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COVID-19 Vaccine

COVID-19 Vaccine Information for Older Adults
Last updated April 15, 2021

The following information is being provided to GSA members who work with older adults and wish to support conversations about COVID-19 vaccine. For timely updates and shareable resources from HHS, consider joining the COVID-19 Community Corps.

Results of COVID-19 vaccine trials have been more positive than anticipated, and products are now entering the market through emergency use authorizations (EUAs) from the U.S. Food and Drug Administration (FDA). Information related to the development of COVID-19 vaccine changes rapidly. While GSA tries to keep this information up to date, consider verifying specific numbers and licensure stages at the links provided or other publicly available sources.

If you have a question that is not answered below, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..

What is known about the safety and efficacy of COVID-19 vaccines? Were older adults included in clinical trials?

Since the first weeks of COVID-19 spread in the United States, older adults have been at higher risk of infection, disease, severe symptoms and hospitalization, and death. Approximately 4 in 10 of patients needing hospitalization were 65 years of age or older and 80% of those who died of COVID-19 were in this age group. Long-term care facilities have accounted for an inordinate number of cases and deaths, even though only about 1.3 million Americans reside there.

Following clinical trials conducted in small numbers of people (phase 1 and phase 2 trials), phase 3 trials are launched to establish efficacy and safety of vaccine candidates. As of early January 2021, Pfizer/BioNTech and Moderna COVID-19 vaccines have been approved for emergency use authorization (EUA) from FDA. The limited details currently available from these trials are shown in Figures 1 and 2. As of early March 2021, Janssen COVID-19 vaccine also has been approved for emergency use authorization from FDA, and details are shown in Figure 3. 

As of April 13, 2021, the FDA and CDC put a pause on administration of Janssen COVID-19 vaccine to investigate 7 cases of a rare and severe type of blood clot among 6.8 million doses of vaccine delivered. The cases are among women aged 18-48. The CDC is providing updated information as more is learned and recommendations are updated.

Figure 1. Phase 3 Results for the Ongoing Pfizer/BioNTech mRNA COVID-19 Vaccine (BNT162b2)

Source: New England Journal of Medicine article and editorial; Pfizer website and news release.

figure 1

Figure 2. Phase 3 Results for the Ongoing Moderna mRNA COVID-19 Vaccine (mRNA-1273)

Source: Moderna phase 1 update news release, enrollment completion news release, and phase 3 news release.

figure 2

Figure 3. Phase 3 Results for Ongoing Jannsen Adenovirus COVID-19 Vaccine (Ad26.COV2.S)

Source: Johnson & Johnson website, ACIP slide presentation, and the FDA website and press release

figure 2

What is the difference between an emergency use authorization and FDA approval? 

Taken from the FDA website: "Emergency Use Authorization (EUA) is one of several tools the FDA is using to help make certain medical products available quickly during the COVID-19 pandemic. In certain emergencies, the FDA can issue an EUA to provide access to medical products that may potentially be used when there are no adequate, approved, and available options.

The EUA process is different than an FDA approval or clearance. Under an EUA, in an emergency, the FDA makes a product available to the public based on the best available evidence, without waiting for all the evidence that would be needed for FDA approval or clearance.

When evaluating an EUA, the FDA carefully balances the potential risks and benefits of the products based on the data currently available.

EUAs are effective until the emergency declaration ends. EUAs can also be revised or revoked by the FDA at any time as they continue to evaluate the available data."

It is anticipated that most COVID-19 vaccines will seek full FDA approval (clearance, licensure) as more data become available and the emergency declaration ends. 

Where will COVID-19 vaccine be available?

