As everyone knows, the COVID-19 pandemic has caused a public health — and societal — crisis of epic proportions. The impact has been especially severe on older adults, who are more likely to be severely affected by COVID, and who represent a distressingly high proportion of the U.S.’s COVID deaths.
But, in an amazing feat of scientific achievement, COVID vaccines were developed in truly record time, and as of Spring 2021, a large-scale vaccination campaign has been rolled out in the U.S., with healthcare workers and older adults being prioritized for vaccination.
This doesn’t mean everything will be back to normal very soon. But vaccination is what will enable us to eventually pull out of the danger and disruption the pandemic is causing.
Although it’s exciting to see COVID vaccination start to take place in the U.S., it also raises a lot of questions for people. This article summarizes what I think is most important for older adults and families to know about coronavirus vaccination.
In particular, I want to offer science-based information to help with common questions, such as “Which COVID vaccine is better for seniors?” or “Which COVID vaccine for a 90-year-old?”
I’ll also cover vaccine safety, and what we know so far about how effective these COVID vaccines are in older adults.
Latest Updates:
Here is a video update from March 26, 2021:
(For a short tutorial on how to slow down the video or search the transcript, see here.)
This update includes data on COVID mortality rates in older adults (note: these figures apply to unvaccinated older adults), data on how COVID cases and deaths have fallen in nursing homes (hurray!), what the FDA data on the Johnson & Johnson vaccine shows for older adults, and more.
I also address these FAQs:
- Should I get vaccinated against COVID?
- Should my 90-year-old parent get the COVID vaccine?
- How well does the vaccine work in older adults?
- Can you get COVID if you’ve been vaccinated?
- Should you be vaccinated if you already had COVID?
- Which COVID vaccine is better for seniors? Which vaccine is safest?
- Should I worry that the vaccine might harm me (or my frail older parent)?
- When can I get vaccinated? Which vaccine should I try to get?
- If I’ve been vaccinated, is it safe to …?
What’s Most Important to Know About COVID Vaccination
What COVID vaccines are currently available?
You can see which COVID vaccines have been approved for use in the U.S. on the FDA’s COVID-19 Vaccines page: FDA COVID-19 Vaccines.
As of March 26, 2021, in the U.S., three COVID-19 vaccines have received an Emergency Use Authorization (EUA) from the FDA: Pfizer, Moderna, and Janssen (which is the pharmaceutical branch of Johnson & Johnson).
On December 11, 2020, the FDA granted an emergency use authorization (EUA) to Pfizer’s COVID-19 vaccine. Moderna was granted a similar EUA on December 18, 2020.
On February 27, 2021, the FDA granted emergency use authorization to Johnson & Johnson’s COVID vaccine. Unlike the Pfizer and Moderna vaccines, which require two injections spaced about a month apart, the J&J vaccine only requires one injection.
Dozens of other vaccines are under development worldwide, of which some are in “Phase 3,” in which the vaccine is given to thousands of people to test it for efficacy and safety. You can see a list of vaccines in Phase 3 on the NYTimes Coronavirus Vaccine Tracker page, which also includes a helpful summary of the vaccine approval process.
Vaccines were initially prioritized for frontline health workers and nursing home residents, and more recently have been available to older adults in most areas. As of March 2021, experts expect that all adults who wish to be vaccinated will be able to do so by May or June of 2021.
About the mRNA COVID Vaccines (Pfizer and Moderna)
How the Pfizer and Moderna COVID vaccines work
The Pfizer and Moderna vaccines use a new approach for vaccination: messenger RNA (“mRNA”). This technology has never before been used in a licensed vaccine. But it seems to offer several advantages over pre-existing vaccine technology.
Whereas most vaccines work by injecting a person with a killed virus or portion of virus, mRNA vaccines use a totally different approach: they contain limited instructions that prompt the body’s cells to create copies of the COVID spike protein component (but not the whole virus).
The body’s immune system then recognizes the COVID spike protein as foreign, and builds up immunity. This means that when the body later encounters the complete COVID virus during an infection, it can ramp up quickly and defeat the virus before the person feels ill, or becomes seriously ill.
So, it’s impossible to get COVID from the mRNA COVID vaccines, because they don’t inject killed or weakened COVID, and the injected instructions cannot cause the body to create complete functioning COVID virus.
Another advantage of the new mRNA technology is that vaccine doses can be manufactured much more quickly.
You can learn more about these mRNA vaccines here: CDC: Understanding mRNA COVID-19 Vaccines
For the Pfizer and Moderna vaccines, two doses are required (3 and 4 weeks apart, respectively).
mRNA COVID Vaccine Efficacy in Older Adults: What we know so far
What we know about how well these vaccines work is based on two types of information: randomized trial data submitted to the FDA to get emergency use authorization, and then observational analyses conducted over the past several months.
Although few observational analyses have been published yet in peer-reviewed journals, CDC data indicates that since vaccination began, COVID case rates and death rates have fallen dramatically in nursing home residents and among people aged 85+. A UK study also noted a significant drop in COVID hospitalizations after their vaccine rollout.
(See the video above for an explanation of where to find this data.)
For this reason, I highly encourage COVID vaccination for adults of all ages.
What we know from the COVID trial data submitted to the FDA
The Pfizer phase 3 trial data was published in the New England Journal of Medicine (NEJM) on December 10, 2020, and the Moderna phase 3 trial data was published on December 30, 2020.
The Pfizer trial included about 43000 participants, who were randomized to get the Pfizer COVID vaccine or a placebo injection. During a follow-up period of a few months, there were 8 cases of Covid-19 among vaccine recipients and 162 cases among placebo recipients. The authors concluded that the vaccine was 95% effective in preventing Covid-19.
But before you assume that you — or your aging parent — will be 95% protected by vaccine trial data: it’s extremely important to take a good look at the study data, to find out: how many people like you were studied, and what were the results in that group?
Being a geriatrician, I always want to know how many older adults were included in a study, what was the age breakdown of older participants (because the average 65-year-old is medically fairly different from the average 85-year-old), and what happened with those participants.
