Despite the widespread availability of COVID-19 vaccines and easy access, the U.S. has fallen behind 40 other countries in getting its people fully vaccinated in a pandemic that is still raging.
About 55% of Americans have gotten at least two doses of the Pfizer or Moderna vaccines or a single shot of the Johnson & Johnson vaccine, according to Johns Hopkins University’s Coronavirus Resource Center. That compares with top-ranked Malta, which has fully vaccinated 83% of its population. Our Canadian neighbors have a 70% vaccination rate. China is at 72%. The UK is at 66%.
And though the pace of vaccinations rose slightly in August, it has trended downward the last two weeks.
Editorial: An appeal to vaccinated Free Press readers
At this rate, “by the end of September, the U.S. will have the lowest vaccination level of all prosperous democracies, With the largest supply & the biggest head start,” Andy Slavitt, who stepped down in June as senior adviser to the White House pandemic response team, said in a tweet last week.
Michigan’s vaccination rate lags behind the national average, with 51.4% of its population now fully vaccinated, CDC data shows.
And that’s despite a supply of coronavirus vaccines that is now abundant. Anyone 12 and older who wants a shot can get a shot. All they have to do is go to a local pharmacy, or text their ZIP code to 438829 or call 800-232-0233.
Don’t have a ride? The government will pay an Uber or Lyft driver to take you there. And in some communities, including Detroit, health care workers will even make a house call to bring the vaccine to you.
What types of COVID-19 vaccines are available in the U.S.?
There are three different coronavirus vaccines widely available today:
Pfizer: Made in partnership with the German-based biotechnology firm BioNTech, this coronavirus vaccine is fully authorized by the U.S. Food & Drug Administration for use in Americans ages 16 and older. Adolescents ages 12-15 also are eligible for the Pfizer vaccine under an FDA emergency use authorization. It is given in a series of two doses, spread three weeks apart. It is being marketed now under the brand name Comirnaty.
Federal regulators have recommended a third dose for people with immune-suppressing conditions. A decision is expected next week on whether Americans ages 65 and older, along with people who are at high risk of severe disease, should also take a third dose.
Moderna: Available under an emergency use authorization for Americans 18 and older, the Massachusetts-based company has applied for full approval from the FDA for its coronavirus vaccine. It is given in a series of two doses, spaced four weeks apart. Federal regulators have recommended a third dose for people with compromised immune systems.
Johnson & Johnson: Available through an FDA emergency use authorization for Americans ages 18 and older, the J&J vaccine, made by its Belgian-based pharmaceutical branch, Janssen Pharmaceuticals, is given in a single dose.
The CDC published a study Friday analyzing the effectiveness of all three vaccines in use in the U.S. from March to August, when the more contagious delta variant was circulating.
It found the Moderna vaccine was 93% effective at preventing hospitalization and death among U.S. adults who were not immunocompromised. Pfizer’s vaccine was 88% effective and J&J’s was 71% effective.
How do the COVID-19 vaccines work?
Both Moderna’s and Pfizer’s COVID-19 vaccines are made with messenger RNA technology. They use a protein that mimics the spike protein of the SARS-CoV-2 virus. It tricks the body into mounting an immune response that will protect a person from the virus.
They do not use the live virus and cannot give a person COVID-19.
The mRNA used to make these vaccines does not affect or interact with a person’s DNA or genetic material. It is quickly broken down by the body and eliminated.
The J&J vaccine is different. It is an adenovirus vector vaccine. It uses a modified cold virus that has been stripped of several of its genes. Those genes are replaced with genetic material from the SARS-CoV-2 virus, which then triggers an immune response to protect a person from the virus.
The Johnson & Johnson vaccine cannot multiply in the body, and it cannot give a person COVID-19. It also does not alter a person’s DNA.
Is the technology used to develop the mRNA vaccines brand new?
No, it’s not new.
The technology has been studied and tested for decades, including in the development of vaccines for flu, Zika, rabies and cytomegalovirus. It’s just that the COVID-19 mRNA vaccines created by Pfizer and Moderna were the first to complete the federal regulatory process and bring an mRNA vaccine to market.
