Your Guide To Adult Vaccines
En español | Before COVID-19, you probably didn't spend much time thinking about vaccines — or hours discussing them. They were just something you had to endure when you went in for your annual checkup.
The coronavirus pandemic — and the extraordinary development of new vaccines to combat it — changed that. Suddenly, we were asking questions about how vaccines are developed, their potential side effects and how to assess effectiveness.
Experts and health care providers say much of what we've learned about the COVID-19 vaccine also applies to other recommended vaccines, and they hope those lessons will help encourage Americans to stay up to date on all of their shots.
"When people get older, we tend to see vaccination rates drop,” says Ranit Mishori, M.D., a professor of family medicine at Georgetown University School of Medicine. And that's discouraging, she adds, since these shots aren't just something you need until you graduate from college. “They're also incredibly effective for older adults.”
Here are seven important lessons we've learned about vaccines during COVID-19.
1. Aging means you need some shots more than ever.
Not only have older adults proven the most vulnerable to COVID-19 — with 95 percent of all deaths from the virus occurring in those 50 and older — they're also more susceptible to other types of illness because of how their immune system weakens with age, Mishori explains.
What's more, older adults are more likely to have other health conditions — such as diabetes, heart disease or high blood pressure — that increase the chance of complications from a disease, whether it's COVID-19, influenza or pneumonia. For those reasons, experts say it's crucial for older adults to get all of their recommended shots on time.
The waning immunity that comes with age is also why the U.S. Centers for Disease Control and Prevention (CDC) recommends some shots just for those 65 and older, such as the pneumococcal vaccine. “It's not that you're more likely to get a pneumococcal infection” than younger people, Mishori says. “It's that if you get one with advancing age and a weakened immune system, you are more likely to have complications.”
Shingles is another shot recommended just for older adults — specifically, those 50 and older. Caused by the same virus as chicken pox, it lays dormant in your body for decades. Then, as you get older and your immune system weakens, it emerges with a painful, blistering rash. “Vaccines are really critical for older adults because your body isn't as adept at launching its immune system,” Mishori says. “You need that additional kick from a vaccine.”
2. Some work better than others.
It's a fact: Because of their weaker immune response, people 65 and older also get less protection from certain vaccines. The standard flu shot, for example, has been shown to stimulate a less robust immune response in older adults. For that reason, the CDC recommends either the adjuvanted flu vaccine or the high-dose version for people 65 and older. Both are specifically formulated to stimulate more antibodies to fight influenza.
In one study, participants age 65-plus who received the high-dose flu vaccine had 24 percent fewer influenza illnesses, compared with those who received a standard vaccine.
But then there's the two-dose COVID-19 vaccines — which have very high effectiveness for every age group tested so far. Part of their success may be due to their newer mRNA technology, says L.J. Tan, a medical researcher and chief strategy officer for the Immunization Action Coalition. The Pfizer-BioNTech vaccine was shown to be 95 percent effective in both older and younger adults, while the Moderna vaccine showed only a slight decrease in effectiveness among those 65 and older.
"There is a lot of optimism because the COVID vaccines have shown us that there are platforms that can develop strong responses in older adults,” Tan says. “I think you're going to see mRNA technology used as a platform for more vaccines.”
3. Their side effects can be — yes — uncomfortable.
For many, the second dose of their COVID-19 packed more punch than they may have expected — by way of fatigue, headache, chills and fever, among other side effects — if only for a day or two.
Reactions from other vaccines are less well-known, but they're not uncommon, experts say. The seasonal flu shot, for example, can cause fever, fatigue and other reactions. And the vaccine to prevent shingles can induce shivering, muscle pain and an upset stomach.
The upside of this kind of discomfort? Side effects are “an indicator the vaccine is working,” Mishori says. “Once [the side effects] go away, you're left with the immune protection.”
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4. Protection can be imperfect — yet still lifesaving.
Most vaccines aren't an all-or-nothing proposition. Just because you're vaccinated doesn't mean you won't get sick. However, the vaccine significantly reduces your risk of having a severe case.
"If you do get illness, it will be a milder illness,” says Clare Rock, M.D., an infectious diseases physician and hospital epidemiologist at Johns Hopkins School of Medicine. “The chance of having a serious illness and needing hospitalization is much, much lower.”
