Communicating About COVID-19 Vaccination
(Updated January 26, 2021)
COVID-19 vaccines currently available for use either have an Emergency Use Authorization (EUA; in the U.S.) or an Interim Order (Canada). See our chart, COVID-19 Vaccines, for a comparison of available COVID-19 vaccines. The chart below answers common questions your patients may have about COVID-19 vaccination and includes talking points and strategies to address COVID-19 vaccine misconceptions.
Question |
Answer/Pertinent Information |
COVID-19 vaccines are being approved more rapidly than other vaccines. How can you reassure patients about this expedited approval process? |
The COVID vaccine has been developed at a more rapid pace than what is normally seen with other vaccines. But this does NOT mean safety steps have been skipped.34 The vaccine development process has been expedited because of the pandemic (e.g., early funding to ramp up manufacturing, overlapping phases of trials).34
COVID-19 vaccines are going through the same RIGOROUS approval process as other approved vaccines. Data are reviewed/analyzed by independent experts (i.e., not scientists employed by the manufacturer). The independent reviewer recommendations are then presented to the approving agency (e.g., FDA, Health Canada).50 Reassure patients that COVID-19 vaccine safety is a top priority.21,27 COVID-19 vaccines are being studied through phased testing to ensure safety and efficacy before they are made available to the public.
|
Which patients were excluded from early COVID-19 vaccine trials? |
Some early COVID-19 vaccine trials’ exclusion criteria included:
|
Some of the COVID vaccines are utilizing new types of technology. How can you reassure patients these newer vaccines are safe? |
Many COVID-19 vaccines are a new type of vaccine (e.g., messenger ribonucleic acid [mRNA], viral vectors).22,35
|
What are some talking points to use with patients who may be hesitant to get vaccinated for COVID-19? |
Remind patients about the benefits of COVID-19 vaccination. Vaccination may:16
Explain that the COVID-19 vaccine is one important tool in the toolbox to end the pandemic.16
Encourage vaccination as the safer path toward immunity.
|
What age groups should receive a COVID-19 vaccine? |
The Pfizer/BioNTech vaccine is authorized for ages 16 years and older.49,69 The Moderna vaccine is authorized for ages 18 years and older.49,69 Generally, children and adolescents outside of these authorized age groups should not receive a COVID-19 vaccine.49,69 In Canada, the Pfizer/BioNTech vaccine may be considered for adolescents between the ages of 12 and 15 years who are at very high risk of severe outcomes (e.g., due to other medical conditions known to increase risk for hospitalization or mortality) and at increased risk of exposure (e.g., living in a congregate care facility).69
|
What are the expected short-term adverse effects with COVID-19 vaccination? |
Be transparent that patients may experience short-term adverse effects after vaccination (i.e., don’t sugarcoat or downplay these adverse effects). For other two-dose vaccines, this has been a well-received strategy in ensuring patients returned for their second dose (e.g., Shingrix vaccine).52
|
What can patients do to minimize expected vaccine adverse effects? |
Help patients reduce and prepare for adverse effects. For example:
|
Have there been serious or unusual adverse effects from COVID-19 vaccination? |
Serious adverse effects from COVID-19 vaccination seem extremely rare. But it takes time and large numbers of people getting vaccinated before we may know more about possible adverse effects. Safety monitoring will continue even after a COVID-19 vaccine is approved.4
There have been reports of severe allergic reactions, including possible anaphylaxis, after receiving COVID-19 vaccine.45,47,58,76 Anaphylaxis is a known, but rare side effect with any vaccine.45,76
|
What are long-term safety concerns with COVID-19 vaccination?
|
More time and data are needed to assess long-term safety of the COVID-19 vaccines. |
What are strategies to encourage patients to return for the second dose of their COVID-19 vaccination? |
Stress the importance of completing the vaccination series with the same vaccine (COVID-19 vaccines are NOT interchangeable),36 if more than one dose is needed (most COVID-19 vaccines currently in development require two doses separated by a few weeks).2
Help patients understand why two doses are used for many vaccines, including most of the COVID-19 vaccines.