Here is the short video presentation I recorded in December 2020, about how I assess whether the COVID vaccine (or other treatment) is effective in older adults, especially those over age 85 and those in nursing homes. I also have summarized some key vaccine information below.
In this video, I review the data for Pfizer’s vaccine, and I show you how you can assess the data on older adults when the data for upcoming vaccines is released.
Here’s what I found out, for the Pfizer trial:
- The median age of participants was 52 years, and 42% of participants were older than 55 years of age. The age range of participants was 16-91.
- COVID cases and vaccine efficacy results are reported for four age ranges (see Table 3):
- 16-55 years (19852 people) –> 5 cases (vaccine) vs 114 cases (placebo) –> 95.6% efficacy (statistically likely range: 89.4–98.6%)
- >55 years (15043 people) –> 3 cases (vaccine) vs 48 (placebo) –> 93.7% (statistically likely range: 80.6–98.8%)
- >65 years (7728 people) –> 1 case (vaccine) vs 19 (placebo) –> 94.7% efficacy (statistically likely range: 66.7–99.9)
- >75 years (1559 people) –> zero cases (vaccine) vs 5 cases (placebo) –> 100.0% efficacy (statistically significant range: −13.1–100.0%)
Please note that it’s not a typo: for participants aged 75 years or older, they are reporting a statistically likely efficacy range of negative 13% to 100%. (!)
What does this result mean? Since the statistically likely efficacy range includes the number zero, it means it’s possible the vaccine has zero efficacy.
But honestly, that’s unlikely. The data right now is showing this large efficacy range because in practical terms, they didn’t have enough people aged 75+ catch COVID during the study period. (This may be because everyone in this age group was being careful to minimize their COVID exposure.) So, there was not enough data to determine how well the vaccine works in this age group.
In short, when Pfizer’s vaccine was authorized, it wasn’t clear just how effective it was in older adults aged 75+, much less those aged 85-90+. They also didn’t report just how many people aged 85+ were in the study, but probably it was a small number.
As a geriatrician, this concerned me. Most vaccines, such as the influenza vaccine, tend to work less well in older adults because of an aging immune system. (This is why vaccine makers have designed flu vaccines specifically for older adults.)
That said, in February researchers published a study of the Pfizer vaccine efficacy under real-world conditions in Israel, which noted a real-world vaccine efficacy of over 90%. The study did exclude nursing home residents from the study, and did not specify effectiveness in people over age 80. But it was excellent to see the vaccine demonstrating such good results overall.
What about the efficacy of the Moderna vaccine?
The Moderna data was overall similar to the Pfizer data. They also had a limited number of participants over age 75, and so could not draw statistically significant conclusions regarding the efficacy of the vaccine in people over age 75. The peer-reviewed Moderna vaccine study results published in the New England Journal are here.
However, the more interesting data is what Moderna submitted to the FDA when requesting emergency approval, which can be viewed here.
- In Table 17 (page 29), you can see that in people aged 65+, the point estimate for vaccine efficacy was 86.4% (95% likely range of 61.4 – 95.5%), compared to an efficacy of 95.6% (range 90.6%, 97.9%) in people age 18 to under 65.
- This is still a very good efficacy, but note that it has dropped compared to a younger population. And…the aged 65+ group was most people aged 65-75.
- You can see the number of participants aged 75+ and the vaccine efficacy results in Table 10 (page 24).
- The number of people over age 75 was quite small (about 1300 overall) and there were only 3 COVID cases in the vaccinated group.
- So the posted efficacy rate of 100% is not statistically significant (which is why they don’t provide a range).
Needless to say, the participants in the vaccine trials who were aged 75+ are overall much younger and healthier than people in nursing homes, and should be assumed to have a better immune system response to vaccines than even a healthy 90 year old will have.
If you are wondering why there weren’t more people aged 75+ in the trials, see this interview with geriatrician Dr. Sharon Inouye, of Harvard: Why Aren’t Highest-Risk People Better Represented in COVID Vaccine Trials?
In my opinion, the biggest risk in vaccinating frail older adults is that people may overestimate the associated protection and then take fewer precautions around these older adults. So even if all residents of a nursing home are vaccinated, it’s important for staff to be vaccinated as well, and that everyone continues to take precautions until the levels of COVID community transmission finally drop down.
Do the Pfizer and Moderna vaccines protect against the new variants of COVID?
As of late January 2021, the CDC has become aware of several COVID variants that appear to be more contagious than usual. These seem to have originated overseas but appear to be circulating in the United States. The variants include:
- B.1.1.7 (first identified in the U.K.)
- B.1.351 (first identified in South Africa)
- P.1. (first identified in Brazil)
The vaccine makers are actively studying how well their vaccines protect again these variants. Preliminary evidence suggests that the Pfizer and Moderna vaccines may be less effective at neutralizing the “South Africa variant”.
It is possible that the vaccine makers will offer “booster shots” later in the year, to provide better protection against the variants.
To find out if the COVID variants are causing cases near you, see this CDC page: US COVID-19 Cases Caused by Variants.
Are the Pfizer and Moderna COVID vaccines safe?
In general, they appear to be quite safe and there were very few true severe problems noted in the study.
As of March 26, 2021, over 130 million doses of these vaccines have been administered. To date, the primary safety issue that has emerged is the possibility of severe allergic reactions. However, these are uncommon and only affect a handful of people per every million doses administered. For more on this, see this CDC page.
Now, it’s important to note that it was quite common for vaccine recipients to feel unwell after vaccination, especially after the second dose. The most common symptoms were fatigue and headache, and some people experienced fever, as well.
These are signs that the immune system is responding to the vaccine! (Which is why they occurred less often in older participants than younger ones.) So these should not be taken as a sign that the vaccine is dangerous, or not worthwhile.
About the Johnson & Johnson COVID Vaccine
The Johnson & Johnson vaccine requires only a single injection. A good summary of the J&J vaccine, including how it’s different from the Pfizer and Moderna vaccines, is here: How does the Johnson & Johnson vaccine work? When is it available? What to know about the new shot.