In addition to using mRNA in the production of vaccines, the technology also has been used in cancer research to trigger the immune system to attack cancer cells.
What was the approval process like?
The coronavirus vaccines were created and tested using the same process the FDA and CDC require for every vaccine in use in the U.S. today. They were not experimental.
Here is how it worked:
The pharmaceutical companies first had to apply to the FDA for permission to test new vaccines to fight the novel coronavirus. The FDA evaluated those applications, and was satisfied the ideas and the technology they planned to use met its standards for quality and safety.
Clinical trials began next.
Each company recruited thousands of volunteers for randomized, blinded and controlled trials conducted in a series of phases that expanded at each level to include more people. The trials helped scientists determine whether the vaccines worked, what the side effects were and identified the ideal dose.
Data from the clinical trials was then submitted to the FDA and CDC for review. Federal regulators inspected the vaccine manufacturing facilities to ensure that the companies could produce the vaccines reliably and consistently.
Then, the companies each had to submit a licensing application, asking for permission to distribute and market their vaccines to the public.
The FDA’s Vaccines and Related Biological Products Advisory Committee, made up of an independent panel of expert scientists, reviewed all the data and recommended each vaccine for emergency use authorization. The FDA commissioner signed off on the recommendations.
At that stage, the CDC’s Advisory Committee on Immunization Practices developed recommendations for the use of each of the vaccines, establishing who should get them, the number of doses that should be given and how far apart they should be spaced.
After the CDC committee issued guidelines for the vaccines, the CDC director approved them. They then could be injected into the arms of Americans.
Pfizer was the first to win an emergency use authorization in mid-December 2020. It was soon followed by Moderna and then Johnson & Johnson in late February.
In August, the FDA fully approved the Pfizer vaccine for Americans ages 16 and older. The vaccine remains under emergency use authorization for teens and tweens ages 12-15 and for a third dose for people who are immunocompromised.
An FDA committee recommended Friday that an emergency use authorization be granted for a third dose of the Pfizer vaccine for people six months after the second dose if they are ages 65 and older or are at high risk for severe COVID-19 complications because of underlying health conditions such as obesity or diabetes.
The FDA commissioner, a CDC committee and CDC director must all agree before that emergency use authorization can be granted. Those steps could come as soon as next week.
Moderna also has applied for full authorization of its vaccine, and Johnson & Johnson is expected to apply for full approval soon.
What are the risks?
All three coronavirus vaccines continue to undergo the most intensive safety monitoring of any vaccines in U.S. history. Both the FDA and the CDC say the benefits of being vaccinated far outweigh the risks.
The most commonly reported side effects for all three vaccines are mild and tend to dissipate within one to two days. They include pain, redness and swelling at the injection site, fatigue, headache, muscle or joint pain, chills and fever. There also have rarely been reports of severe allergic reactions.
All three vaccines are considered safe and effective in preventing hospitalization and death from COVID-19, but there have been some safety concerns:
JOHNSON & JOHNSON: In April, the FDA added a safety warning, saying there’s an association with rare reports of thrombosis-thrombocytopenia syndrome following vaccination. The condition causes blood clots combined with low levels of blood platelets that can be life threatening. Those at highest risk for the complication are women ages 18-49.
A warning also was added in July about a small increased risk of developing Guillain–Barré syndrome after taking the vaccine. The rare neurological condition causes the body’s immune system to damage nerve cells, and can lead to muscle weakness and sometimes paralysis.
In August, warnings were added that the vaccine also could trigger tinnitus, or ringing in the ears, diarrhea and vomiting.
PFIZER & MODERNA: In June, the CDC vaccine advisory committee reviewed reports of heart inflammation among teens and young adults after they were immunized with either a Pfizer or Moderna COVID-19 vaccine.
The CDC’s Advisory Committee on Immunization Practices acknowledged there likely is an association with myocarditis and pericarditis among 12- to 39-year-olds following vaccination.
The complication is more likely to occur in boys and young men, and the condition is most likely to appear within the first five days after vaccination. Most who developed the heart complication post-vaccination have made full recoveries.
