COVID-19: Who Should Be Vaccinated?
Philip A. Chan, MD, Contributor
COVID-19: Who Should Be Vaccinated?
On August 27, the United States Food and Drug Administration (FDA) announced that updated COVID-19 vaccines were approved for 2025-2026. Vaccines have already been shipped and people have reported being able to access these vaccines. So, who should be vaccinated and what does the data show?
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The following COVID-19 vaccines were approved by the FDA (Note the slightly different age groups for each vaccine product):
Pfizer/BioNTech: 65 years and older OR 5-64 years with at least one underlying medical condition that places them at high-risk for severe COVID-19;
Moderna: 65 years and older OR 6 months through 64 years with at least one underlying medical condition that places them at high-risk for severe COVID-19;
Novavax: 65 years and older OR 12-64 years with at least one underlying medical condition that places them at high-risk for severe COVID-19;
In 2024, the Centers for Disease Control and Prevention (CDC) recommended that “everyone ages six months and older receive an updated 2024-2025 COVID-19 vaccine.” (Source) However, the recent FDA approval limits the use of COVID-19 vaccines for this year. In addition, the CDC Advisory Committee on Immunization Practices (ACIP) is scheduled to meet later this month. Historically, most physicians and other medical providers have followed the recommendations of the ACIP. Importantly, insurers have also covered vaccines based on ACIP recommendations so people don’t have to pay for vaccines themselves. However, the Secretary of Health and Human Services, Robert F. Kennedy Jr., fired all 17 members of the ACIP in June of 2025 and appointed new individuals, many of whom have expressed vaccine skepticism in the past. In addition, Kennedy recently fired Dr. Susan Morarez, PhD, over disagreements in vaccine policy. It’s unclear what the “new” ACIP will recommend.
In terms of who should be vaccinated, the biggest risk factor for COVID-19 remains age. The data and evidence clearly show that the older you are, the higher the risk of severe COVID-19. Based on COVID-19 hospitalization and death data, compared with ages 18–29 years, the risk of death is 25 times higher in those ages 50–64 years, 60 times higher in those ages 65–74 years, 140 times higher in those ages 75–84 years, and 340 times higher in those ages 85+ years.
Source: www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html
As a physician, I recommend COVID-19 vaccination in people who are 50 years of age and older.
There is also overwhelming data and evidence that people with underlying medical conditions are at higher risk of severe COVID-19. Underlying conditions which increase the risk of severe COVID-19, per the CD,C include:
Lung disease (Asthma, COPD, and many other pulmonary disorders)
Cancer
Cerebrovascular disease including strokes
Chronic kidney disease
Chronic liver disease (cirrhosis, alcohol liver disease, autoimmune hepatitis, and other liver disease)
Diabetes type 1 and 2
Obesity
Physical inactivity
Smoking (current and former)
Cystic fibrosis
Disabilities including Down Syndrome
HIV and other immunodeficiency syndromes
Use of steroids or other immunosuppressive medications
Heart conditions (heart failure, coronary artery disease, and others)
Mental health conditions (depression, schizophrenia and others)
Neurologic conditions (dementia and Parkinson’s)
Pregnancy and recent pregnancy
Solid organ or blood stem cell transplantation
Tuberculosis
Source: www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html
It’s also interesting to note what other countries recommend in terms of COVID-19 vaccination:
Australia (65+ years and/or underlying health conditions)
Belgium (>65 years and/or underlying health conditions, healthcare workers, household contacts of those at high risk)
Canada (65+ years and/or underlying health conditions, healthcare workers)
Denmark (65+ years and/or underlying health conditions)
Finland (75+ years and/or underlying health conditions)
France (80+ years and/or underlying health conditions)
Germany (60+ years and/or underlying health conditions, household contacts of those at high risk)
Netherlands (60+ years and/or underlying health conditions)
Norway (45+ years and/or underlying health conditions)
Sweden (80+ years or 65-79 years with daily care needs; <65 years by prescription only)
Switzerland (65+ years or 16+ years with underlying health conditions)
United Kingdom (75+ years and/or underlying health conditions)
Source: www.nejm.org/doi/full/10.1056/NEJMsb2506929
It’s clear that the COVID-19 vaccine can reduce your risk of severe COVID-19, which includes reducing your risk of being hospitalized and/or dying from COVID-19. Studies of the 2024-2025 COVID-19 vaccine show that it was 33% effective against COVID-19–associated emergency department or urgent care visits among adults aged ≥18 years and 45%–46% against hospitalizations among immunocompetent adults aged ≥65 years, compared with not receiving a 2024–2025 vaccine dose. In addition, recent studies also strongly suggest that vaccination helps prevent long COVID.
The benefit of COVID-19 vaccination is less clear in some groups and particularly among low-risk persons who have previously received multiple doses of COVID-19 vaccines and/or had multiple infections. More data is needed to understand the risks and benefits of vaccination in this group. There could be benefits in terms of reducing infection and transmission to others. There is some evidence that recent vaccination reduces infection and not just the severity of disease. However, more data is needed on this.
The COVID-19 vaccines are quite safe, including the most recent 2024-2025 vaccines (Source). The most common reactions are pain and swelling at the injection site, as well as some fatigue and headache. I often explain to my patients that this means the vaccine is working and your body is making antibodies to fight COVID-19. There have been rare cases of inflammation of the heart (myocarditis) reported after COVID-19 vaccination. However, this is rare and most people who had this recovered following rest and simple treatments. Importantly, the vaccine cannot give you a COVID-19 infection. The only true medical contraindication to the vaccine is if you have an allergic reaction to the vaccine. The vaccine is safe in people who are pregnant or breastfeeding.
As a physician, and based on the data above, I routinely discuss COVID-19 vaccination with all my patients. For individuals 50 years of age and older, and/or those with underlying medical conditions, I generally recommend and encourage COVID-19 vaccination. For individuals who are younger and who do not have any underlying medical conditions (which I find uncommon), I offer the COVID-19 vaccine. I also recommend vaccination for people who are around others who are at higher risk. This could include people who live with an older person or someone with an underlying medical condition (which I find is a lot of people), or those of us in healthcare who routinely care for people who are at high risk.
At the end of the day, if you have any questions, I would make sure to discuss COVID-19 vaccination with your medical provider.
As a healthcare worker, I continue to receive my routine COVID-19 vaccines to protect my patients and those around me as best I can.
Philip A. Chan, MD, works for Open Door Health, the Rhode Island Public Health Institute, the Rhode Island Department of Medicine, and Brown University Health.