By Dr. Dora Anne Mills
COVID-19 vaccine production is not ramped up globally or nationally, and as a result, there is very little vaccine in Maine or anywhere, compared with the numbers of those who need it. (For example, Maine has been receiving fewer than 18,000 doses per week, yet 330,000 are currently eligible for the vaccine, mostly those 70 years and older.) However, I recommend that if you’re interested in the vaccine (and I hope you are) or if you have an appointment for one, there are several steps you should take to get ready.
Although the two current vaccines in the U.S. – Pfizer-BioNTech and Moderna – boast extraordinary efficacy and safety profiles, there are some relatively rare circumstances that you should be aware of, since if they apply to you, you should assess further, including considering discussing your situation with your PCP. Additionally, going through these steps below and answering some questions ahead of time will help your appointment go more smoothly.
Reasons you may not be eligible
First, you’ll want to review if you’re one of the very few people who may not be eligible for the vaccine, either on the day of your appointment or more permanently. We’ve had people show up for vaccine appointments at our clinics and not be able to get the vaccine that day. The most common reason? They’ve had another vaccine (e.g. shingles or flu vaccine) within the last 14 days. You should not get any other vaccine within 2 weeks of the COVID-19 vaccine. This Is generally true of all vaccines, since while your immune system is mounting a response to one vaccine, if you have a second one too soon, then your immune system will have limited ability to fully respond to the second vaccine.
Another less common reason people show up for their appointment disappointed they can’t get the shot that day is because they are fairly sick, including with a fever. If you’re fighting off a significant infection (e.g. COVID-19), then your immune response to the vaccine is unlikely to be optimal. If you’ve been diagnosed with COVID-19, you can still get vaccinated, but your acute symptoms should be resolved and you must be finished with your isolation period.
A much less common reason for people being unable to get vaccinated is if they’ve had a severe allergic reaction (e.g. anaphylaxis) to previous dose of the mRNA vaccine or any of its components, or if they had any immediate (within 4 hours) allergic reaction of any severity to a previous dose of the vaccine (reactions could include hives) or to any of its components, including polyethylene glycol (PEG), or to polysorbate (related to PEG). In these situations, US CDC says you should consult with an allergist.
If you have a history of any immediate allergic reaction (within 4 hours) to another vaccine or injectable therapy, then you should talk with your PCP first to determine if you need to see an allergist first or be observed for 30 minutes post-vaccine (versus the usual 15 minutes).
Review these ahead of time
There are very few reasons why someone cannot receive the Pfizer-BioNTech or Moderna vaccines. The screening questionnaire you’ll be given at your appointment to make sure you’re fine to receive it can be found here: Pre-vaccination screening form. It reviews the situations I’ve mentioned above in addition to others. I recommend you review the screener beforehand so your appointment goes as smoothly as possible. This version of the screener has several pages of guidance for positive answers to the questions, including a list of the vaccine ingredients.
Second, you may want to review your own individual health conditions. The most common questions we hear from people at the vaccine clinics is if they can get vaccinated, despite their conditions or situations, such as being pregnant or lactating, being immune suppressed, having an autoimmune disease, having many allergies, etc. The answers are generally, “yes, you can get vaccinated”, but sometimes a conversation is needed. If you have questions on your situation, there is a good chance you’ll find some guidance on this webpage, a CDC document with discussions on clinical considerations related to the vaccines: Clinical considerations.
Third and finally, I recommend you review the FDA Fact Sheets on the vaccines ahead of time. You’ll be given these at your appointment, but they are several pages long, and easier to read and digest ahead of time. The one for Moderna vaccine is here: Moderna and the one for the Pfizer vaccine is here: Pfizer.
It is often the case that we don’t know which vaccine will be administered at a particular clinic ahead of time, so it is probably prudent to read both, though since the two vaccines are extremely similar, the FDA Fact Sheets are as well.
I am often asked about the long term effects of the vaccines. These vaccines boast extraordinary safety and efficacy profiles and based on how these vaccines work, there is no reason to think there will be long-term adverse effects. However, neither these specific vaccines nor COVID-19 disease has been known about for more than a few months, so we don’t really know. What we do know is COVID-19 infection is quite contagious, is currently the leading cause of death in the U.S., and has numerous effects that last weeks or months in a significant proportion of people.
Vaccine is our ticket to more normalcy (likely a “new normal”). It is our ticket to eventually celebrating holidays together, hugging our loved ones, and our children returning to school full time. In the meantime, vaccine provides us an additional and critical layer of safety, to be added to other safety layers – masking, distancing, hand hygiene, not gathering, ventilation, etc. I hope you’re interested in getting vaccinated; the protection it gives you helps protect all of us. Taking the three steps above will also help your vaccine appointment go smoothly.Dora Anne Mills, MD, MPH, FAAP, Chief Health Improvement Officer, MaineHealth