Updated January 18th, 2021

This past week marked the first full month since hundreds of thousands of vials for the COVID-19 vaccine rolled into New York and New Jersey after the U.S. Food and Drug Administration authorized emergency use for two versions of the drug: one produced by Pfizer and its German partner BioNTech; the other manufactured by Moderna.

On December 13th, New York and New Jersey received their first shipments of the Pfizer-BioNTech vaccine, containing 170,000 and 76,000 doses, respectively. The next day, Sandra Lindsay, an intensive care nurse at Long Island Jewish Hospital, became the first person in the United States to receive the vaccine, prompting what many viewed as the beginning of the end. Her vaccination came just three days after the Pfizer-BioNTech shot was authorized.

Despite its long-anticipated arrival, the rollout has been sluggish, due to the insufficient supply delivered to New York, vaccine hesitancy, restrictions on eligibility, and clearing logistical hurdles in dispatching the vaccines to millions of people across the state. To date, figures from the Centers for Disease Control and Prevention show that of nearly 1.8 million doses allocated to New York, 632,473 people have received a first dose.

In New York City, figures show 794,650 doses have been delivered as of January 14th, but less than half of this allotment has been distributed—with 303,671 initial doses administered and 37,114 people receiving a second. Mayor Bill de Blasio has since announced a goal of getting 1 million doses into the arms of New York City residents by January 31st.

But even with New York and New Jersey’s vaccination efforts underway, hanging up your mask to breathe a sigh of relief is still not recommended. If the vaccines prevent spread, around 75% of the population would need to be fully immunized to achieve herd immunity. If that’s accomplished by summer 2021, it’s possible that by the end of next year, “we can approach very much some degree of normality that is close to where we were before,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in December.

With so much that’s changed in the last month, Gothamist/WNYC updated our explainer on how the vaccine rollout has gone so far.

Here’s What We Know So Far

How will the vaccines be administered?

Both the Pfizer-BioNTech vaccine and the Moderna vaccine require two doses per person to achieve full immunity. Pfizer-BioNTech doses have been spaced 21 days apart, while Moderna’s period between shots is 28 days.

While the Pfizer-BioNTech vaccine was approved for anyone older than 16, the Moderna shot is available to people age 18 and older.

How effective are the vaccines?

Pfizer and BioNTech say after the second dose, their vaccine proved 95% effective in preventing recipients from developing COVID-19 symptoms in clinical trials. Moderna claims its vaccine is 94.1% effective.

In a study published in the New England Journal of Medicine, the Pfizer-BioNTech vaccine is 52% effective upon the first dose. In its application to the FDA for emergency use authorization, the first dose of the Moderna vaccine is 51% effective two weeks after taking the first dose. However, too few people in each study received a single dose to draw conclusions about what missing a second dose means for long-term protection.

More research will be required to determine how long vaccine immunity lasts and whether recipients will ultimately need a booster shot after the two doses.

Can people who have been vaccinated still spread the virus?

It’s still unclear. Clinical trials for the Moderna and Pfizer-BioNTech vaccines studied whether participants were protected against symptoms but not whether they could still catch and pass it on to others.

Much of that is because the CDC did not ask Moderna and Pfizer whether the vaccine can stop the spread of the virus.

On its FAQ page, the CDC recommends those vaccinated continue wearing face masks, wash their hands, and remain socially distant until the drugmakers and health regulators determine whether the vaccine prevents transmission of the virus.

One immunologist, Deepta Bhattacharya from the University of Arizona, told The New York Times in December: “Preventing severe disease is easiest, preventing mild disease is harder, and preventing all infections is the hardest.”

How do the vaccines work?

Both the Pfizer-BioNTech and Moderna vaccines use genetic material known as messenger RNA to instruct the body’s cells to produce a protein that’s typically made by the coronavirus. After the viral proteins are created, the genetic material from the vaccine is destroyed, and it cannot alter our human DNA.