Reviewing the J&J vaccine data is more complicated in that the Phase 3 trial was conducted in three regions (the US, South Africa, and 6 Latin American countries), and also took place in the winter of 2020-2021, when some areas had COVID variants spreading.
The trial data submitted to the FDA can be viewed here: FDA Briefing Document: Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19.
In reviewing the J&J data, I noted:
- Vaccine effectiveness (VE) overall, by region was:
- US: 72% (95% confidence interval 58-82%)
- Latin America 61% (95% confidence interval 47-72%)
- South Africa 64% (95% confidence interval 41-79%)
- 35% of participants were over age 60
- 3.7% over age 75
- VE after 28 days against moderate-severe COVID:
- Age 18-59: 66% (95% CI 53-76%); 64% if comorbidities
- Age 60+: 66% (95% CI 37-83%); 42% if comorbidities
- VE after 28 days against hospitalization/ICU/death
- No cases were noted among vaccine recipients; VE 100% (31-100%)
The bottom line is that although the posted overall efficacy rate appears to be lower (72% in the US) than that of the mRNA vaccines, the J&J vaccine is still quite effective overall and after 28 days, it had good efficacy (83%; see table 16) in preventing severe/critical COVID.
It is perhaps a little bit concerning that it was less effective among older adults with comorbidities, but it is still better than being unvaccinated.
There was no very detailed data on the vaccine efficacy in people over age 75; they are mentioned in some results tables (e.g. table 12) but there does not seem to be enough data to draw an efficacy conclusion.
The vaccine also appeared to be safe. Similar to the previously approved COVID vaccines, many vaccine recipients did experience side effects such as headache, fatigue, and body aches, and these were more common in younger recipients.
Updates on Vaccine Safety Data:
Update January 29, 2021: The CDC’s Advisory Committee on Immunization Practices (ACIP) reviewed COVID vaccine safety data in a meeting on January 27, 2021. You can view the meeting slides and safety data here. This meeting included data on the immunization of nursing home residents (slides 39-41). These vaccinations used Pfizer and Moderna vaccines.
The safety data so far, for nursing home residents, is reassuring. As the slides explain, so far it doesn’t look like people in nursing homes are more likely to die within after vaccination, compared to nursing home residents who are not vaccinated.
Who shouldn’t be vaccinated against COVID?
At this time, there are not many specifics on who should not be vaccinated, provided a vaccine is approved for your age group. (None of the available vaccines have an emergency authorization for children.)
As of January 2021, there have been a relatively small number of severe allergic reactions, which the FDA is investigating. So people with a history of anaphylactic allergic reactions should probably check with their health providers before pursuing vaccination.
That said, with millions of vaccine doses being distributed over the next several months, guidelines are likely to rapidly evolve, regarding who should not be vaccinated, or who should be vaccinated with caution. For accurate information on this topic, I recommend reputable information sources, such as the FDA and the CDC’s COVID information pages. (See Resources, below.)
My current recommendation for COVID vaccination
As of March 26, 2021, I am urging all adults to get vaccinated for COVID, unless your own health provider advises you otherwise. I also would not recommend worrying about which vaccine to get; at this point, any vaccine is better than risking COVID.
That’s because:
- The Pfizer and Moderna vaccines appears to be quite effective, especially in people up to age 75.
- The Johnson and Johnson vaccine is quite effective as well.
- Even though it’s unclear exactly how effective these vaccines are in people over age 75, COVID case numbers and deaths in this age group have fallen as older adults have been vaccinated.
- Remember, this is the age group in which COVID is mostly likely to cause hospitalization or death; 60% of all US COVID deaths have occurred in people over age 75.
- COVID cases and deaths in US nursing homes appear to have decreased since the vaccination campaign started.
- So far there is no reason to believe these vaccine are unsafe or likely to cause lasting harm.
- Until COVID rates drop way, way, down, the risks of catching and transmitting COVID should vastly outweigh the potential discomfort of vaccination or very small risk of an adverse reaction.
What is an older person’s risk of dying from COVID?
To get an estimated answer to this question, I queried the CDC’s COVID-19 Case Surveillance Public Use Data set, which is available online.
In reviewing available data for COVID cases since 9/1/20, I calculated the following:
- For people aged 80+
- 16.4% mortality overall
- 43% mortality if hospitalized
- 67% mortality if admitted to the ICU
- For ages 70-79
- 6% mortality
- For ages 60-69
- 2% mortality
What to remember if you — or your loved one — is over age 75:
I strongly urge you to get vaccinated! We have more of a reassuring track record with Pfizer and Moderna’s vaccine, but any approved vaccine should be considered acceptable.
Please note that vaccination will make you much safer from COVID, but it’s probably not 95% safer and I especially urge caution for those who are frail, immuno-compromised, or over age 85.
Until adequate research is done, we will not know just how effective these vaccines are for our most vulnerable older adults. COVID is also mutating and although so far the current vaccines appear protective against variants, that could change.
So it’s important to keep taking precautions and continuing efforts to reduce COVID exposure, such as masks, physical distancing, and avoiding indoor gatherings.
You can find the CDC latest recommendations for fully vaccinated people here: CDC: When You’ve Been Fully Vaccinated
We can also protect nursing home residents and other vulnerable older adults by encouraging all younger adults around them to accept vaccination.
Please take care, stay safe, and I hope you’ll get vaccinated once it’s available to you!