Consider these tips to improve the likelihood patients will return for second doses:
See our toolbox, Medication Adherence Strategies, for other adherence ideas.
|
What happens if the second COVID-19 vaccine dose is not given on schedule (too soon or too late)? |
To get the most benefit from vaccination, adhere to recommended vaccine dosing intervals.53,71
For COVID-19 vaccines, it is too soon to know how early or late second doses will impact immunity.71 Follow local health authority guidance for specifics in your area. Generally in:
|
How long does it take to develop immunity after COVID-19 vaccination and how long does immunity last? |
It usually takes a few weeks after any vaccination to develop immunity.35 See our chart, Vaccines for COVID-19, for specific timing to develop immunity for each of the available COVID-19 vaccines.
We still don’t know how long immunity after vaccination will last.12,34 Explain that we only have data for as long as the trials have been going on.9 Once we have more data about how long vaccine-induced immunity lasts, it will be possible to determine how often patients may need to be vaccinated against COVID-19 to maintain immunity.12
|
Can
a COVID-19 vaccine cause a
|
No.34 None of the COVID-19 vaccines currently in development use the live SARS-CoV-2 virus.6 |
Will COVID-19 vaccination lead to a positive COVID-19 test? |
COVID-19 vaccination may lead to a positive test for COVID-19 antibodies (serology tests).6 COVID-19 vaccination will NOT lead to a positive test for active COVID-19 infection (molecular or polymerase chain reaction [PCR] tests and/or antigen tests).6
|
If vaccine supplies are limited, who will be prioritized for vaccination? |
Vaccination may occur in multiple phases. Sub-prioritization within the phases may be needed when vaccine supplies are limited. For example:14,25,29
Per ACIP, there are currently four priority groups for COVID-19 vaccination if supply is limited. These priority groups include healthcare workers; essential/critical workers (e.g., law enforcement, first responders, educators, grocery store workers, food manufacturers); people with certain underlying medical conditions that put them at risk for severe COVID-19 illness (e.g., cancer, chronic obstructive pulmonary disease [COPD], heart failure, severe obesity, type 2 diabetes); and people age 65 years and older.13
|
What do we know about COVID-19 vaccines during pregnancy? |
Pregnant patients are at higher risk for severe illness from a COVID-19 infection or possibly preterm birth.49 There are currently little to no data available about the safety or efficacy of COVID-19 vaccines during pregnancy.1,8,29 The medication and vaccine approval process typically assesses safety and efficacy in healthy women of childbearing age, before testing them in pregnant patients.30 Though pregnant patients were excluded from initial trials, information about vaccine effects and possible adverse effects are being collected (and will be evaluated) in patients that became pregnant during clinical trials.1,8 In addition, there are no safety concerns from animal data with mRNA COVID-19 vaccines.49 Gynecology and obstetrics experts, as well as the CDC, support offering mRNA COVID-19 vaccines to pregnant and lactating patients. As more data become available, updates to these recommendations will be made.49,56,59
|
What do we know about safety and efficacy of COVID-19 in immunocompromised patients? |
No data available, as patients who are immunocompromised were not included in early COVID-19 vaccine trials. We know that people who are immunocompromised are at risk for severe illness from COVID-19.37 We also know that people who are immunocompromised may have a lesser response to vaccinations compared to patients who are immunocompetent.40 Per the CDC, it is acceptable to offer an mRNA COVID-19 vaccine to patients with immunocompromising conditions (e.g., cancer, HIV, taking an immunosuppressant or biologics).49,70 These vaccines do not contain a live virus. Be sure to counsel these patients about the lack of data and the potential for a reduced immune response.49,70 For patients who opt not to receive the vaccine, counsel patients to continue to follow recommendations to reduce risk of infection (e.g., social distancing, hand washing) and wait until we have more vaccine data in these patient populations.39,49
|
Can COVID-19 vaccines be given with other vaccines? |
There are no data available about safety or efficacy of coadministration of a COVID-19 vaccine and other vaccines.31 Separate vaccinations whenever possible. This way it is possible to collect “clean adverse effect data” associated with COVID-19 vaccines and specifically linked to individual vaccines.69
|
Should COVID-19 vaccines be avoided in patients taking anticoagulants or antiplatelets? |
Taking
anticoagulants or antiplatelets are NOT a contraindication to receiving a
COVID-19 vaccine As with all other vaccines given IM, consider the following to minimize bleeding risk:63-65