Anyone can report side effects to the federal government’s Vaccine Adverse Event Reporting System by calling 800-822-7967 or online at vaers.hhs.gov/reportevent.html.
Do the benefits of vaccination outweigh the risks?
Yes. Unvaccinated people are 4.5 times more likely to be infected with coronavirus compared with fully vaccinated people. They also are over 10 times more likely to be hospitalized with COVID-19 and 11 times more likely to die of the disease, said CDC Director Dr. Rochelle Walensky.
The data comes from a new study of case rates, hospitalizations and deaths from the virus among more than 600,000 people in 13 states from April 4-July 17, when the highly contagious delta variant was circulating in the U.S.
The study, Walensky said, “offers further evidence of the power of vaccination.”
While a very tiny percentage of people have had complications from vaccination, 1 in every 500 Americans has died of COVID-19 since the pandemic began. It was the third leading cause of death in the month of August and has now infected more than 41.8 million people and killed more than 668,000 in the United States.
The virus also can cause little understood long-term complications that can be disabling and last four or more weeks after the initial infection. Known as long COVID or post-COVID syndrome, it can affect every major organ system and can include fatigue, pain, brain fog, difficulty breathing, cough or shortness of breath, headache, heart palpitations, dizziness and more.
Scientists know the vaccines work at preventing hospitalization and death from COVID-19. Comparatively, the risk of serious side effects from any of the vaccines is extremely small.
Among 1 million women ages 18-49 who received the J&J vaccine, seven developed blood clots with low platelet count, according to the CDC. The incidence of Guillain-Barré syndrome among Americans 18 and older who got the J&J vaccine is estimated to be about 1.5 in 100,000.
For those who took the Moderna or Pfizer vaccines, cases of serious heart inflammation — myocarditis or pericarditis — have been reported at a rate of 12.6 per million people within 21 days after a second dose of a vaccine, though some cases have also been reported after the first dose as well.
Anaphylaxis, a severe allergic reaction, has occurred in 2 to 5 people per 1 million who get a COVID-19 vaccine in the U.S.
What are the religious objections to the vaccines?
Very few religions are opposed to COVID-19 vaccines as a matter of doctrine.
Traditionally, Christian Scientists have rejected the use of vaccines; most of its members rely on prayer for healing and have sought religious exemptions from vaccine mandates.
However, the church issued a statement on its website, saying that members “are free to make their own choices on all life-decisions, in obedience to the law, including whether or not to vaccinate. These aren’t decisions imposed by their church.”
Some members of the Dutch Reformed Church also oppose vaccines, believing they interfere with God’s will. But that isn’t an absolute, either. Some members also view the vaccines as gifts from God, according to a review of religious objections to vaccines from Vanderbilt University.
Catholics have some objections, too.
In early March, Michigan’s seven Catholic bishops, including Archbishop Allen Vigneron of the Archdiocese of Detroit, called the J&J vaccine “more morally problematic” than the Pfizer and Moderna vaccines.
That’s because J&J “utilized in the design, production, development, and confirmatory testing a cell line that originated from tissue taken from an aborted baby,” and abortion violates Catholic doctrine.
The bishops urged the state’s Catholic faithful to take Pfizer’s or Moderna’s vaccines instead, and to only take the J&J vaccine “if there are no other alternatives.”
Why isn’t natural immunity just as good as a vaccine?
While a person who contracts coronavirus is likely to develop antibodies that should provide some protection from reinfection for at least a little while, it’s unclear how long that protection will last.
The CDC urges everyone, including people who’ve already had COVID-19, to get vaccinated. The federal agency published a study in August that analyzed coronavirus reinfections from May to June among hundreds of fully vaccinated people and unvaccinated people in Kentucky.
It found that those who were unvaccinated were more than twice as likely to be reinfected with the virus than fully vaccinated people were.
“If you have had COVID-19 before, please still get vaccinated,” Walensky, the CDC director, said in a statement. “This study shows you are twice as likely to get infected again if you are unvaccinated. Getting the vaccine is the best way to protect yourself and others around you, especially as the more contagious delta variant spreads around the country.”
