Does It Matter Which COVID-19 Vaccine You Get?

both wearing a disposable face mask, an elderly patient is listening to doctor's explanation about his diagnosis, treatment or consent form

With three COVID-19 vaccines authorized for use in the United States, people are asking if it matters which COVID-19 vaccine you get.

The answer, for most people, is not really. All three vaccines are safe and highly effective, and the U.S. Centers for Disease Control and Prevention (CDC) and the American Medical Association encourage individuals to get the first vaccine that’s available to them. The differences between the vaccines are so minor that it’s far better to receive any COVID-19 vaccine than wait for a particular type of vaccine—and risk COVID exposure, infection and spread in the meantime.

However, it’s worth understanding the differences and eligibility requirements between the three authorized vaccines—the Moderna, Pfizer-BioNTech, and Johnson & Johnson/Janssen COVID-19 vaccines—so you know what to expect when it’s your turn to be vaccinated.

Pfizer-BioNTech COVID-19 vaccine

Authorized: December 11, 2020

Authorized for: Ages 12 and older, as of May 10, 2021; the vaccine may be authorized for younger people later in 2021

Type of vaccine: mRNA

Number of shots: 2 shots, spaced 3 weeks apart (second dose can be administered up to 6 weeks later, if necessary)

The first COVID-19 vaccine approved for use in the United States, the Pfizer-BioNTech vaccine is an mRNA vaccine. It uses messenger RNA (mRNA) to teach the body’s immune system how to fight the novel coronavirus. Think of the mRNA as a secret messenger that’s smuggling blueprints that teach an army how to construct weaponry that precisely targets their enemies’ bombs. After your body builds the weapons and your immune system fires it, it degrades the mRNA. The second dose is reinforcement.

Because the vaccine does not contain any coronavirus, it is impossible to get COVID-19 from vaccination.

According to clinical trial data, the Pfizer-BioNTech vaccine is approximately 95% effective at preventing symptomatic COVID-19 infection, both in people who have had COVID-19 previously and in those who were not previously infected. In the real world, the Pfizer-BioNTech vaccine is 90% effective in preventing asymptomatic COVID-19 infection as well.

Side effects of the Pfizer-BioNTech vaccine include redness and discomfort at the injection site, as well as fatigue, fever, headache, muscle pain, and chills. Systemic reactions (such as fatigue and fever) are more common after the second dose than the first dose and tend to occur more commonly in people ages 55 and over. Systemic side effects usually occur 1 to 2 days after vaccination and resolve in about a day, but they may last a few days.

A few people have experienced severe allergic reactions, including anaphylaxis. Based on millions of doses, anaphylaxis occurred at a rate of 4.7 cases per million doses. Although the risk of a serious reaction is very low, healthcare providers require people to stay at least 15 minutes after vaccination, so they can be monitored for signs of trouble (and treated immediately, if necessary). People with a history of severe allergies should be monitored at least 30 minutes after vaccination.

Moderna COVID-19 vaccine

Authorized: December 18, 2020

Authorized for: Ages 18 and older, although the vaccine may be authorized for younger people later in 2021

Type of vaccine: mRNA

Number of shots: 2 shots, spaced 4 to 6 weeks apart

The Moderna vaccine is a mRNA vaccine, just like the Pfizer vaccine. The vaccines have different formulas, but they are both RNA. You cannot catch COVID-19 from the vaccine.

According to clinical trial and real-world data, the Moderna vaccine is highly effective at preventing symptomatic COVID-19 infections and COVID-19-related hospitalizations. In clinical trials, the vaccine was 94.1% effective at preventing symptoms of COVID-19 in people who hadn’t previously had COVID-19 and received both doses of the vaccine. Like the Pfizer vaccine, the Moderna vaccine is 90% effective in real-world conditions (beyond the clinical trial).

Anaphylaxis occurs at a rate of about 2.5 cases per million doses with the Moderna vaccine. Everyone who is vaccinated should be monitored at least 15 minutes after receiving the Moderna vaccine; those with a history of severe allergic reactions need to stay at least 30 minutes.

Johnson & Johnson COVID-19 vaccine

Authorized: February 27, 2021

Authorized for: Ages 18 and older, although the vaccine may be authorized for younger people later in 2021

Type of vaccine: Viral vector

Number of shots: 1

The first single-dose COVID-19 vaccine authorized, the Johnson & Johnson (J&J) vaccine is easy to store and ship—unlike the Pfizer and Moderna vaccines, which require special handling and very cold storage. (The vaccine was developed and manufactured by Janssen Pharmaceuticals Companies of Johnson & Johnson.)

The J&J vaccine does not use mRNA technology; instead, it uses a harmless adenovirus (an inactive version of a common cold virus) to deliver the “blueprints” the immune system needs to effectively fight the novel coronavirus. You cannot catch COVID-19 from the J&J vaccine.

In clinical trials, the J&J vaccine was 66.3% effective, overall, in preventing COVID-19 infection and 85% effective in protecting against severe disease. The J&J vaccine was also highly effective at preventing COVID-related hospitalizations; none of the people who received the vaccine during the clinical trial and contracted COVID-19 at least 4 weeks after vaccination had to be hospitalized.

Some people are concerned the J&J vaccine is not as effective as the Pfizer-BioNTech and Moderna vaccines; however, the vaccines were not tested side by side or in the same countries. The J&J vaccine was tested in the United States, but also in countries where COVID-19 variants were already circulating, which presumably lowered overall vaccine effectiveness.

Similar to the other authorized vaccines, the most common side effects of the J&J vaccine are pain at the injection site, headache, fatigue, muscle aches, and nausea. Most side effects were mild to moderate in severity and lasted 1 to 2 days. One case of anaphylaxis occurred in the trial.

There is a remote chance of developing a rare but serious type of blood clot after receiving the J&J vaccine. The CDC and Food and Drug Administration (FDA) temporarily paused J&J vaccinations in April for vaccine experts to review the cases and understand the risks. After a thorough safety review, they lifted the pause. However, the J&J vaccine now includes a warning about the possibility of developing blood clots combined with a low platelet count 1 to 2 weeks after receiving the J&J COVID-19 vaccine. Most people who developed this condition were females ages 18 to 49 years. The condition is life-threatening, and some of the women died. Seek medical care promptly if you have received the J&J vaccine and develop shortness of breath, chest pain, leg swelling, persistent abdominal pain, severe or persistent headache, blurred vision, or tiny red (blood) spots under the skin.

COVID-19 vaccine effectiveness against variants

Laboratory research suggests the Pfizer-BioNTech and Moderna vaccines will likely provide protection against the so-called U.K., Brazil and South Africa variants, but may be less effective than the original circulating strain, particularly with the South Africa variant. The vaccines protect against the U.K. variant in the “real-world” as well. It’s effectiveness against the other variants in people is not yet known because there is not enough data on infections caused by these variants. Vaccination programs around the world will continue to provide additional information on vaccine effectiveness with the variants.

Based on the clinical trial, the J&J vaccine is less effective against the South Africa and Brazil variants, but still protects people from severe COVID-19 disease, hospitalization and death. There is less information about its effectiveness against the U.K. variant, but the CDC’s guidance for fully vaccinated individuals states that “currently authorized COVID-19 vaccines may provide some protection against a variety of strains, including B.1.1.7 (originally identified in the United Kingdom).”

Healthcare providers encourage eligible people to get the first COVID-19 vaccination available to them. If you have any questions about the vaccines, talk with your healthcare provider.

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