Who Should—and Shouldn’t—Get an mRNA COVID-19 Vaccine?

Who Should—and Shouldn’t—Get an mRNA COVID-19 Vaccine?

You might be surprised to learn exactly how few people fit in the shouldn’t category. We break down the current immunization recommendations for kids, pregnant women, and people who have allergies or an underlying condition

COVID-19 Vaccine

After a grueling year of pandemic living, many Americans are allowing themselves to feel hopeful as the government rolls out the Moderna, Pfizer/BioNTech, and Johnson & Johnson vaccines to the general public. The shots were deemed safe and effective after more than 100,000 adults participated in the phase 3 clinical trials. Although researchers worked to ensure that the trials were racially diverse and represented a range of ages, some groups weren’t part of the studies. People who were knowingly pregnant, for example, were excluded. And only about 300 people with HIV were included. So, if you happen to be immunocompromised, or if you have a history of allergic reactions, you may very wisely be wondering if the new COVID-19 vaccines are safe for you.

The overwhelming expert opinion? Almost everyone who’s eligible to get the shot should do so. “Every 30 seconds, somebody dies from COVID,” says Erin Reigh, M.D., an allergist at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H. “We cannot completely predict who will have severe complications from COVID-19,” she adds. “One of the best ways to deal with this disease is to avoid getting it, so take the vaccine if it’s offered to you.”

If you’re hesitating because the vaccines were developed so quickly, rest assured that the new shots are based on solid science that’s been in the works for decades, experts say. “Just because they managed to get the vaccine to market quickly doesn’t mean it’s not safe,” says John Segreti, M.D., an infectious disease specialist at Rush University Medical Center in Chicago. “They’ve gone through the same rigorous trials as other vaccines. I’m very comfortable with their safety and efficacy.”

But having questions is totally normal, so we asked experts to share some specific recommendations for different groups. Check out the advice below, and as always, speak to your doctor about what’s best for you.

Want to learn more about who is eligible or find where to schedule an appointment?

Visit HEALTHY.ARKANSAS.GOV
or call the Arkansas Department of Health at 1-800-803-7847.

Children
There aren’t any completed clinical trials on children yet, so right now the government is only recommending the Pfizer/BioNTech vaccine for individuals ages 16 and up, and the Moderna and Johnson & Johnson vaccine for ages 18 and older.

But that will change soon. Moderna has started a vaccine trial with 3,000 participants ages 12 to 17, with data available (they hope) by spring. And Pfizer/BioNTech already has safety data on about 100 children ages 12 through 15. Once we have more clinical data on how the vaccine works for adolescents, trials will begin for younger children.

Experts think we might have a vaccine for kids by the end of 2021, but it’s unclear if it will be ready in time for the new school year.

People With Severe Allergies
If you have a history of severe allergic reactions (meaning you’ve had to use an EpiPen or go to the hospital), news stories about allergic reactions to the vaccine might have you spooked. Bring up any concerns you have with your physician, but according to Centers for Disease Control and Prevention (CDC), people who have had severe allergic reactions to things that are not vaccines, like foods or latex, can still get a COVID-19 shot.

And if you have a history of severe reactions following injections in particular? “Talk to your doctor about it first,” Dr. Segreti advises. “But unless you have a [known] allergy to any components in the vaccine, there’s no reason why you shouldn’t take it.”

You’ll be monitored for at least 30 minutes after you get the shot, and in the rare, rare case that you experience a negative physical reaction, medical professionals will be on hand to help. “At my hospital, we had already immunized about 8,500 people [by January], with only three reports of mild reactions and no incidents of anaphylaxis,” Dr. Segreti says. Nationwide, between December 14–23, only 21 cases of anaphylaxis had occurred among nearly 1.9 million administered doses of the Pfizer/BioNTech vaccine—that translates to 0.0011%. None of those people died.

The only people with a history of severe allergic reactions that the CDC says should definitely not get the COVID-19 vaccine? Anyone who had a severe allergic reaction to the first dose.

People Who Are Immunocompromised or Have an Underlying Health Condition
If you have cancer, a heart condition, type 2 diabetes, chronic kidney disease, or any other chronic health condition, you might feel a bit on edge about taking a brand-new vaccine. But experts say that it’s one of the most critical things you can do to ensure your safety. That’s because those with underlying health conditions are far more likely to get very sick and be hospitalized if they get the COVID-19 virus.

In fact, having an underlying health condition may help move you to the front of the vaccine line. A group of Vanderbilt University Medical Center researchers recommended that people with diabetes be given priority in the vaccine queue. And in the journal Cancer Discovery, researchers noted that people with cancer “should be considered among the very high-risk groups for priority COVID-19 vaccination.”

Remember, these vaccines don’t contain the live virus, and you can’t get COVID-19 from the shot, Dr. Segreti says. However, there is a chance that immunocompromised people may not respond as robustly to the vaccine as others simply because their immune systems aren’t working at full capacity to begin with.

“Still, even if they’re less effective, it’s better than zero,” says Dr. Segreti. “For people in active cancer therapy, those with an advanced HIV infection, or those who have had a recent bone marrow transplant, my recommendation would be to get the vaccine.”

Pregnant and Nursing Women
Moderna and Pfizer/BioNTech, and Johnson & Johnson haven’t done studies on pregnant women yet. But the CDC does note that “experts believe that mRNA vaccines are unlikely to pose a risk to the pregnant person or the fetus because mRNA vaccines are not live vaccines.” The World Health Organization (WHO), in a statement published January 26th, recommended the shot for pregnant people at high risk of exposure to the coronavirus or who have underlying health conditions that would make it more likely they'd get very sick if infected. (This is a change from guidance the WHO published just a few days earlier.)

Expecting women should weigh the risks and benefits of getting the vaccine, making the choice that’s best for them based on factors like how fast COVID-19 is spreading locally and their personal risk of contracting it. For instance, pregnant women who are health care professionals or other frontline workers may make a different decision than someone who is able to work to from home. Keep in mind that getting COVID-19 while pregnant can result in considerable complications. Research has shown that women who get COVID-19 during pregnancy are about twice as likely to end up in the ICU and be put on a ventilator as COVID patients who aren’t pregnant.

What about women who are nursing? Here’s what the American College of Obstetricians and Gynecologists says: “ACOG recommends COVID-19 vaccines be offered to lactating individuals similar to non-lactating individuals,” they wrote in a statement published in December. Although there isn’t extensive clinical data looking at COVID-19 vaccination in women who are nursing, ACOG notes that “theoretical concerns regarding the safety of vaccinating lactating individuals do not outweigh the potential benefits of receiving the vaccine.”

Dr. Segreti agrees: “There’s no evidence that the vaccine causes any problems for nursing mothers or their babies,” he says. And similarly, the CDC also released a statement saying that “mRNA vaccines are not thought to be a risk to the breastfeeding infant.”


The information in this story is accurate as of press time and posting. To limit the spread of the coronavirus, it’s important to continue practicing social distancing (keeping at least 6 feet away from people outside your household) and washing your hands frequently. You should also be appropriately masked per CDC guidelines. Because the situation surrounding COVID-19 continues to evolve, we encourage readers to follow the news and recommendations for their own communities by using the resources from the CDCWHO, and their local public health department.