Alba Feliz is a little nervous about getting the vaccine. At 17, she's the first person in her immediate family to seriously consider getting it. "In my house, they never really trust the vaccine," she says. Social media has been her main source of information, and the contradictory messages have been confusing.
She doesn't believe the COVID vaccines will put a chip in you, but she does have some concerns about "side effects and all that."
Another teen, Ryan Howard, 16, says he has become the resident vaccine expert among his friends. "My friends will send it to our group chat and I'll be like 'ehhhh that's kinda, like, wrong.' "
A lot of teens are still deciding about the vaccine. People ages 12 and up have been able to get one since mid-May, but two out of three teens have not gotten their shots.
Yet getting vaccinated could mean freedom for a lot of young folks who've been pretty cooped up. "A lot of us didn't like being at home for a whole year," says Feliz.
NPR asked teens to share their most pressing questions about the vaccines. Here are answers from several ace pediatricians and trusted sources of health information.
What's the difference between the Pfizer, the Moderna, and Johnson & Johnson COVID-19 vaccines?
— Kaitlyn, California
Let's start with what's similar. All three COVID-19 vaccines are currently available for free in the U.S., and they're proven to be safe and effective. And all three offer good protection against all known strains of the coronavirus.
What's different is the way they teach your immune system to recognize the coronavirus.
The J&J vaccine uses a harmless virus — an adenovirus, not a coronavirus — to ferry instructions, in the form of DNA, to your cells. These instructions, train your immune system to recognize proteins that stud the surface of the coronavirus and to create antibodies and immune cells that can fight off the virus if you ever become infected. The Pfizer and Moderna vaccines uses a microscopic bubble of grease to carry instructions to your cells in the form of something called messenger RNA.
Here's another difference: The two mRNA vaccines (Pfizer's and Moderna's) each require two doses, spaced three to four weeks apart. The J&J vaccine is just one shot. In all cases, it takes time for your body to make sufficient antibodies — so a person is considered "fully vaccinated" and protected from COVID-19 only after at least two weeks since the final shot.
Right now, only the Pfizer vaccine is authorized for use in people as young as 12 to 17 years old. The FDA is reviewing data from Moderna's studies in younger people right now, and it's likely that Moderna shots will become available to teens soon, too.
What are the most common side effects for teenagers who have received the vaccine? Do the different brands of vaccines have different common side effects?
— Daniel, Rhode Island
The common side effects are basically the same for all three vaccines, and all the evidence from the Pfizer vaccine — the one currently available to teens — suggests teens experience the same range of side effects as adults do.
Your arm might be a bit sore that day or the next, explains Dr. Yvonne Maldonado, a pediatrician at Stanford Children's Hospital. Beyond that, many people don't really feel bad at all, but worst case, if you do get symptoms, it would be like getting a mild flu.
You might get a low fever within a day or so after getting your shot, says Maldonado. You could also feel some body aches, tiredness, headaches or nausea.
If you feel this way, don't worry. Just rest, drink plenty of fluids and take acetaminophen if you have a headache. You'll feel better soon. Remember, these symptoms are signs that your body is revving up to fight the virus if it comes your way.
In online forums, we've seen other concerns from teens — that the vaccines might increase the risk of infertility, for example, or chronic fatigue. But anything that suggests those is misinformation pure and simple.
So let's be clear. The American College of Obstetricians and Gynecologists (the group of top medical doctors who have been keeping an eagle eye out for any worrisome side effects regarding pregnancy, infertility or reproduction) is very firm in dismissing the first concern: "Claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them."
And while long-term fatigue is certainly a part of what's come to be called "long COVID" in adults and young people, that's a side effect of an infection with the coronavirus — not a side effect of the vaccine. Getting vaccinated is your best protection against getting COVID-19 and long COVID.
When getting the COVID-19 vaccine, what are the main risks for someone with severe allergies, and what are the chances of going into anaphylaxis?
— Nina, Rhode Island
For most people, even those with significant allergies, the risk is very small. If you have hay fever or even a severe allergy to bee stings, peanuts or other foods, no problem. The vaccine is as safe for you as it is for anyone else.
On the other hand, if you've ever had any kind of allergic reaction to an ingredient in one of the vaccines (such as the food additive polysorbate in the J&J vaccine or the common drug additive polyethylene glycol, in the Moderna and Pfizer vaccines), you should get a different COVID-19 vaccine, the CDC advises. And if you've ever had a severe allergic reaction to past vaccinations of any kind, check in with a doctor for advice specific to your situation.
In a very few cases, people have had severe allergic reactions, or anaphylaxis, after getting a COVID-19 vaccine. Luckily, as serious as that is, it's reversible and treatable, generally with a shot of epinephrine. When you go get your vaccine, you'll be asked to sit and wait for 15 to 30 minutes, just in case you have a severe reaction, so you can be treated on the spot.
How rare are these allergic reactions? For every million doses given out, roughly two to five people have an anaphylactic reaction.
Some people have experienced some serious side effects from the vaccine, how worried should we be about these possible side effects?
— Shanti, Washington, D.C.
OK, yes. It's true that very, very rarely, some people are getting serious side effects. One that's turned up related to the Pfizer and Moderna vaccines is temporary heart inflammation, which appears to be happening in about 13 out of every million shots given to people under 40, and more so in young men.
But here's the thing: This is a short-term issue that gets better with rest and care in a matter of days.
