All Your Lingering Vaccine Questions, Answered

Vaccines are rolling out, hot vax summer is getting hotter, and everyone, fairly, has a lot of questions about the spring’s hottest accessory: a little bandage on the shoulder, marking the spot where you got your COVID-19 jab.

First of all, it’s so sick (in a good way) that we arrived at this point so quickly. Second of all, chill out! The most important thing is that you get your vaccine—even if you’re young and/or not at high risk for severe infection—and that the science thus far points to all three vaccines in the U.S. being extremely safe and effective. For everything else, including when it’s cool to take Tylenol and what to do if you missed your second dose, VICE consulted several experts on the COVID-19 vaccine to get your most pressing vax-related questions answered.

Do I still need to get the vaccine if I already had COVID?

Yes, for several reasons.

The vaccine is still recommended for those who had lab-confirmed or suspected cases of COVID-19, though you should wait 14 days after symptoms subside or 90 days if you received a plasma treatment before getting jabbed. You should get the shot even if you had an infection and think you’re all good on antibodies, explained MarkAlain Dery, an infectious disease doctor in New Orleans.

“We don’t know what level of immunity you may have as a result of your COVID infection,” Dery told VICE. “You may have had a light antibody response that would potentially put you at risk for reinfection.”

The immune response you’ll gain from the COVID-19 vaccine is relatively well-established (each vaccine available in the U.S. is at least 86 percent effective upon full immunization), but the immunity you carry from a previous infection can vary in effectiveness and length of time. The vaccine gives a pretty standard immunity to those who get it, which is a key step in reaching herd immunity, Dery said.

Another reason is that data increasingly shows that some of the new, highly infectious variants emerging in the U.S.—like the P.1 variant originally discovered in Brazil—are able to reinfect those who’ve already had coronavirus, but the vaccines may prevent serious infection from known variants. As Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor College of Medicine, told VICE, effectiveness against variants varies from vaccine to vaccine, but boosters (a concern for the future, but not right now) will likely be added to increase effectiveness against evolving strains of the virus.

Finally, emerging science suggests that vaccinated folks are less likely to spread COVID-19, which means each vaccinated person is playing a crucial role in stopping the spread of coronavirus (especially if they’re regularly interacting with those who refuse to or cannot get the shot).

I’m not at high risk of severe infection. Can I skip my second dose?

No.

Data on how effective just the first dose of the Pfizer or Moderna vaccine is varies across studies. A CDC study of health workers found that just one dose could be up to 80 percent effective, while a new study out of Israel found that the first Pfizer dose may only be 40–60 percent effective. But both Pfizer and Moderna are at least 90 percent effective after the second dose, according to a “real-world” study by the CDC. There’s also some degree of individualization, as Maria Bottazzi, associate dean of the National School of Tropical Medicine at Baylor College of Medicine, told VICE.

“Some people may have a better immunological response from the first, and others may be weaker,” Bottazzi said. “When you get the second dose, it kind of raises everybody to the same level of immunity. If you only get one, you may not have as robust a response and your response may not last as long.”

In short, studies show that being fully vaccinated—whether that means the two doses of either Pfizer or Moderna—is extremely effective, while being only halfway vaccinated appears to have varying success. If you want to be well-protected against COVID-19, don’t bail on your second shot.

I got my first shot like, three hours away. Do I have to go back to the same location for my second one?

Yes, if you don’t want to be an asshole.

So you got eager about getting vaxxed, booked an appointment two counties away, wound up with a Pfizer or Moderna shot, and now don’t feel like driving six hours round-trip for jab number two. Sorry, but even though you may be able to find a dose closer to home, it’s best to stick with your original location, or, at the very least, call to cancel it so that your second dose doesn’t run the risk of getting wasted.

“It’s a logistics thing,” Dery said about no-showing your second vax appointment. “If somebody goes to another location, it just throws all the math off.”

Let’s say there are ten doses per vial. If you went somewhere an hour away for shot one, that location will automatically book you for a second dose. If you then schedule your own second shot at a different location, you run the risk of the first location having to throw out your dose when you end up being a no-show. Also, with states and locales in various stages of vaccine eligibility, you also run the risk of delaying someone from getting their first shot, because the doses are chemically identical, Bottazzi said.

What happens if I accidentally (or on purpose) miss my second dose of the Pfizer or Moderna vax? Will I not be as immune if I get it a little later?

Don’t freak out, just reschedule it.

As Hotez explained, the reason why the Pfizer and Moderna vaccine appointments are scheduled so closely together is because we are still in the midst of the pandemic, and it’s in our best interest to get people fully vaccinated in as short an amount of time as possible. Three weeks to one month (depending on which vax you got; Pfizer is three weeks later, while Moderna is four weeks) is the earliest you can do dose two, not the latest. There’s a window of opportunity to get fully vaxxed if you miss your appointment.

“If you were not doing this in the middle of a pandemic, it would not be unusual to do a two-dose vaccine six months apart,” Hotez said. “Because we’re in a pandemic, there’s an urgency to fully vaccinate the U.S. population.”