Resources:
- FDA (Food & Drug Administration):
- COVID-19 Vaccines
- FDA: Emergency Use Authorization for Vaccines Explained
- FDA Briefing Document: Pfizer-BioNTech COVID-19 Vaccine (Dec 10, 2020)
- FDA Briefing Document: Moderna COVID-19 Vaccine (Dec 17, 2020)
- FDA Briefing Document: Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19. (Feb 26, 2021)
- CDC:
- How CDC Is Making COVID-19 Vaccine Recommendations
- Frequently Asked Questions about COVID-19 Vaccination
- Provisional COVID-19 Death Counts by Sex, Age, and State
- New Variants of the Virus that Causes COVID-19
- CDC Advisory Committee on Immunization Practices: COVID-19 vaccine safety update (January 27, 2021)
- First Month of COVID-19 Vaccine Safety Monitoring — United States, December 14, 2020–January 13, 2021
- COVID-19 Case Surveillance Public Use Data
- Nursing Home Covid-19 Data Dashboard
- Suspected Recurrent SARS-CoV-2 Infections Among Residents of a Skilled Nursing Facility During a Second COVID-19 Outbreak
- Risk for COVID-19 Infection, Hospitalization, and Death By Age Group
- CDC: When You’ve Been Fully Vaccinated
- New England Journal of Medicine:
- Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine (12/10/20 publication of the Pfizer vaccine phase 2/3 trial data)
- Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine (12/30/20 publication of the Moderna vaccine phase 3 trial data)
- BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting (Pfizer vaccine in Israel)
- New SARS-CoV-2 Variants — Clinical, Public Health, and Vaccine Implications
- New York Times:
- Washington Post: How does the Johnson & Johnson vaccine work? When is it available? What to know about the new shot.
- MedPageToday “Track the Vax” Podcast Interview transcript: Why Aren’t Highest-Risk People Better Represented in COVID Vaccine Trials?
- Uptodate.com COVID-19 Resources & Tools (Coronavirus Resources)
- Coronavirus disease 2019 (COVID-19): Vaccines to prevent SARS-CoV-2 infection
This article was first published on Dec 18, 2020, and was last updated by Dr. Kernisan on March 26, 2021.
What about people who have had covid and are now well?
That’s a good question that is touched on on the CDC FAQ page about the vaccine, here https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
Right now, it’s not clear how long natural immunity will last after having coronavirus infection, so there is no clear recommendation about whether those individuals need a vaccination yet. I hope we have more information soon.
What is your commentary on the debate from Dr. Wolfgang Wodarg and Dr. Michael Yeadon about how the vaccine can cause permanent infertility?
I haven’t delved into this debate in detail, but there is definitely a lot of discussion about vaccine safety. The consensus from leading experts in health is that the vaccine is safe and is an important part of promoting public health during the pandemic.
Thanks, Dr. Leslie. An excellent summary I’ve not seen anywhere else.
Thanks for reading!
do covid + people who get ccp automatically become negative? are they retested after infusions?
I’m not sure what you mean by “CCP”, so I’m sorry if I can’t answer your question in more detail.
Whether or not a person with COVID is retested when they are no longer showing symptoms depends on the person’s other health issues and lifestyle (for example, do they need to go back to work in a healthcare setting or to care for a person at high risk? are they severely immunocompromised?). Here’s what the CDC has to say about when to stop isolating: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html
Thank you Dr. Kernisan. Very Helpful! I agree with you, that there needs to be much more done to study these vaccines in older adults.
I also agree, that it is the staff of long term care facilities and family caregivers who really need to be vaccinated, since this is who has been exposing most seniors, especially those in congregate care, where visitors have been severely restricted since mid March.
It would have been so helpful if the researchers had recruited participants living in congregate senior communities, such as Independent and Assisted Living facilities, since those residents are all over the age of 65. I am sure that many would have willingly participated in the research trials, had they been asked.
Relieved, there are vaccines being rapidly developed and deployed, (Michigan is now being shorted 24,000 doses of the Pfizer vaccine, why?), but saddened that we may not know for quite sometime, if they are actually “effective” in a larger senior population.
Sad, since restrictions on family visitors to long term care facilities, and extended family gatherings will most likely continue for months and months more, until the general public can get vaccinated…prolonging the severe isolation seniors have been enduring.
When it is available, I will sign off for my soon to be 85 yrs old mom, to get the vaccine despite already having had Covid-19. Although she survived Covid-19, she is forever changed by the lasting/permanent effects of the virus, the effects of severe isolation imposed by restrictions to family visitors and group meals/activities at her Assisted Living facility…or both!
Many seniors have survived having Covid-19, but we haven’t even begun to process the lasting effects they may be dealing with afterward. I know seniors aren’t alone in being “long haulers”, but it’s my hunch that they are disproportionately effected.
Thank you so much for sharing your thoughts about the vaccine. You highlight the challenges and limitations of testing a new vaccine very well in your comment.
I also appreciate you sharing how hard the pandemic restrictions have been for your family. That echoes what I’m hearing from many patients and families right now. There will definitely be a reckoning when all of this has passed, and it has prompted us to take a long, hard look at how we treat our elders in society. I know there is a lot of research going on in this area right now and I’m looking forward to learning more.
Thanks again for your comment and for reading the article!
Apparently the vaccine does not prevent people from catching the virus. Instead, the vaccine stimulates the immune response to the virus, so that when the person does catch the virus, their symptoms will be less severe, or they may even have no symptoms at all, but still be capable of transmitting the virus.
My mother and all 10 other people in her secured memory care building caught the virus in June.
Science now says that a second infection is extremely unlikely. There have been about 20 recorded cases of a true second infection, among the tens of millions around the world who have already survived the virus.
Given these facts, why should my mother and the other residents in her building receive the vaccine? It certainly doesn’t seem medically necessary, especially since they all already survived the virus.
thanks!
You are correct that a person who’s been vaccinated could still get COVID, and could potentially transmit it, although would do so at a much lower rate than a non-vaccinated person with COVID exposure. That’s part of the reason we need to remain vigilant with other infection control measures like handwashing and social distancing.
The question about vaccination in someone who has had COVID is touched on on the CDC FAQ page about the vaccine, here https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
Right now, it’s not clear how long natural immunity will last after having coronavirus infection, so there is no clear recommendation about whether those individuals need a vaccination yet. I hope we have more information soon.
I wish that those of us who are over the age of 80 would not have to wait until all the essential workers are vaccinated. But it appears that reopening the economy is more important than saving lives.
I understand your concerns about having to wait to be vaccinated. It’s such an unprecedented situation with vaccine supply being limited and need being universal, and it’s hard to imagine that there wouldn’t be some delay in getting everyone vaccinated.
