On Dec. 14, the first Americans were vaccinated with Pfizer’s COVID-19 vaccine, a landmark moment as the country struggles to contain the ongoing pandemic.

The first inoculation went to one of the people with the highest need — an ICU nurse at Long Island Jewish Medical Center in New York, one of the hospitals hardest hit by COVID-19 at the start of the pandemic. Over the rest of the day, week and month, millions more will be vaccinated with Pfizer’s vaccine.

But when can every American get the vaccine, and how will vaccinations work? Those are some of the many questions still lingering as the lengthy vaccination process begins. Here’s what is currently known about how to get vaccinated against COVID-19.

Who Will Get Vaccinated First?

The first doses of the COVID-19 vaccine are going to those at the highest risk — frontline health care workers and the residents and staff of long-term nursing facilities, which have been ravaged by the virus. An advisory panel at the Centers for Disease Control voted in early December that those groups should get priority, and they are expected to recommend that the next doses go to essential workers, such as emergency responders, grocery workers, public transit workers, teachers, correction officers and police officers.

Adults over 65 years old and those with preexisting conditions would likely go next. And the last group of Americans, healthy, younger adults with non-essential jobs, probably won’t be vaccinated until late spring or early summer.

However, while the CDC will make recommendations for the order for vaccinations, the final decision is actually up to individual states. To stay up-to-date on state vaccination decisions, check state health department websites.

How Does the Vaccine Work?

Currently, the Food and Drug Administration has approved just one vaccine for use, Pfizer’s; however a second one from Moderna is expected to also receive emergency use approval this week. Both vaccines require two shots to be fully effective, meaning that people will need to plan for two trips to the doctor.

With Pfizer’s vaccine, the shots are given three weeks apart. The first shot appears to be about 50 percent effective in preventing COVID-19 infection, and the second one brings it up to around 95 percent effectiveness.

Where Can People Get Vaccinated?

Health care workers and nursing home residents will be vaccinated at their facilities. For everyone else, at pharmacy chains, like CVS and Walgreens, and eventually, at doctor’s offices. Some areas may also set up mobile vaccination sites or drive-thru clinics to reach underserved communities.

One issue, though, is that Pfizer’s vaccine needs to be kept extremely cold — at minus 70 degrees, colder than Antarctica in the winter. That requires special freezer setups that could complicate vaccine distribution, though Pfizer has created special packaging to make the process easier. And Moderna’s vaccine will be simpler — it needs to be kept at just minus 20 degrees, which a normal freezer can do.

How Much Will the Vaccine Cost?

It won’t cost Americans a penny to get vaccinated against COVID-19. The federal government has promised that it will be free, and the incoming Biden administration is expected to say the same. The U.S. government has already spent $7.76 billion on vaccines from four companies, Pfizer, Moderna, AstraZeneca and Novavax.

"We've paid for the vaccines, we paid for the shipping costs, and the administration costs … will be covered by healthcare payers, private insurance, Medicare, Medicaid, and our program to cover COVID-19 expenses for the uninsured," Health and Human Services Secretary Alex Azar said December 3.

Is the Vaccine Safe?

Yes, any vaccine that the FDA has approved for use has been tested and analyzed to ensure its safety. In Pfizer’s case, more than 44,000 volunteers tested the vaccine and were monitored for any issues, and the FDA found it to be safe and effective against COVID-19.

Americans who get the vaccine, though, should be prepared for mild side effects. Some trial volunteers said that they experienced pain at the injection site, fatigue and occasionally mild flu symptoms such as a fever 24 hours after getting the shot, particularly the second dose. However, the symptoms resolved in a few hours and could be managed with over-the-counter pain medications like Aleve.

Is There Anyone Who Shouldn’t Get the Vaccine?

Currently, Pfizer’s vaccine is only approved for people aged 16 and older, as they only just started testing it on younger volunteers. Until the company collects more data on safety in kids, those below age 16 will not be able to get vaccinated. The American Academy of Pediatrics said that they hope to have a vaccine approved for children around the start of the 2021-22 school year.

Those with a history of severe allergies should also wait on the vaccine until more data is available, or get it in a hospital setting, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said. During the United Kingdom’s first week of vaccinations, two health care workers with serious allergies had an allergic reaction to Pfizer’s vaccine, and the company is currently working to determine if the vaccine caused the reaction. During clinical trials, there were no severe allergic reactions to the vaccine.

Another major question is whether pregnant women should get vaccinated. They were excluded from clinical trials, however, during Pfizer’s trial 23 people got pregnant, and none who received the vaccine had adverse effects.

The FDA did not restrict pregnant women from getting the Pfizer vaccine. The best plan is for pregnant women to talk with their doctors to decide.

Do People Still Need to Wear Masks After Getting Vaccinated?

Yes — life is not going to immediately go back to pre-pandemic times. Americans should expect to continue wearing a mask and social distancing for most of 2021, as people slowly get vaccinated. With the gaps in vaccinations and doses — and the lingering question of whether vaccinated people can unknowingly transmit the virus without getting sick — masks are still needed. Eventually, enough people will be vaccinated to slow down COVID-19 infections and hopefully end the pandemic, but until that happens they should stick to coronavirus safety precautions.

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