Who Shouldn’t Get the Covid-19 Vaccine—and Why

First, the people who should get the Covid-19 vaccine

The answer is nearly everyone should be vaccinated as soon as they’re eligible now that we finally have new Covid-19 vaccines. When enough people get the vaccine we’ll achieve herd immunity—in other words, the small number of people who can’t get the shot will still have protection because the virus won’t be able to spread as easily. Reaching herd immunity is crucial because not everyone is a good candidate to receive the vaccine. Here’s how to know if you or a loved one is among that group.

Is the Covid-19 vaccine safe?

That’s a strong yes: The Moderna and Pfizer-BioNTech vaccines have enough safety data to satisfy the Food and Drug Administration (FDA) approval requirements. Plus, they’ve passed through committees like the Advisory Committee on Immunization Practices, an expert group that advises the Centers for Disease Control and Prevention (CDC). (Find out what it’s like to participate in a Covid-19 vaccine trial.)

You may have heard some ludicrous Covid-19 vaccine conspiracy theories, but you can comfortably dismiss them. Look at the data, not social media, advises Sharon Nachman, MD, the chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital who works in the Covid-19 vaccination pod. The evidence for both safety and efficacy of the vaccine is reassuring, she explains. (Here are other things doctors wish you knew about vaccines.)

Note for people who are pregnant, lactating, or trying to become pregnant

Pregnant people were not in clinical trials for the vaccine, but studies in pregnant people are coming. The current two Covid-19 vaccines use messenger (mRNA) which means they carry genetic material to cells with instructions on how to make proteins. For now, experts believe that the mRNA vaccine is unlikely to pose a risk to the pregnant person or the fetus because mRNA vaccines are not live vaccines, according to the CDC.

“The American College of Osteopathic Obstetricians and Gynecologists issued a statement in December 2020 that pregnant women and lactating women should both get the vaccine,” Dr. Nachman notes.

The Society of Maternal-Fetal Medicine also recommends taking the vaccine, according to board-certified immunologist Purvi Parikh, MD, with Allergy & Asthma Network, who is also a co-investigator with the Covid-19 vaccine trials. “The reason being is that pregnancy is a high-risk condition for severe Covid-19 and the risks of not taking vaccine are worse than potential side effects,” Dr. Parikh says.

There are mixed reports on whether or not pregnant people should receive the vaccine, but Dr. Parikh and Allergy & Asthma Network are currently recommending vaccinations. (Here’s what pregnancy is like during coronavirus.)

Dr. Nachman believes both pregnant and lactating women should get the vaccine. “It will protect the pregnant woman, it does not cross the placenta, and the good news is that if those women make antibodies, the antibodies will cross the placenta and help protect the baby,” Dr. Nachman says. “And if they’re breastfeeding, it will also help protect their baby.”

Talk with your health care provider if you’re pregnant and are part of a recommended group to receive a Covid-19 vaccine, like a health care worker.

However, there are some people who should definitely skip the Covid-19 vaccine.

If you’re allergic to any of the vaccine components

You shouldn’t take the vaccine if you have a true allergy to any of the components of the vaccine, according to Dr. Nachman.

The vaccine ingredients for the Moderna Covid-19 vaccine and the Pfizer-BioNTech Covid-19 vaccine are on the FDA website and on their corresponding company websites. “If one of those components is something you truly have an allergy to, you should not be taking the vaccine,” Dr. Nachman says.

If you are allergic to any ingredients in the vaccine, avoid it until other alternatives are on the market, says Dr. Parikh.

A very tiny group—fewer than 20 people so far—had an anaphylactic reaction to the first dose, Dr. Nachman says; they should definitely skip the second round, she says.

If you have had a severe allergic reaction to other types of vaccinations, discuss the Covid-19 vaccine with your doctor first. People with allergies unrelated to vaccines—such as pet or food allergies—can still get the vaccine. After receiving the vaccine, people are under observation for 15 minutes or double that amount if you have a history of severe allergic reactions, according to the CDC.

People should know that it’s very rare in general to react to the vaccine, especially if you have never reacted before, according to Dr. Parikh. “The stats overall for vaccine allergies are 1 in 1.3 million,” Dr. Parikh says. “You’re more likely to be hit by lightning.” (Here are the things allergists won’t tell you.)