Here in Canada, those who live and work in long-term care will be first, followed by those over 80, those over 70, healthcare workers and persons in Indigenous communities. Next will be other health workers and essential workers.
There may be a great deal of regional variation in vaccine prioritization, so I would check with your local public health unit for more information.
Thank you for such excellent information!
I am 73 years old and have been diagnosed with ME/CFS. At this point my varies from moderate to moderate/severe. Is it okay to proceed with the vaccine when it becomes available to me? (Most doctors here know very little about ME/CFS, so can’t discuss with them.
I’m so glad that you enjoyed the article!
A person with a diagnosis of ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) is still eligible for a COVID vaccine, unless they have an allergy to the vaccine components.
Having said that, many of the symptoms of ME/CFS can be mistaken for vaccine side effects, and I would be careful about that if possible. That is, if there’s a symptom after the first dose of the vaccine, I would carefully consider if it is related to the vaccine or to the ME/CFS, and not avoid the second dose of the vaccine which is necessary for immunity to develop.
Thanks for reply to this question and acknowledging ME/CFS. I have something like that (definitely, fibromyalgia, along with arthritis). I had both Pfizer vaccines by the last day of February, and have been sick ever since (ie., for about 2 weeks, now). It’s as though all my other symptoms have been magnified, viz. migraines, fatigue and joint pain. Perhaps all this is separate, but I have no way of telling. I am hoping this doesn’t last much longer. Are there any reports of Covid vaccine side effects lasting 2 weeks or longer in those who are already ill with other things? And how does one tell whether it’s an illness flareup, or an extended vaccine effect? Thanks.
BTW, I’m 71 and female. I should have added that to the other comment.
I’m sorry to hear you’re not feeling well, Linette. I’m so glad you got the vaccine, though and I’m encouraging everyone to do the same.
Most vaccine side effects resolve within a few days at most, but a small percentage of people will have them for weeks or longer. If you’re not sure if it’s vaccine-related or a flare that needs attention, I’d talk it over with your primary care provider if you can. In the meantime, listen to your body and rest if you need to, try to get some light exercise outdoors and stay hydrated. Hope you feel better soon.
What is your opinion now that we have some information about the frail seniors passing in Norway after their Pfizer booster?
I don’t have all of the details about this story, but from what I’ve read, it sounds like this could have been a coincidence that these frail individuals, who resided in nursing homes, passed away after getting immunized (and I believe it was after their first shot). Right now, there’s no indication that we’re being told to not offer the vaccine to frail adults.
What about taking tylenol before or after the Covid vaccination? I understand that anti-inflammatory medications (NSAIDs) should not be taken before, because they may blunt the effects. But what about non-anti-inflammatory drugs, such as acetaminophen?
The recommendations that I’ve read suggest that acetaminophen is reasonable to take, but most are recommending the avoidance of ibuprofen.
Your thoughtful analysis of how much we can rely on the test results from the Pfizer data is extremely helpful in putting things into context. Thank you.
Now that the Moderna vaccine is out, what do we know about it’s efficacy in older adults? The headline is that the test results show it’s only 86% effective in those over 65. But your analysis shows how difficult it is to actually get statistically significant results given the size of the test groups.
Can you please analyze the Moderna results the same way you’ve analyzed the Pfizer data?
Thanks for your comments and I’m glad the article was helpful. Based on my quick review, it looks like the Moderna vaccine, also an mRNA vaccine had a similar
lack of older adults in its trials. But their report on a small group of about 40 individuals over the age of 56 seemed to have immune responses similar to younger adults so that bodes well. It will probably be about the same as the Pfizer vaccine. Let’s all just get one when we can!
My mom is 99 years old. She has COPD, congestive heart failure, Asthma and diabetes. We have questions about whether she should get the vaccine. In light of these underlying conditions and her age what are the risks in her receiving the vaccine.
It sounds like your mother is living with some chronic illnesses and she is fairly advanced in age, even by a Geriatrician’s standards!
Based on what I’ve read, unless a person like your mom is acutely ill, or if any of those underlying conditions are unstable, it should be safe to go ahead with vaccination. You can look at the CDC recommendations here: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Appendix-A It’s a good idea to talk about vaccination with her doctor if you still have concerns.
I had an anaphylaxis reaction years ago with non-ionic iodine injected for a radiological test. As you probably know, non-ionic is supposed to be very safe, only containing 5% iodine, yet my reaction was rather severe. Does this qualify for concern with the new CDC guidelines? It doesn’t seem like a reason to avoid the vaccination but I wondered your thoughts? Thanks.
From what I have read, neither of the currently available vaccines contain iodine, and you can read the ingredients list, here: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Appendix-B.
If you’re worried, though, I would have a conversation with your doctor before being immunized.
Thank you!
Well written. Great summary. Thank you.
I’m so glad you found the article to be helpful! Stay well!
Thank you for this summary, it was very helpful. Do you believe I should get the Pfizer or Moderna vaccine for my 87 and 88 years old Dad based the information that we have so far. I have heard that the Moderna say offer more efficacy after just one dose of the Pfizer vaccine. I want the best efficacy is the long run, but also would like to get them some protection between the doses at this point?
I’m glad you’re getting informed about the vaccine and plan to get your dad immunized.
Well, I don’t know if we will ever be in a position to choose which vaccine we prefer, given the current challenges with vaccine supply, but the evidence we have is that there is not a major difference between these two compounds. It takes 2 shots for full efficacy and I would encourage everyone to continue to use good infection control practices even after the first and second shot.
I’m 52 yrs old and in good health when will I be able to get my vaccine?
I’m glad you’re anxious to get the vaccine but I’m afraid I don’t have any answers about vaccine timing. A lot depends on your location and vaccine supply. This website has information for your state: https://www.dshs.state.tx.us/coronavirus/immunize/vaccine-hubs.aspx
Great article.
My father is 97, lives at home, and had his first Moderna vaccine a month ago. He is scheduled to get his second shot this Friday, but our other sibling says he should not get it because she is panicking he will get so weak and die from the second vaccine. He did fine with the first vaccine with no reactions or side effects.