The viral proteins can’t cause full-blown COVID-19, but they can be recognized by our immune system, which builds an arsenal of antibodies and white blood cells to fight future infections.

Other vaccines in development work differently, but none of them require injecting people with the full strength virus.

Do the vaccines have any negative side effects?

Some people have reported experiencing initial side effects such as pain at the injection site, headaches, fevers, fatigue, muscle and joint pain, and chills linked to both vaccines. Such side effects are common with vaccines, but that doesn’t mean they’re unsafe.

Rare severe cases—including one reported in New York City on December 23rd—have produced anaphylactic allergies that require treatment.

On January 6th, a CDC report showed only 21 of 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine administered during the initial 10 days of the rollout produced severe anaphylaxis. Nineteen of those 21 cases were successfully treated with epinephrine, the drug in EpiPens. In early January, the CDC recommended anyone who experienced a severe allergic reaction to the first dose from either brand to avoid getting the second dose. It’s unclear how the other two patients—women ages 30 and 41—were not treated with epinephrine but were taken to an emergency room, where they immediately recovered and released.

In Phase 3 trials of the Moderna vaccine, more than half of the recipients reported side effects, though most were mild such as fatigue, chills, headache, muscle pain, or soreness at the injection site. During Phase 3 trials of the Pfizer-BioNTech vaccine, about 3.8% of participants reported fatigue, and 2% experienced headaches.

“Just because you’re sore doesn’t mean that [the vaccine] didn’t work or wasn’t effective,” Dr. Melanie Swift, an occupational medicine physician helping to lead COVID-19 vaccination at the Mayo Clinic, told USA Today last month. “It just means that your body responded the way it’s supposed to.”

What about the people who had allergic reactions to the vaccine in the U.K.?
Two health care providers who received the Pfizer-BioNTech vaccine in the U.K. last month experienced anaphylactoid reactions (both recovered after using EpiPens). The U.K.’s National Health Service is now recommending that people with a history of severe allergic reactions avoid the Pfizer-BioNTech vaccine.

Infectious disease experts say it’s essential to learn more about the effects of the vaccine, rather than ruling out its use for the roughly 10 to 16 million Americans prone to severe allergic reactions.

Fauci said last month that such reactions are most likely rare, but if they’re prevalent among a certain subset of the population, those at risk may need to wait for one of the other vaccines in development.

How many doses have New York and New Jersey received?
New York state received an initial 170,000 doses of the Pfizer-BioNTech vaccine on December 13th and reserved it specifically for healthcare workers who treat COVID-19 patients. By the end of 2020, the total number of doses delivered to regions across New York state was 521,518. The federal government has based vaccine distribution on population estimates determined by the U.S. Census Bureau’s 2019 5-Year American Community Survey.

Over the last several weeks, Cuomo said the number of doses delivered to the state weekly has stabilized, with Governor Andrew Cuomo reporting that 300,000 doses are delivered by the federal government weekly through the Operation Warp Speed program. The same stability has not applied to New York City. Both Cuomo and de Blasio have been pressing the federal government to provide more vials to quickly achieve herd immunity.

The number of doses shipped to each state has been based on its adult population, according to federal officials. The federal government initially ordered 100 million doses of the Pfizer-BioNTech vaccine, and then another 100 million doses to be delivered by late June. The U.S. also purchased 200 million vaccines from Moderna and hundreds of millions more doses from companies that are still in the process of testing their vaccines, including AstraZeneca and John & Johnson.

New Jersey Governor Phil Murphy says there may be 460,000 doses by mid-January. The initial batch from Pfizer is 76,000 doses, and the first vaccine was administered at University Hospital in Newark on December 15th.

Who has already received the first vaccination?

The CDC introduced a set of recommendations that categorized who should be prioritized for the shot. Those categories were broken down into two phases, with subcategories also established for Phase 1.

Phase 1a comprises those in the healthcare sector, with the shot initially intended to those who directly treat COVID-19 patients at hospitals. The vaccine was also made available to nursing home residents under a federal program that allows providers to partner with big chain pharmacies to deliver the shot. That program was implemented in New York on December 21st.