The Centers for Disease Control and Prevention (CDC) is leading states in developing plans to distribute vaccines. Each state has its own plan, and final decisions regarding distribution of vaccines are made at the state level. The plans are based on several factors:

  • Priority groups as determined by the Advisory Committee on Immunization Practices (ACIP) at CDC (see next section), with final decisions made at the state level.
  • Storage needs of the vaccine. For example, the Pfizer/BioNTech vaccine requires ultracold storage and will likely be distributed through academic medical centers to health care professionals first. More temperature-stable vaccines will likely be the ones shipped to offices and pharmacies.
  • The Pharmacy Partnership for Long-term Care is coordinating vaccine distribution and administration in long-term care facilities. The pharmacy chains CVS and Walgreens are contracted with the federal government to conduct 3 vaccination days at participating facilities for both residents and staff to receive each of the 2 doses required for the initially available vaccines. With many LTC facilities completing their 3 vaccination days, staff who initially declined a vaccination will need to find an appointment at the same locations as other eligible individuals in the state.
  • Pfizer has provided a U.S.distribution fact sheet with additional details about how they are shipping vaccines in collaboration with the government.
  • With more vaccine availability, vaccinefinder.org has been activated to share sites that have available vaccine.

Who will get the COVID-19 vaccine first?

While technically states have the last say regarding who gets vaccine and in what order, most are expected to follow recommendations of the CDC’s ACIP. Using ethical principles to guide its decisions (benefits/harms, health inequities, justice, transparency), this group recommended and the CDC Director agreed to initially offer COVID-19 vaccines to both health care personnel and residents of long-term care facilities. Paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials are eligible for vaccination.

ACIP will vote later on which groups should be vaccinated next; Figure 3 shows the current thinking of an ACIP work group.

Figure 4. Proposed Interim Phase 1 Sequence

figure 3

Abbreviations: HCP = health care professionals; LTCF = long-term care facility.
Source: Dooling K. Presentation to the Advisory Committee on Immunization Practices, November 23, 2020.


The National Academies of Sciences, Engineering, and Medicine was also commissioned to develop a report on equitable allocation of COVID-19 vaccine. Its final recommendations are similar to those made later by the ACIP.

What is Operation Warp Speed? How is the federal government involved in the development of COVID-19 vaccines?

Operation Warp Speed is a multi-agency collaboration that has successfully accelerated the COVID-19 vaccine discovery and testing process. By investing money in some companies’ research and development process, paying for manufacture of some doses before clinical testing is completed, and agreeing to purchase doses once products are approved for marketing, the federal government accelerated activities of partnering companies.

Not all companies participate in all components of Operation Warp Speed. For example, Pfizer developed its vaccine without research and development or manufacturing costs. But the government contracted to purchase doses if a vaccine is shown to be effective and receives FDA approval (which has now occurred under an emergency use authorizations).

What is the best way to approach the topic of vaccination with people who may be hesitant?

A December 3 webinar provided updates for health professionals on CDC’s vaccine planning and implementation, including vaccine distribution strategy, current state planning efforts, and the COVID-19 “Vaccinate with Confidence” strategy. This national strategy is intended to reinforce trust in COVID-19 vaccines, empower health care providers in getting vaccinated and recommending the vaccine to patients, and engaging communities in a discussion about these vaccines.

CDC also recommends the SHARE strategy for strongly advocating COVID-19 vaccines:

  • SHARE the tailored reasonswhy the recommended vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.
  • HIGHLIGHT positive experienceswith vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in vaccination.
  • ADDRESS patient questionsand any concerns about the vaccine, including side effects, safety, and vaccine effectiveness in plain and understandable language.
  • REMIND patients that vaccines protect them and their loved onesfrom many common and serious diseases.
  • EXPLAIN the potential costs of getting the disease, including serious health effects, time lost (such as missing work or family obligations), and financial costs.

What other COVID-19 vaccines are in development?

Dozens of other COVID-19 vaccines are in development in the United States and other countries. For the most up-to-date information on progress for individual vaccines and therapeutics, visit the BIO COVID-19 Therapeutic and Development Tracker: https://www.bio.org/policy/human-health/vaccines-biodefense/coronavirus/pipeline-tracker

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