"There's no zero-risk proposition," explains Dr. Brian Feingold, medical director of the heart transplant program at Children's Hospital of Pittsburgh. But, he says, the health risks you face if you don't get vaccinated are much higher. He has been advising his friends, family members and most patients, including those with existing heart problems, to get vaccinated as soon as possible.
A few other very rare side effects have turned up in relation to the J&J vaccine: Serious blood clots have occurred in around three out of every million people who got the vaccine, mostly middle-aged women. And Guillain-Barré syndrome, a neurological disorder that can lead to weakness in the muscles and sometimes paralysis, has occurred in around eight of every million people who get the vaccine, mostly among men over 50 — but it's usually temporary.
But before you get too freaked out, remember that the risks associated with getting COVID-19 include long-term heart damage and long-haul COVID, and in the worst case, you can die from the disease.
To stay healthy, it still makes a lot more sense to get vaccinated than not. "If you're statistically going after what's safest, the data right now stacks up [to show] that vaccines are absolutely the safer route," Feingold says.
What are the chances that a person will contract COVID-19 despite being fully vaccinated?
— Ruby, Rhode Island
Breakthrough cases, in which someone who is fully vaccinated still gets infected with the coronavirus at some point, do happen — but the infections have mostly been mild or even symptomless.
Once you're fully vaccinated, your body is prepped to fight the virus. That means if you're exposed to the delta variant or any other form, you are very unlikely to get sick enough to require hospitalization.
The other thing you should know is that in this latest surge of COVID-19 cases across the U.S., 97% of people who got hospitalized were unvaccinated.
"If you are vaccinated you are protected," says CDC director Dr. Rochelle Walensky. "If you remain unvaccinated, you are at risk."
I was planning to get the HPV vaccine this summer and was wondering if it was OK to get the COVID vaccine and the HPV vaccine at the same doctor's visit?
— Drew, South Carolina
Yes! Vaccine experts now say you can get the COVID-19 vaccine at the same time you get other routine vaccines, like the HPV vaccine or the flu shot.
If you missed a regularly scheduled vaccine like a Tdap or the meningococcal jab during the pandemic, you're not alone. Doctors say that getting several vaccines together this summer is safe and effective and could be a good opportunity to catch up on vaccines before going back to school.
As a teen who is already vaccinated against COVID-19, I am wondering, would those vaccinated need to get a booster shot? How often would a booster shot be necessary?
— Isabella, Rhode Island
You will probably need a COVID-19 booster shot at some point, say doctors who are tracking the pandemic, but it may not be any time soon.
So far, the best evidence suggests that people who are fully vaccinated — even those who got their shots way back in December or even earlier — are well-protected from getting very sick or dying from COVID-19.
Still, health officials are particularly watching for any sign of lowered protection in a couple of different groups, especially the elderly and the immunocompromised.
If boosters are needed, they'll likely be recommended for specific groups first — based on when you got your vaccine and whether you're at special risk for getting very sick from COVID-19 yourself or accidentally spreading it to vulnerable people (like if you work at a hospital or nursing home).
What is likely to happen if I refuse to get the COVID-19 vaccine? Because in my head, one part of me is saying, "You'll live it out, you'll be fine."
— Aleia, Washington, D.C.
It's true that the younger and healthier you are, the less likely you are to get very sick or die from an infection with the coronavirus. But some kids and teens have gotten serious cases of COVID-19, which can lead to complications like MIS-C, an inflammatory disorder that can cause a range of serious effects that are sometimes lethal.
Then there are the lingering effects of an infection — what's come to be called long COVID. Among adults, the evidence shows that one out of every three or four has lingering problems after getting COVID-19 — fatigue or difficulty breathing for weeks or months after the virus is gone. There's less research about this condition in teens, but some do develop it.
"The question," Maldonado says, "is: Are you willing to take that risk of getting infected and having those long-term impacts when we don't have any answers to how to treat them — whereas we know we have an answer to how to prevent them?"
And even kids and teens who don't get very sick from the coronavirus can still infect those around them, including friends or family members who are older or in worse health or not able to get vaccinated.
Teens and 20-somethings, Maldonado says, are "the primary age group that could really make a difference in preventing transmission of the disease."
Whatever your age, in an era when so much of life seems beyond our individual control, she says, choosing to get vaccinated against COVID-19 is a way to contribute personally to the health of your community and the world.
I just want to know why the vaccine was free, but we don't have any other free stuff in America that's much needed?
— Ryan, Washington, D.C.
Good point. Dr. Benjamin Danielson, a pediatrician at the University of Washington School of Medicine, says he finds the spirit of this comment refreshing. It's an unfortunate reality that people who make more money in the U.S. often have better access to good health care than people who make less.
COVID-19 has hit communities of color particularly hard — Black, Latinx, and Native peoples have been more likely to catch COVID-19 and get very sick and die from it.
That tragedy is one way the pandemic has illuminated how poverty and systemic racism are hurting people's health, Maldonado says.
"This is an opportunity to shine a light," she says. "I think this is something that communities of color, and all communities, should take on as a social justice issue."
While there are no easy answers here, Danielson says he's happy to hear young people starting to reject the status quo. He says it reflects "an expectation of things being different, which is a whole different mindset from hope or aspiration." It's the right mindset to spark change, Danielson says, to start demanding equity in the U.S. health care system.