As Hotez explained, it may even turn out that the vaccine is more effective if the second dose is scheduled later than a month or three weeks from the first dose, but because reaching herd immunity is our first priority, everyone should take the first second-shot appointment they can get, and, if you miss it, rescheduling it ASAP. Remember, the CDC says you’re not fully vaccinated until two weeks after your final shot. The sooner you get your second dose done, the sooner we all can re-enter the world and do all the things we miss doing.

If the doses are the same thing, why does the second shot seem to make people so much sicker with side effects?

It has to do with how your body identifies and reacts to the stuff that’s in the shot.

As Dery explained and as the data shows, each person’s reaction to the shot—whether it’s the first of two or the second of two—varies. Evidence suggests that those who previously had COVID-19 may experience a more severe reaction to their first dose, while those who haven’t are anecdotally having more side effects after their second.

“When you see the vaccine the first time and you were never exposed to the virus, it’s the first time your body sees the spike protein,” Bottazzi explained. “The second time, you already saw it, so your body remembers it and you react and make a great immunological response.”

In other words, the body’s immune response is more robust the second time it encounters the spike protein (the thing in the shot that kicks off your immunity), which, for some, can lead to side effects ranging from a sore arm to fever and chills.

I don’t wanna feel like shit. Can I take Tylenol before my shot?

It would be better if you didn’t, but it’s likely fine.

Bottazzi recommended against “prophylaxis,” or preemptive treatment against possible side effects that may occur after your shot. The CDC also errs on the side of caution and recommends not pre-treating your vax side effects with Tylenol and other medicines like it. The consensus at the moment is that taking over-the-counter painkillers like ibuprofen or acetaminophen before the shot may diminish your body’s immune response, making the shot less effective.

However, I say “consensus” and not “the data shows” because, as Dery explained, the idea that anti-inflammatories might dampen a shot’s effectiveness comes from a review of studies on vaccine efficacy in children. The review found that preemptive treatment didn’t have a meaningful impact on immune response in children. So if you didn’t know this and took a couple of Tylenol before your first or second dose, don’t sweat it; there’s no need to get “re-vaccinated” or feel gravely concerned that you are not adequately protected.

“Consensus at this point is to not pre-treat,” Dery said. “But I always say that with a note that there’s no science behind it. I wouldn’t take steroids—steroids blunt your immune response—but ibuprofen doesn’t necessarily blunt your immune system, and Tylenol has no effect on the immune system whatsoever.”

What about after? I have a fever!

Yes, go for it.

While recommendations on how to treat side effects after you start experiencing them varies (for example, my shot provider said to wait until my fever reached a daunting 101 degrees, which sounds, to me, like a miserable experience!), both Bottazzi and Dery said it’s fine to take Tylenol or Advil if you start feeling like ass after your shot.

“When you feel uncomfortable, go ahead and take it,” Dery said.

Wait, I felt totally fine after my shot(s). Does that mean it didn’t work?

No.

“There’s no evidence for that,” Hotez said. “People respond differently.”

Hotez added that you should avoid the temptation to get a COVID test or antibody test after your vaccine to “check” whether it worked. According to the CDC, you will not test positive for COVID after your vaccine, and only some antibody tests will show you are positive for antibodies, even though you very much have them. “Those antibody tests were not licensed to look for anti-spike protein immunity, so don’t do those tests,” Hotez said.

Basically, once you’re fully vaccinated, you should assume the vaccine worked, unless, as Hotez added, you have a known immunocompromised condition (like if you are a transplant patient) that you see a specialist for. In those cases, your specialist or GP should be able to advise you on how to proceed post-vax, Hotez said.

What should I do with my freaking vaccine card?

Protect and keep it!

Take a photo of that sucker and upload it to the Cloud, or whatever storage thing you use, so that, even when you inevitably lose it upon flashing it around at the local dive bar, you still have proof of your full vaccination. Dery and Bottazzi both said you can also send it to your general physician, so that it becomes part of your vaccine record. Then Dery’s personal recommendation is to put it in a fireproof safe (if you have one) or in some other special place where you keep your important documents. It’s possible that vaccine passports may become a reality (to some degree), in which case, you’ll want proof that you got your COVID vax.

Can I laminate it, though?

Probably not.

Hotez (plus a majority of surveyed epidemiologists) feels relatively confident that boosters will be a reality in the near-to-distant future, maybe sometime around the end of this year at the earliest. (Which is yet another reason to safeguard your card.) So when you have to go back for another shot, you’ll want your card to be unlaminated so that the next booster can be added to the lines below your existing shots.

Boosters are exactly what they sound like: additional shots that add to the immunity provided by the initial round. Experts like Hotez believe we’ll likely need COVID-19 boosters to lengthen the amount of time immunity for COVID-19 lasts and to combat emerging variants. Hotez added that he doesn’t believe it’ll be an annual thing—as in, we won’t be getting COVID shots at the same regularity as flu shots—but is almost certainly going to be something we all do again, as COVID continues to spread around the globe.

What about getting it tattooed on my body?

Go with God.

If you’re cool with your full name and DOB being printed on your body, and feel so compelled to memorialize this moment in scientific history, by all means, get it tatted. Might look pretty sick on a bicep.

Follow Hannah Smothers on Twitter.