If you had the virus and were treated with monoclonal antibodies or convalescent plasma, the CDC recommends waiting 90 days before getting a coronavirus vaccine.
Who should get a booster shot?
For now, federal regulators have not approved COVID-19 vaccine boosters for the majority of Americans.
However, the CDC urges some people to get another shot. Anyone who had a two-dose series of the Moderna or Pfizer vaccines who has a moderately to severely compromised immune system should get a third dose, the CDC advises.
That’s because people who are immunocompromised might not build up the same level of immunity from the vaccines as healthier people.
The recommendation for a booster includes people who:
- Are being treated for tumors or cancers of the blood.
- Received an organ transplant and are taking immune-suppressing medication.
- Received a stem cell transplant in the last two years or are taking medicine to suppress the immune system.
- Have moderate or severe primary immunodeficiency, such as DiGeorge syndrome or Wiskott-Aldrich syndrome.
- Have advanced or untreated HIV infection.
- Are undergoing treatment with high-dose corticosteroids or other drugs that may suppress immune response.
On Friday, the FDA’s Vaccines and Related Biological Products Advisory Committee voted to recommend a third dose of the Pfizer vaccine for Americans ages 65 and older and for people who have other underlying health conditions that put them at high risk for severe complications from COVID-19. Those conditions include diabetes and obesity.
The third dose for that population would fall under an emergency use authorization and would be recommended six months after the second Pfizer dose. FDA officials are also considering whether to include in the recommendation that health care workers and other front-liners who are at high occupational risk of exposure to the virus get a third dose.
But there are still some hurdles it has to jump before that recommendation goes into effect. It first must be approved by the FDA director. It also must be reviewed by the CDC’s Advisory Committee on Immunization Practices, which meets Wednesday.
If the CDC director signs off on the recommendation, a third dose of the Pfizer vaccine could win an emergency use authorization as soon as next week for those 65 and older, people with underlying health conditions, and, potentially, front-line workers.
Federal authorities also are investigating whether people who took the Moderna and Johnson & Johnson vaccines should get another dose, but so far, no recommendations have been made.
What we don’t know
There’s so much scientists are still learning about the SARS-CoV-2 virus, how to treat it and why it seems to cause severe symptoms in some people but not in others.
Because the virus is mutating, every new strain of the virus brings with it new questions and concerns. Some variants, like the delta strain, are more transmissible than others. Scientists worry that as the virus continues to spread, new variants will emerge that could evade the current tests or render the vaccines and treatments ineffective. Such a strain could be deadlier as well.
That’s one of several reasons why doctors and health officials urge as many people as possible to get vaccinated. Immunizing more people will reduce the rate of infection and thereby cut the chances the virus has to mutate.
Because the coronavirus vaccines have been on the market for less than a year, some people who’ve yet to get vaccinated say they are concerned about potential long-term effects.
While there aren’t studies yet showing their safety over a long period of time, the CDC says serious side effects that could cause long-term health problems are extremely unlikely for the COVID-19 vaccines, as they are for any vaccine.
That’s because side effects from any vaccination are most likely to occur within six weeks after getting a shot, the CDC reports.
How can I learn more?
To compare the data about the three COVID-19 vaccines available now in the U.S., and weigh the risks and benefits of getting a shot, go to: https://bit.ly/3zvOYrf.
How can I get a COVID-19 vaccine?
Text your ZIP code to 438829. You’ll receive an immediate response with a list of vaccination sites in your area, a number you can call if you need more help, and information on how you might get a free ride to the location using Uber or Lyft.
Search for vaccine locations by ZIP code: https://www.vaccines.gov/search/.
You an also call 800-232-0233 for information about getting a vaccine.
Tell us what you think
The Detroit Free Press is conducting a survey as part of this project on vaccine hesitancy. This survey will take less than 2 minutes to complete. It is anonymous unless you choose otherwise; sharing your email address is optional.
Contact Kristen Jordan Shamus: firstname.lastname@example.org. Follow her on Twitter @kristenshamus.