Our questions are: How safe is the second Moderna vaccine for a relatively healthy 97 year-old,and will it make him so weak, he won’t even be able to walk?
What data do you have on the second Moderna shot for people in their 90’s? Has anyone this age group not in a nursing home had severe after effects?
How long will the first vaccine be effective to protect him? How long can we wait to get a second vaccine if she refuses to take him To get it?
Thank you
Hi Kathy, those are all reasonable questions about the vaccine. We have very limited data on how the Moderna (or Pfizer) vaccine works in adults over age 90, and unfortunately, that’s not likely to change in the short term.
I can tell you that from what I have seen on the CDC and Health Canada websites, most reactions (whether local or systemic) are happening in those under 65. In those over 65, milder adverse reactions are common, and less than one tenth of one percent of those vaccinated got ill enough after the second vaccine dose to seek help in a hospital or emergency room.
Having said that, it appears that about 70% of individuals got some kind of reactions, such as fever, chills, body aches, fatigue or nausea (compared to 30% of those in the placebo group).
As far as I know, one dose of COVID-19 vaccine is not enough to confer any protection. Current recommendations are that the second dose should be given within 42 days of the first, and that immunity might occur about 2 weeks after that second dose.
Many are asking me whether the vaccine id right for their older relative, and in general, the only reason to not vaccinate is if the person has had an anaphylactic (severely allergic) reaction to a vaccine in the past. If a family member is worried about how their relative will be able to tolerate the vaccine, I would suggest they talk to their doctor or primary care provider about it.
I completely agree with Dr. Didyk’s comments above. There is basically no published data on vaccine efficacy or side-effect on 97 year olds who are outside the long-term care system, as your father is.
The CDC is collecting COVID vaccine safety data through vsafe.cdc.gov (an optional smartphone-based program) and also their usual vaccine surveillance systems, but I don’t believe that data is easily accessible to the public.
We also don’t know how much protection is conferred by a single Moderna dose in someone your father’s age. There is some evidence suggesting that a single dose of Pfizer or Moderna provides some protection from COVID, but no one knows for how long, and most of that evidence is in people much younger than your father.
We do know how vaccines work in general: they need to stimulate the immune system, and the immune system ages and gets harder to stimulate as people get older. So for the influenza vaccine, we have developed “stronger” vaccines for older adults: they either have more antigen, or include an extra substance (an “adjuvant”) meant to goose the immune system.
Because of what we know about vaccines in older adults, I think that the older people get, the more likely it is that they really need that second dose, to get whatever protection is possible from the vaccine. Multi-dose vaccines in general work under the premise that you get better (meaning stronger and/or more durable immunity) when you give the immune system more than one exposure to the antigen.
With millions of people getting vaccinated, there will surely be someone somewhere in their late 90s who has a reaction or health crisis after their second vaccination. It will be hard to say whether it’s likely due to the vaccine or just random (very old people are prone to health crises in general).
I would reassure your sister that because of your father’s age and the fact that he did fine after the first vaccine dose, it’s very unlikely that the second Moderna dose would cause a serious health crisis in him. He is overall at higher risk of harm from COVID. So I hope he’ll get his second dose…even if the vaccine is only 50% effective in him rather than 95%, that’s much better than not being vaccinated at all.
Oh and, no one knows how long he can wait…it has not been studied…and of course no one knows yet just what is happening in the immune systems of 97 year olds in regards to this vaccine.
Sorry we don’t have better answers for you! We are all in uncharted waters, especially when it comes to people 85+.
This relates to my questions. I have a 97 year old healthy mother who lives by herself in her own home. Takes no medicines. Exercises daily. The challenge is we are in Texas which is hell bent on opening up March 10th even though we are 48th out of 50 states in terms of vaccination rate. Right now, it’s just about impossible to get her an appointment, has been for two months, and it anytime appointments become available, thousands (ten times the number of available appointments) jump in line and they never tell you the time the appointments go live beforehand. On top of that there is a fight in the family between those who want her to get it pronto and those who don’t want her to get it (yes, basically we have some in the family that believe the conspiracy theories and think the vaccine is unsafe and will kill her, they have heard stories from their “doctor” that two unrelated otherwise healthy 90+ year old mothers of his patients had heart attacks and died within days of getting the first shot. I have to wonder why that medical professional is spreading stories he has heard from his other patients, but it certainly is causing conflict in our family). So given the sketchiness of the data for those over 90. Given she can isolate in her home, and wear masks on once a week grocery shopping and that the local store has promised to still require masks. How hard to push to try to find a vaccine appointment? Is it irresponsible to take a wait and see attitude, look for more data to come in ? She decided to stop driving herself this past year, so there is logistics problems as any of these appointments are more than 30-40 miles away and someone will need to drive her, most likely me and I live hours away, not in the same city.
Hi Gary and thanks for sharing your story which I am sure is a common one! Even after vaccination, I think it’s a good idea to use precautions like mask wearing, handwashing and avoiding crowds until this pandemic is truly over. I wish it were easier to get a vaccine in your area and I understand your frustration. I would make a reasonable effort to get an appointment and I hope they get easier to obtain as more people have their dose. I don’t think we need more data to tell us that the vaccines we have available will provide some protection, even in those over 90, but every family has to make a decision about how much risk is worth the benefit.
My uncle is 95. We were banned from their house (my cousin is a doctor) up until he got the vaccine. Believe it or not, someone was with him when he got his second dose. We all felt he was going to get one or all the symptoms the second dose brings. WRONG!!!, he was well all the time…He had none of the symptoms all of us have. Is this an everyday fact? I am a MPH and believes there should be more studies regarding this fact…
I agree that we would benefit from more studies, Maria-Luisa! You can watch my video about that here:https://youtu.be/2G5LZDYiiCs It does seem that, in general, older adults have fewer vaccine side effects from the COVID shots than younger ones. This may be related to the dampened response of the aging immune system, but doesn’t necessarily mean that the vaccine will not be effective. I’m so glad your uncle got his immunization!