Reassure patients that vaccination benefits outweigh the small risk of bruising. Serious effects are NOT expected. Advise patients to monitor for bleeding or bruising and to report unusual or excessive bleeding or bruising to their healthcare provider.65
|
Should someone who has COVID-19 or who was previously infected get vaccinated? |
Previous COVID-19 infection (with or without symptoms) is NOT a contraindication to COVID-19 vaccination.29 It may be reasonable for people with recent COVID-19 infections to temporarily delay COVID-19 vaccination (especially when vaccine supply is limited), as the risk of reinfection is low in the months after initial infection, but infection risk may increase over time.29,49 Defer vaccination with an mRNA COVID-19 vaccine until patients have recovered from the acute COVID-19 illness and meet criteria to stop isolation (including patients who develop COVID-19 in between doses one and two of the vaccine).49 There is NOT clear guidance on whether or not to give COVID-19 vaccines to someone with an acute illness (other than COVID-19). In general, moderate to severe illness is considered a precaution against vaccination (as vaccination side effects can make it difficult to assess management of the acute illness), while vaccination during a mild illness (with or without fever) is not a precaution.43
|
Should someone who previously received monoclonal antibodies or convalescent plasma for COVID-19 get vaccinated? |
There are no data about the use of mRNA COVID-19 vaccines in patients who received either monoclonal antibody therapy or convalescent plasma.49 To avoid any possibility of lessening a patient’s immune response to an mRNA COVID-19 vaccine, wait at least 90 days before vaccinating a patient who received either monoclonal antibody therapy (e.g., bamlanivimab, casirivimab/imdevimab) or convalescent plasma to treat COVID-19.49 Waiting 90 days before vaccinating applies to patients before receiving any dose of a COVID-19 vaccine or who are in the middle of the vaccination series.49
|
Do COVID-19 vaccines contain aborted fetal cells? |
Cell lines with remote fetal origins are not used in the production of either the Moderna or Pfizer/BioNTech COVID-19 vaccines.60 Fetal cells (from elective abortions in the 1970s and 1980s) were used to confirm that COVID-19 mRNA vaccines are taken up by cells and used as a blueprint to make a SARS-CoV-2 spike protein.60
|
What should U.S. healthcare providers know about billing for COVID-19 vaccinations? |
There will be no charge to patients for the COVID-19 vaccine. COVID-19 vaccines are currently purchased by the government. You will only be billing for the administration fee, not for the vaccine itself.2 To ensure pharmacies are appropriately reimbursed for the administrative fee, it is recommended to enter the following:24
Proposed reimbursement rates for COVID_19 vaccine administration fees:62
COVID-19 vaccine and administrative CPT (current procedural technology) billing codes:61
For additional medicare billing information (how to submit claims including institutional, professional, and for centralized billing), go to https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration. For additional pharmacist-specific reimbursement information for COVID-19 vaccine administration (e.g., steps to take to ensure eligibility for reimbursement, becoming eligible to give vaccines under Medicare, how to handle uninsured patients), go to https://www.pharmacist.com/sites/default/files/audience/APhACOVID-19ReimbursementforAdmin1120_web.pdf.
|
Are safety precautions (e.g., masks, social distancing) still necessary after COVID-19 vaccination? |
Yes.34 Until more is known about “real world” protection provided by COVID-19 vaccines, advise patients to:2
It is too soon to know if COVID-19 vaccines will stop a person from spreading the virus, even people who are asymptomatic. For example, it may be possible that if someone was vaccinated and then exposed to the virus, though they might not get sick, they could still spread the virus to others.9 Implementation of safety precautions may change over time as we learn more about the protection provided by COVID-19 vaccination. The number of people who get vaccinated and virus spread in local communities may also play a role in determining this.2
|
- For more information about the V-SAFE monitoring system go to https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-09/COVID-03-Shimabukuro.pdf.
- Operation Warp Speed is comprised of Department of Health and Human Services (HHS), including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense (DoD).
Prepared
by the Editors of Therapeutic Research Center (370101); last modified January 26,
2021.
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Cite
this document as follows: Clinical Resource,
Communicating About COVID-19 Vaccination.
Pharmacist’s Letter/Prescriber’s Letter.
January 2021.