizations for the first two COVID-19 vaccines, the agency brought in independent experts to review safety data on the vaccines.

And while those new vaccines from Pfizer-BioNTech and Moderna use groundbreaking messenger RNA (mRNA) technology, Tan said that researchers have been familiar with such vaccines for at least 15 years.

Both vaccines also far exceeded the FDA's threshold for effectiveness of emergency vaccines, which was set at 50 percent.

"Those of us involved with these vaccines were not surprised at how safe and effective they are," Tan said in late January. "We have now vaccinated more than 20 million people and we see that the sky is not falling."

About 1 in 4 people experience some sort of side effects from receiving the COVID-19 vaccine, but it's mostly fever or soreness at the injection point.

Reported side effects and (rare) allergic reactions are pretty consistent among the approved vaccines, although a recent report found that some recipients of the Moderna vaccine have experienced delayed rashes at or near the injection site.

Rather than being alarmed, vaccine recipients should view such symptoms positively, Tan said.

"If I feel crappy, I'm happy because it shows your immune system is doing its job, and I know the vaccine took," he said.

Overall, the COVID-19 vaccines are causing fewer side effects than the vaccine for shingles but somewhat more than the flu shot, according to Tan.

Swatting away another myth, he noted that the vaccines can't give you COVID-19 because the viral material they contain is "absolutely dead."

On Dec. 11, the FDA granted an emergency use authorization for the first COVID-19 vaccine.

Developed by Pfizer and BioNTech, the vaccine was authorized for use in people 16 years and older. Delivered in two doses, the vaccine was found to be 95 percent effective in preventing severe disease.

"While not an FDA approval, today's emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine holds the promise to alter the course of this pandemic in the United States," said Dr. Peter Marks, the director of the FDA's Center for Biologics Evaluation and Research in a statement at the time.

"With science guiding our decision making, the available safety and effectiveness data support the authorization of the Pfizer-BioNTech COVID-19 vaccine because the vaccine's known and potential benefits clearly outweigh its known and potential risks," Marks said.

The recommended interval between the first and second dose of the Pfizer-BioNTech vaccine is 21 days.

A week after approving the Pfizer-BioNTech vaccine, the FDA issued an emergency use authorization for a second two-dose COVID-19 vaccine. This one was developed by pharmaceutical company Moderna.

The Moderna vaccine is authorized for use in adults 18 and older. It was found in clinical trials to be 94 percent effective against COVID-19.

The Moderna vaccine is "stronger" than the Pfizer-BioNTech vaccine in the sense that each dose contains more vaccine material: 100 micrograms compared with 30 micrograms for each Pfizer-BioNTech shot.

The recommended interval between the first and second dose of the Moderna vaccine is 28 days, a week longer than for the Pfizer-BioNTech vaccine.

Like the Pfizer-BioNTech product, the Moderna vaccine doesn't contain weakened viruses like traditional live attenuated vaccines.

A live vaccine would have required far more safety testing. It also would have taken a long time to grow in sufficient quantities to distribute to the public, said Mary Premenko-Lanier, PhD, a biosciences research scientist at the nonprofit scientific research institute SRI International.

Rather, both vaccines are built around genetic material called mRNA that's derived from SARS-CoV-2.

According to the Centers for Disease Control and Prevention (CDC), mRNA is basically instructions to cells on how to make a piece of the "spike protein" that's unique to SARS-CoV-2.

"When a person receives this vaccine, their body produces copies of the spike protein, which does not cause disease, but triggers the immune system to learn to react defensively, producing an immune response against SARS-CoV-2," according to the FDA.

Researchers have been working to develop mRNA vaccines for at least a decade, but the need to rapidly respond to the COVID-19 pandemic pushed the technology out of the lab and into practice, Quay said.

"It absolutely works the way we hoped it would," he told Healthline.

The vaccine most recently approved by the FDA comes from Janssen Pharmaceutical Companies, a subsidiary of Johnson & Johnson.

In an announcement, the company pledged to distribute 20 million doses of the vaccine in the United States by the end of March and 100 million doses for the first half of the year.

On Jan. 29, Johnson & Johnson announced that the vaccine was 72 percent effective in preventing moderate to severe COVID-19 28 days after vaccination. Severe disease was prevented in 85 percent of cases.

That's less effective than the Pfizer-BioNTech and Moderna vaccines. However, "having an efficacy of 70 to 80 percent is still very good for a vaccine," Premenko-Lanier told Healthline.

"This vaccine has several advantages compared to the existing ones," Ahmadi said. "It is a single dose… You can store the vaccine for months in a regular refrigerator [both the Pfizer-BioNTech and Moderna vaccines must be stored at extremely low temperatures]. And it was effective in the U.K. and South Africa where there are concerns about the new strains."

The vaccine uses genetically modified inactivated adenoviruses — a group of viruses that includes the common cold — to carry part of SARS-CoV-2's instructions into the body, rather than mRNA.

Side effects reported in clinical trials for the Johnson & Johnson vaccine are similar to those of the Pfizer-BioNTech and Moderna vaccines: pain, redness of the skin, swelling at the injection site, headache, fatigue, muscle aches, nausea, and fever. Rarer allergic reactions have also been reported.

The Johnson & Johnson vaccine has run into some resistance by anti-abortion groups, who expressed concern that the vaccine was tested (although not developed) with cell lines derived from fetal tissue.

In a statement, the U.S. Conference of Catholic Bishops stopped short of saying that Catholics should not get the Johnson & Johnson shot due to ethical concerns.

"However, if one has the ability to choose a vaccine, Pfizer or Moderna's vaccines should be chosen over Johnson & Johnson's," the group advised.

Tan said that whatever vaccine you get will not only protect your health, but also serve the greater good of helping to end the COVID-19 pandemic.

"We need to do everything we can to slow down and stop the spread of this disease," he said. "The more opportunities you give a virus to replicate, the more opportunities it has to evolve and evade the immune response."

By the end of 2020, two other vaccine candidates were in phase 3 clinical trials, the last step before possible application for emergency use authorization by the FDA.

These vaccines are being developed by AstraZeneca and Novavax.

On Jan. 29, the AstraZeneca vaccine was recommended for use in the European Union, although not yet in the United States.

Like the Johnson & Johnson vaccine, the AstraZeneca injection uses modified adenovirus to provoke an immune response against COVID-19.

In studies, researchers who administered the AstraZeneca vaccine in two doses to test people 18 and older found no cases of severe infection or hospitalization for 14 days after the second dose.

Quay said the adenovirus approach used in the Johnson & Johnson and AstraZeneca vaccines has been "well known and well used" over the past 30 to 40 yeas in fighting other diseases, such as Ebola.

The Novavax vaccine hasn't yet been authorized for use in the United States or Europe.

However, the company reported on Jan. 28 that the vaccine had an 89 percent effectiveness rate and has also been shown to be effective against emerging SARS-CoV-2 variants first detected in the United Kingdom and South Africa.

The biotechnology company uses nanoparticles to carry the spike proteins into the body to activate the immune system.