Hello Patti and I completely understand how you’re feeling. We’ve been making sacrifices for the sake of our health for over a year and it’s frightening to think about what happens now. Not having side effects after a vaccine doesn’t necessarily mean it’s not working, and I don’t recommend an antibody test (see my answer to previous comments).
Vaccines reduce our risk of getting very ill with COVID, but no vaccine is 100% effective. There’s no way to tell how “immune” a person is after getting immunized, but almost certainly, they will be much safer if they happen to get in contact with someone with COVID.
On the other hand, continuing to avoid social contact could have serious health consequences for many. I am advising my patients to be sensible with handwashing, masking in public and staying home if they’re ill, and to move towards a more relaxed way of moving around as they feel comfortable. I hope you get back to seeing your grandchildren very soon!
I just got my first shot of Moderna and am 70 years old. I’m reading that the antibodies drop off for people 65 and older between 50 and 75 percent after 3 months and am now wishing I had waited for a Pfizer vaccine. Will I be able to get booster shots after 3 months? How often will I need them? and can I change vaccines to one that will provide longer efficacy?
Hi Teresa and I’m glad to hear you got your first vaccination. I’m not sure what source you are reading to get those stats about the “antibodies dropping off”, but right now, there is no need for a booster (except for your second shot in about 28 days ). From what I have read about the vaccines, the efficacy is similar, so waiting for a particular brand (Pfizer or Moderna) is not advisable. Right now, it’s not clear that getting 2 different brands of vaccine would be as effective as getting the same one, so I would think that getting a second dose of the Moderna would be the way to go if one has already received the first dose with that brand.
I’m glad you got your vaccine and I would encourage you to keep up your good infection control practices and get that second shot when you can!
Terrific article, best I’ve seen out there on possible studies for advanced aged. We are in Dallas, still unsure whether it’s in best interest of a homebound and home-based 95 year old mother with heart issues and on max. blood pressure meds—to receive vaccine. thanks thanks for any additional info you might receive since Jan 2021—–concerning frail, heart issues, over 90 year olds. thanks thanks
Thanks for your kind comment and I hope you’re safe and well in Dallas. I am fielding a lot of questions about COVID vaccine safety for older adults, and you can hear what I surmised from the data we have so far in this video.
Officially, there’s no absolute reason to avoid the vaccine unless a person has had a severe allergic reaction to a an immunization in the past, and frail older individuals seem to be at higher risk for complications of COVID compared to younger adults. So it’s a balance between the risk of a vaccine versus the risk of getting ill with COVID. IT also seems that older adults have milder or fewer side effects after vaccination compared to younger folks. I’m tending to lean towards vaccination for my frail patients in almost all cases.
I understand being worried and I am advising individuals in your situation to have a chat with their PCP to help make this tough decision.
I agree that this article was extremely informative which has now stimulated more questions. What’s being shared on the news is the overall efficacy of the vaccines, not what was discussed in this article. As a result, people who do receive the vaccine feel they are fully protected and are totally unaware they may have minimal or reduced protection if they are older. The CDC just issued initial guidelines for vaccinated people. Should the older population follow these guidelines given the lack of knowledge surrounding the actual efficacy of this group? My parents are 99 and 105 and have received both doses of Moderna and did well with the vaccine (my Dad was tired the second day). They live in a senior community with my brother who is their caregiver. I’m around them 4 days a week. We’ve been keeping them isolated in their apartment except when they are at my home twice a week. We have not had them around their grandchildren (late thirties) and their great-grandchildren (8 and under). Do we continue with what we are doing or should we feel more comfortable having them around the rest of the family? Should they wear masks or follow the new CDC guidelines that they may see families at low risk for severe infection indoors without a mask? Can we sit outside at a restaurant not knowing who may be at the next table? Since I am around my parents, should I feel comfortable seeing vaccinated friends and my family indoors following the new CDC guidelines or should I continue doing what I’ve been doing for another couple of months? Do we wait to see how the new variants affect our numbers and the spread of the virus? (My husband, 78, and I, 71, have both been vaccinated.) Part of me wonders if the new CDC guidelines are to just to give people reasons to get vaccinated. If there are no “benefits” to getting vaccinated (ie seeing family and socializing again), why get vaccinated? Are these guidelines truly safe and reasonable especially for the elderly population? Any feedback would be greatly appreciated. Thank you.
Those are all great questions and I’m not sure we have all the answers. There’s no question that the vaccine will confer some immunity from contracting COVID, even in the very elderly, and will also reduce the risk of getting extremely ill even if a COVID infection happens, so I think it’s reasonable to relax some of the physical distancing we’ve all been practicing.
Nothing will reduce the risk to zero, and every decision involves some trade offs and compromises. If you’re able to ask your parents what they prefer, then follow their lead. They may be willing to accept some (reduced, now that they’re vaccinated) risk in order to return to a more family-filled lifestyle.
I am 75 and have had the two doses of the Moderna vaccine. Four weeks after the second dose, I had an antibody test, and it was negative. I am a blood cancer patient on a clinical trial of a bispecific antibody drug and reached remission recently. Like most blood cancer patients, I have somewhat suppressed immune response, but it is not drastic, and I am not neutropenic. Are the results of the antibody test reliable? Is there any additional step I should take? Meanwhile, I am following all recommended precautions, but I fear I will never see my grandchildren again since they live 3000 miles away.
I’m so glad you had your vaccine.
Antibody tests may not be useful in determining if your vaccine has been effective. Even in those who’ve had COVID, an antibody test may be falsely negative if it’s done before or after the antibody levels have risen. Also, remember that your immune system has other responses than just forming antibodies, that an antibody test won’t reveal.
I wouldn’t wait for a positive antibody test result before doing the activities that you planned to do when you were “immune”, but I would continue to use sensible precautions when you’re out and about. I hope you get to see your grandchildren soon.
Many, many thanks for this great information. Do you think it is, or will be, possible to be tested post-Moderna-vaccinations to see how my immune system has responded?