Many Americans seem to have a better understanding of vaccine effectiveness as a result of the COVID-19 vaccines. That's important, Tan says, because the numbers can be confusing. For example, if the seasonal flu vaccine is 40 percent effective one year, that doesn't mean that 60 out of 100 vaccinated people will get influenza. What it actually means, he explains, is that vaccinated people are 40 percent less likely to get influenza when compared with people who didn't get the vaccine.
In their clinical trials, both of the mRNA vaccines for COVID-19 posted efficacy rates of about 95 percent — exceeding scientists’ expectations by a long margin. The data shows that the actual percentage of vaccinated people who got COVID-19 in both of those trials was just 0.4 percent, and none died of the disease.
The vaccine's efficacy in preventing infection has likely dropped in recent months, with the delta variant fueling breakthrough cases across the country. But the vaccines are still highly effective when it comes to what's most important: preventing death.
5. They are rigorously tested – group by group by group
As anyone reading headlines in the past year and half knows, all authorized vaccines — even those that received emergency authorization from the Food and Drug Administration (FDA) — go through many rounds of study, examination and research before they are allowed to be used.
Mishori says manufacturers must conduct clinical trials on thousands of people and that vaccines have to show efficacy across different groups: sex, race/ethnicity and age. The data is then examined by a panel of scientific advisers who make recommendations to the FDA and the CDC.
"In general, the CDC can't make a recommendation for an age group unless clinical trials have happened in that age group,” Mishori says, because “there are all kinds of physiological differences.” For example, she says, the kidneys of older people may not be as robust in clearing medications as they are in younger patients — so it's especially important for vaccines to be tested in adults over 65.
Many manufacturers go through the FDA process and never get authorization, Tan says. “A lot of research goes on that ultimately doesn't meet the FDA minimums. The truth of the matter is, only about 1 in 10 make it out.” Even after an approval, both the CDC and FDA continue to track the safety of all licensed vaccines.
6. Yes, their protection can wear off over time.
Studies in recent months reveal that the effectiveness of the COVID-19 vaccines does appear to wane. A Mayo Clinic study from five states, conducted through July, found that the Pfizer-BioNTech vaccine's effectiveness against the delta variant dropped from 76 percent to 42 percent, while the Moderna vaccine's effectiveness went from 86 percent to 76 percent. Another CDC analysis of both vaccines found that among nursing home residents, the effectiveness against infection dropped from about 75 percent to 53 percent between March 1 and Aug. 1.
The data prompted the Biden administration to announce plans for a vaccine "booster" shot. It's not unusual for a vaccine to require a booster, Rock says. Many childhood vaccines require boosters later in life, for example. How long immunity lasts varies by vaccine. Some shots (measles) protect for life, while others (the flu shot) need to be renewed every year.
"The immune response — the body's memory — can wane over time,” Rock says. “The body needs another reminder, in a safe way, how to respond to the virus.”
A vaccine's durability depends on a variety of factors, Rock adds, including the type of vaccine, an individual's immune system and whether mutations in the virus allow it to evade immunity.
7. They work best if both you and the grandkids get them.
Since the pandemic arrived, there has been a lot of talk about so-called “herd immunity” or “community immunity.” This is the idea that if enough people are vaccinated against a pathogen, it can't travel as easily from person to person — and the entire community is less likely to get the disease.
Many experts talk about community immunity as a way to end the COVID-19 pandemic. But it's also how we protect those who can't get vaccinated (like children who are younger than 12 who can't get the COVID-19 vaccine) or those who don't mount a strong immune response to a vaccine due to their age or health condition, Mishori says.
The concept of community immunity also applies to other vaccines such as the TDAP booster, Mishori notes. “When I see older patients who have a new grandkid, I tell them: ‘If you're going to hold the newborn, you need the TDAP booster.’ Newborns aren't able to get it early, and whooping cough [pertussis] is a very severe disease in infants before they can get vaccinated.”
A vaccine is a means of contributing to society as well as to your immediate family, she says. “You are protecting those who can't protect themselves.”
Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation's top consumer publications. Her work has appeared in Reader's Digest, Real Simple, Prevention, The Washington Post and The New York Times.