Understand the Data on COVID-19 Vaccines and Long COVID

Since the early days of the COVID-19 pandemic, pharmacists and other health care professionals have been tasked with navigating the challenging landscape of COVID-19 vaccines. Given the variety of vaccine products and cap colors available from different manufacturers, along with the constantly changing recommendations for their use and the guidelines on who should receive doses and boosters and when, it is no surprise that the CDC and its Advisory Committee on Immunization Practices have sought to simplify their recommendations in the most recent updates.¹ This simplification is important for improving vaccine uptake, but it is also critical for pharmacists to stay up to date on the newer education topics surrounding COVID-19 so they can effectively counsel their patients.

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In addition to the confusion surrounding COVID-19 vaccines, post–COVID-19 condition, or long COVID, is a new threat to the health of patients, and the most concerning factor is that it is not widely understood.² Educating patients on the threat of long COVID and how vaccines can help prevent it can be key in their vaccine decision-making process.

Long COVID is a serious illness that can result in chronic conditions that can last weeks, months, or even years after COVID-19 illness. Anyone who had a COVID-19 infection, including children, can experience long COVID. New data from the Medical Expenditure Panel Survey Household Component support prior findings that approximately 7% of US adults have had long COVID. The survey found that an estimated 6.9% of adults (approximately 17.8 million people) reported having long COVID as of early 2023.³

Long COVID includes a wide range of symptoms or conditions that may improve, worsen, or be ongoing. Long COVID is difficult to diagnose, for multiple reasons. Most importantly, it is not 1 single illness and can manifest in myriad ways. Secondly, there is no laboratory test that can determine whether symptoms or conditions are due to long COVID or another illness. Common symptoms of long COVID include fatigue (especially after activity), cough or shortness of breath, problems with memory (brain fog), lightheadedness or dizziness, problems with taste or smell, sleep disturbances, new or worsening headaches, fast or irregular heartbeat, and digestion problems.^2,4

The good news is that clinicians have a way to help prevent long COVID: The CDC states that COVID-19 vaccination is the best available tool to prevent long COVID.² Some patients believe that natural immunity is superior to immunity gained from vaccines, but the CDC refutes this argument. CDC data highlight that the risk of long COVID is present only among those infected with the virus and the risk of developing long COVID increases with severity of infection. The CDC states, “COVID-19 vaccination causes a more predictable immune response than an infection with the virus that causes COVID-19.”⁵ It also states that “staying up to date on COVID-19 vaccination supports avoiding severe COVID-19 illnesses, which directly helps prevent long COVID.”² It is important to ensure that patients understand all the risks, including long COVID, if they choose to not get vaccinated, so that they can make the most informed decision.

The current COVID-19 vaccine recommendation is for everyone 6 months and older to receive a dose of any of the updated 2024-2025 COVID-19 vaccines (Spikevax from Moderna, Comirnaty from Pfizer, or the Novavax vaccine). Patients 65 years or older and those who are immunocompromised are eligible for a second dose at least 6 months later. This is a universal annual recommendation, just like the recommendation for annual influenza vaccines.⁶ Simplifying the recommendation makes it easier for pharmacists to talk to patients about the other vaccine barriers instead of focusing on intricacies of the recommendations.

This simplification of the recommendation is important because, despite the extensive efficacy and safety data available, there are more barriers than ever to vaccine uptake.⁵ Barriers to COVID-19 vaccination today are numerous and include lack of transportation and mis- or disinformation. However, these can often be overcome with community support, motivational interviewing, proper education, and facts.⁷ Providing facts about long COVID can be an effective strategy to help overcome vaccine hesitancy. Long COVID is relatively new, and many patients are likely not aware of the risks.

Community pharmacists know that each patient has unique concerns, questions, and feelings about getting vaccinated. Armed with up-to-date information, pharmacists can provide their patients with a reason to overcome vaccine barriers, as avoiding a long-term illness such as long COVID may be more important to the customer than their other concerns.

REFERENCES

1. Interim clinical considerations for use of COVID-19 vaccines in the United States. CDC. Updated September 9, 2024. Accessed September 24, 2024. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interimconsiderations-us.html

2. Long COVID basics. CDC. July 11, 2024. Accessed September 24, 2024. https://www.cdc.gov/covid/longterm-effects/index.html

3. Fang Z, Ahrnsbrak R, Rekito A. Evidence mounts that about 7% of US adults have had long COVID. JAMA. 2024;332(1):5-6. doi:10.1001/jama.2024.11370

4. Long COVID: lasting effects of COVID-19. Mayo Clinic. August 23, 2024. Accessed September 24, 2024. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

5. Myths & facts about COVID-19 vaccines. CDC. August 30, 2024. Accessed September 24, 2024. https://www.cdc.gov/covid/vaccines/myths-facts.html

6. CDC COVID-19 vaccine guidelines: when is the new COVID vaccine coming out in 2024? American Medical Association. September 4, 2024. Accessed September 24, 2024. https://www.ama-assn.org/delivering-care/public-health/cdc-covid-19-vaccine-guidelines-whennew-covid-vaccine-coming-out

7. Hsu A, Trotman R. Overcoming vaccine hesitancy, skepticism, and hostility in Missouri. Mo Med.2021;118(5):396-400.