If you currently have Covid-19 or have been exposed to Covid-19

People who currently have Covid-19 should not get the vaccine until they recover. Instead, wait until after you meet the CDC criteria to discontinue isolation or quarantine. You may also want to delay your vaccination until 90 days after recovering since current evidence suggests reinfection is uncommon after that amount of time, per the CDC.

The vaccine is unlikely to be effective in preventing disease following exposure to Covid-19, so don’t risk the health of other people by trying to get vaccinated if you are or may be infected. (Here are the coronavirus symptoms you should watch for.)

If you received antibodies

If you received Covid-19 antibodies, wait 90 days before vaccination as a precaution to avoid any interference with immune responses, according to the CDC. (Here’s what you need to know about coronavirus antibody testing.)

If you’re immunocompromised or take immunosuppressive medications

People on other medications like immunomodulatory agents should speak to their health care provider and weigh the risks vs. benefits of vaccination.

“It’s not that the vaccine will harm them, it’s that they may not make a good response to the vaccine,” Dr. Nachman says. “Those immunomodulating agents don’t hurt you when you’re taking the vaccine, but they lower your ability to make a good immune response,” she says.

Dr. Nachman says that means you may not get that “bang for your buck” because these medicines are a substance that stimulates or suppresses the immune system. “That’s not to say you shouldn’t take [the vaccine], you should take it, but you may not make as good a response as someone who’s not on those medicines,” she says.

The CDC says there’s no data currently available on the safety and efficacy of Covid-19 vaccines in persons with autoimmune conditions, though these persons were eligible for enrollment in clinical trials. (Here’s the science on whether Covid-19 can trigger autoimmune reactions.)

According to the CDC, immunocompromised people may receive the Covid-19 vaccination if they have no history of allergic reactions to vaccination. However, they should know about the unknown vaccine safety profile and effectiveness in immunocompromised populations.

People who received the Covid-19 vaccine during chemotherapy or treatment with other immunosuppressive drugs are not currently recommended for re-vaccination or additional doses, per the CDC.

If you have a history of Bell’s palsy or Guillain–Barré syndrome

According to the CDC, there were cases of Bell’s palsy, or sudden weakness in the muscles on one half of the face, reported after vaccination in both the Pfizer-BioNTech and Moderna Covid-19 vaccines clinical trials.

That said, the FDA has not found that these cases were causally related to vaccination. “There is no relation to the vaccine itself as Bell’s palsy occurred at same incidence as in the general population,” Dr. Parikh says.

People can still experience or develop other medical problems during or at the same time as they get the vaccine or when they are doing the trials, she says. These medical problems that arise may not be necessarily due to the vaccine. And contracting Covid-19 and other viruses cause Bell’s palsy, so the risk may be higher not taking the vaccine, according to Dr. Parikh.

“Bells palsy is a very benign and a self-resolving condition in general and should not be a deterrent to obtain the vaccine,” she says.

Anyone with a history of Bell’s palsy may receive a Covid-19 vaccine, unless they have a history of a severe or immediate allergic reaction to the components of the vaccine, according to the CDC.

Dr. Parikh adds that those with a history of a neurological disorder called Guillain-Barré syndrome (a condition in which the immune system attacks the nerves) may also want to consult their allergist or physician before proceeding with vaccination. (Can Covid-19 harm your brain?)

If you are under a certain age

People 18 or older can receive the Moderna vaccine, and people 16 or older can receive the Pfizer-BioNTech vaccine. According to the CDC, neither Covid-19 vaccine is approved for children. The Pfizer trial did include kids aged 12 to 15, but they made up only a small number (266) out of a total of more than 40,000 participants. More research is necessary.

(Learn how this new Covid-19 disease strikes children.)

Bottom line

The vaccine is considered safe for most adults. The people who need to consult with their doctors before receiving the vaccine are especially pregnant women and immunocompromised people or those who take immunosuppressive medications.

If you have a history of a severe or immediate allergic reaction to the vaccines’ ingredients, you should not take the vaccine or the second dose until there is an alternative.

People who currently have Covid-19 should wait for vaccination until after they are finished with quarantine and have recovered. Those who received Covid-19 antibodies should also wait for the vaccine for the best results.

As new research develops, these guidelines may change, but the good news is we’re getting somewhere.

Next, check out the coronavirus myths you need to stop believing.

What to Know About the Covid-19 Vaccine

I Was a Covid-19 Vaccine Trial Volunteer

How to Get the Covid-19 Vaccine at Walmart

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