Because New York received a low supply when compared to the population, the state initially limited the vaccine to those with direct contact with COVID-19 patients, excluding non-medical personnel who work in public health clinics and home care workers. Even with the belief that medical personnel would seek to get inoculated, an estimated 30% of healthcare workers eligible for the shot under Phase 1a declined a shot. This subsequently led hospitals to throw away vaccines.

Cuomo blamed hospitals for not administering the shot to those eligible and threatened to fine them if they didn’t use all their vaccines. De Blasio argued that with some people in the high-priority category declining a shot for the moment, Cuomo open the vaccine to everyone in Phase 1a.

Cuomo relented on January 8th, loosening guidelines and allowing anyone working inside a hospital, including medical workers outside a hospital setting such as home care and hospice workers, to receive the shot. Priority would still be given to those in the initial Phase 1a rollout.

When did the vaccine become available to the general public?

On January 8th, Cuomo began allowing segments of Phase 1b to receive the vaccine. The group is the largest in the state, composed of 3.2 million people, including municipal employees such as teachers and police officers, the homeless, grocery store workers, and in-person college professors. On January 12th, the state also cleared those who are age 65 and over to receive the shot, following recommendations by the CDC.

Cuomo also gave municipal unions the freedom to create their own distribution apparatus for respective members to help offload any strain on city- and state-run distribution operations.

Other essential workers falling in the Phase 1b category will be announced by the state sometime in February, followed by those in the Phase 1c category that will happen around March or April. New Yorkers in Phase 2 will receive the shot over the summer.

Widespread vaccine distribution is still expected by spring 2021, according to Fauci and U.S. Department of Health and Human Services Secretary Alex Azar.

Where can I set up an appointment?

A detailed look at the frustrating process of making an appointment can be found here.

How have vaccines been distributed once they arrived?

The Pfizer-BioNTech vaccine must be stored at ultra-cold temperatures—negative 70 degrees Celsius—that not all facilities can accommodate. Moderna’s vaccine is more durable than Pfizer-BioNTech, with vials capable still efficient if stored in a regular refrigerator at a temperature between 2 and 8 degrees Celsius (36°F and 46°F) for up to 30 days.

New York has identified 90 regional distribution centers to receive the vaccines. In New York City, more than 50 hospitals have freezers that can store the vaccine and the city Health Department can store hundreds of thousands of doses as well, for a total citywide capacity of 2 million doses.

Hospitals, as well as shipping companies like FedEx, have also placed large orders for dry ice in order to ensure the vaccine’s successful transport.

Where will people get vaccinated?

In New York City, de Blasio opened two types of vaccination sites that fall outside a hospital. That includes a so-called 24/7 “mass vaccination site” that offers round-the-clock immunizations, with roughly 5,000 to 7,000 doses administered in one single day. Citi Field and Yankee Stadium are among the 24/7 sites chosen.

Other smaller sites have opened from 9 a.m. to 7 p.m. every day. Though de Blasio said priority will be given to 27 communities hit hard by the virus, the sites are scattered throughout the city. By the end of the month, a total of 250 locations will be up and running across the five boroughs.

On January 11th, the state activated its vaccination campaign, opening several vaccination sites across the state, including one at the Jacob Javits Center in Manhattan. The state also plans to partner with “thousands” of qualified pharmacists across the state to administer the vaccine.

How much will the vaccine cost?

The vaccine is supposed to be free for everyone, regardless of what kind of insurance they have or if they are uninsured.

The federal Centers for Medicare and Medicaid Services has laid out a plan to make sure this happens, including a program that will reimburse health care providers for administering the vaccine to uninsured people.

CMS also aims to create special billing codes for the vaccine that will be easily recognized by insurers. Still, health care billing is an imprecise science, so it will be necessary for vaccine recipients to keep an eye out for any unanticipated charges.

Additional reporting by Jen Chung and Sydney Pereira.