I had no reaction at all, other than slightly sore arm, to either 1st or 2nd vaccine. My PCP assures me that each immune system is different and that my lack of reaction does not mean my immune response is low. I wish I were a scientist so I could understand that!
I’ve read, for example, of a home-test product being developed at Univ of Alabama and now at spin-off co. P3 Diagnostics which says “…rather than using widely available antigens to capture antibodies, [we] map exactly where a patient’s antibodies bind to COVID19.”
Thank you so much for your attention.
I don’t think antibody tests (which can cost around $USD 300-600) are very useful in determining if your vaccine has been effective. This article reviews the factors that affect how reliable a test is, given how much COVID is in the population at a given time: https://www.cell.com/trends/microbiology/fulltext/S0966-842X(20)30280-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0966842X20302808%3Fshowall%3Dtrue
Even in those who’ve had COVID, an antibody test may be falsely negative if it’s done before or after the antibody levels have risen. Also, remember that your immune system has other responses than just forming antibodies, that an antibody test won’t reveal.
I’m glad you got your vaccine, and it’s a great step to take to stay well.
Excellent and timely article, most informative summary I’ve read anywhere and I greatly appreciate Dr Kernisan taking the time and making the effort to research and publish it. For those wondering about 2nd dose effects, my wife and I, both 71, got the Moderna and Pfizer vaccinations. After the second, we both experienced low grade fever (99-100.4) late that night, with chills, shakes, aches, took two extra strength tylenol, and the next day were both tired, lethargic, dragging, etc., just a little tired the third day and completely ok that night. The article reinforces our decision to continue to wear masks when out in public, avoid crowded venues, especially indoors, limit proximity and duration of contact with others unless we know their social behavior.
Thank you for sharing you and your wife’s experiences with the COVID vaccines, and I’m so glad that you got your shots! I completely agree with your decision to continue to use sensible precautions when out of the house, and I’m glad you found the article helpful. Please share it, and check out my take on vaccines, here: https://youtu.be/Q6e9hPcG_6Q
Hello, this is a big concern for many of us who have received two vaccines of either the Moderna or Pfizer and experienced no side effects at all. I’ve read every review I possibly can get my hands on here, with no answers. Some of my age group (around 70 y/o) had reactions but most of us did not. This is perplexing. We worry. Should we now feel safe to go to the grocery store? See our children, grandchildren? Are we no better off than we were prior to the vaccine OR do you just not know our exact situation if we had no reaction to the vaccine? This is something that should be made very clear so we can proceed correctly. Should we go back into our homes and not venture out? Is that best? This is information we need and want. For all intent and purpose it appears if you did not have a reaction to the vaccine, your body did not recognize it. Old immune systems; sad, but we need the truth. We want to be here next year.
Can we be tested to see if we now have adequate antibodies?
Respectfully,
Patti
Hii !!
I wanna know that is it safe to have vaccine in age of 40 yrs old
Hello. The information we currently have is that the COVID vaccines available in the US and Canada are safe for everyone, unless a person has a history of a serious allergic reaction to a vaccine in the past. Millions of vaccines have been administered worldwide and it appears that they are safe and effective. You can learn more here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html
Thank for this informative article on Covid vaccinations in older people. Do you know of any research about side effects of mental fog and extreme memory loss in people over 90 after the first Moderna shot. My father in law has dementia since several years but since his first shot yesterday he is not sleeping, agitated and keeps on saying he does not understand anything?! Just curious if you have heard about this kind if side effect.
I haven’t seen this in my patients or heard about it in the scientific studies and media that I follow, but that doesn’t mean it couldn’t be a side effect. Common side effects include fatigue and headache, so it could be that he’s having typical side effects but responding to them in an atypical way.
It could also be a coincidence, or due to something else, so if it persists or gets worse, I would advise someone in your situation to seek medical advice.
Thanks you Dr. Kernisan for all this information. I had seen the studies on Pfizer and Moderna vaccines but watching your slides made it much easier to read the statistics. I have had my first shot of Moderna and only felt a sore arm after I slept on it that night. I will be 70 years old next month. I too am concerned over the large range in protection for my age group. It looks like I could only have protection of 61% after the first shot which really worries me because in Canada they have decided to extend the second dose for up to 4 months later. Even though I am not in the Health field nor mathematical field I have estimated that my protection after the second shot of Moderna would only be about 78%. For Pfizer, after the second shot it would be maybe 83.5%. That’s not ideal and I really want to be able to go back to the carefree life we use to have. It is also scary that people are being given a false sense of hope that they will be 96% protected. It’s a bit of a relief to hear you say that the stats don’t mean you have less protection. Instead, it’s because of very few people got covid in that age group. I live alone and it has been very hard to live in this isolation. I hope more studies are done on people over the age of 65 and they find out we are more protected than first estimated. It’s hard to wait for these studies to be done. Thank you again. You have provided the best information I have come across on this pandemic.
Hi Sue and I’m so glad you got your first shot. I’m glad that the article was helpful in making sense of the numbers, and I agree with you that there should be more older adults in these vaccine studies.
I hope that being vaccinated doesn’t lead folks to become complacent and stop handwashing and staying home if they’re sick. along with other infection control measures. But, the more vaccines we get in arms, the closer we’ll get to herd immunity, which will be a great thing!
I have a few videos about COVID on my YouTube channel, if you’re interested. Stay well and take good care.
Hello, Dr. Didyk,
Thanks very much for the informative article. I am a 73 y.o. female and I am scheduled to get my second Moderna vaccine in two days. This will be 12 weeks after my first shot, and I am wondering how the length of time between doses will affect the possibility of side effects after this second dose. After the first dose, I only had a sore arm and very slight fatigue. Thank you.
Congratulations on getting your vaccine!
In the studies of Moderna, the interval between the two doses was 28 days, and there did seem to be more side effects after the 2nd dose. I’m not sure if a longer interval between doses will reduce the chance of getting adverse side effects, but it may. Remember, even if you don’t get side effects, it doesn’t mean the vaccine isn’t working.
Good luck and thanks for getting immunized!