COVD-19 vaccination – answers to the most important questions

Vaccination provides protection against developing a severe form of COVID-19 and reduces the risk of potential long-term consequences. Vaccination also helps to ease the burden on the healthcare system and prevent shortages of medical care. 

At a glance

  • Vaccination against COVID-19 has an important role to play in helping to stem the pandemic. The COVID-19 vaccines available in Germany are very effective and safe based on current knowledge. 
  • The Standing Committee on Vaccination in Germany (STIKO) recommends COVID-19 vaccination for all people aged 5 and older.
  • In particular, vaccination provides protection against getting the severe form of COVID-19, even if infected with a variant of the virus – provided people are fully vaccinated.
  • Immunity declines over time. A vaccinated person can still become infected. However, people who have been vaccinated are far less likely to require treatment in hospital.
  • To prevent severe infections, STIKO recommends a booster vaccine dose following double vaccination for everyone aged 12 and older and for children aged 5 and older who have a pre-existing health condition.
  • STIKO recommends a second booster vaccine for people who are at a particularly high risk of infection or of developing a severe form of the illness. 

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

A doctor vaccinating an older woman with an injection into her upper arm.

What are the benefits of COVID-19 vaccinations?

Vaccinations play a crucial role in containing the pandemic. The more people that are vaccinated against COVID-19, the more quickly the spread of SARS-CoV-2 and its variants can be halted.

In particular, there is less risk of becoming seriously ill with COVID-19 or developing long-term health problems and symptoms after an infection – also known as long COVID.

Being vaccinated also protects other people who cannot be vaccinated because of certain pre-existing conditions or because vaccination is not recommended for them. The higher the vaccination rate, the better society as a whole is protected.

Important: Even people who have been vaccinated can still be infected with SARS-CoV-2 and pass on the virus to others. This makes it important to continue observing the infection control measures. It is also critical for people to top up their immunity when needed with a booster vaccine.

How do vaccinations work?

The video below explains how a vaccination works.

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What COVID-19 vaccines are there and how do they work?

Several coronavirus vaccines have been approved in Germany and the European Union. These are divided into mRNA vaccines, viral vector vaccines and protein-based vaccines.

The vaccines are all free from pathogens that are capable of replicating and cannot trigger illness. They are therefore classed as inactivated vaccines.

mRNA vaccines

The vaccines manufactured by BioNTech/Pfizer (Comirnaty) and Moderna (Spikevax) are mRNA vaccines. These are new kinds of vaccines that are classed as gene-based vaccines. They offer the advantage that they can be manufactured in the laboratory very quickly and cost-effectively.

The principle behind all COVID-19 mRNA vaccines is very similar. They are made from messenger ribonucleic acid (mRNA), a natural component of all cells. The mRNA in a body’s cell contains the blueprint for the building blocks of every cell in the body. In the case of the vaccines, the mRNA bears the blueprint for the spike protein, which sits on the surface of SARS-CoV-2.

The blueprint for the spike protein is packaged in nanoparticles. These are tiny lipid particles that are able to enter the body’s cells. As studies have shown, they do not pose any risk to humans.

After vaccination, the body’s cells use the blueprint to manufacture the spike protein themselves. This unfamiliar protein is not recognized by the body and triggers an immune response. The immune system is activated and produces antibodies that attack the spike protein and store information about how to fight it. If a person who has been vaccinated ever comes into contact with the spike protein from the actual virus later on, the immune system is able to mount a rapid, targeted response.

Important: The mRNA from the vaccines does not remain stable in the human body for long and is broken down quickly. Once this happens, the spike protein can no longer be produced. 

Viral vector vaccines

The Vaxzevria vaccine made by AstraZeneca and the JCOVDEN vaccine (previously the COVID-19 Vaccine Janssen) made by Janssen Cilag International/Johnson & Johnson are viral vector vaccines.

A viral vector vaccine delivers the blueprint to the vaccinated person by means of a vector, i.e. a carrier, which is usually a virus. 

Like mRNA vaccines, the viral vector vaccine is designed to make the body of the vaccinated person produce a specific viral protein. This is also known as the “spike” protein. Viruses that do not cause illness are used as carrier viruses. They have also been modified to prevent them replicating in the human body. Once the blueprint for the spike protein has entered several cells in the vaccinated person’s body via the vector, the spike protein is produced in these cells and triggers an immune response. Once the blueprint has been broken down, no further spike protein can be produced.

Protein vaccines

The group of protein-based vaccines includes the Nuvaxovid vaccine from Novavax. Unlike mRNA vaccines, which provide the genetic blueprint for the SARS-CoV-2 spike protein, Nuvaxovid contains a laboratory-produced spike protein linked to nanoparticles. That means that the human body does not have to actually produce it to trigger an immune response. To heighten the immune response – which is less intense than with mRNA vaccines for example – an active ingredient (adjuvant) is added.

For more detailed information on the COVID-19 vaccines that are approved in the European Union, visit the website of the Paul Ehrlich Institute (PEI).

How safe are COVID-19 vaccines?

All vaccines currently available in the European Union were thoroughly and carefully tested by experts to verify their quality, safety and effectiveness prior to their conditional approval. Furthermore, use of the vaccines is closely monitored to identify any side effects that may occur and any previously unknown risks. 

The approval process is coordinated by the European Medicines Agency (EMA). Approvals are issued by the European Commission.

Important: All approved coronavirus vaccines are generally considered to be safe and severe adverse effects have been very rare to date. 

The Paul Ehrlich Institute (PEI) regularly publishes up-to-date reports on the safety of COVID-19 vaccines. 

What does conditional approval mean?

If medicines or vaccines are urgently required – as in the case of the coronavirus pandemic – it is possible to speed up the testing procedure at the EMA to approve products more quickly. Conditional approvals are valid for one year and can be renewed on an annual basis. They come with certain obligations. For example, the manufacturers must launch or complete studies to clarify outstanding questions. If the obligations have been met and all relevant data has been provided, a conditional approval can be converted into full approval.

For more detailed information on the approval procedure for COVID-19 vaccines, please visit the website of the Paul Ehrlich Institute (PEI).

How effective are COVID-19 vaccines?

It normally takes 10 to 14 days for vaccination to take effect. This means that protection is not immediate.

Protection against getting COVID-19

According to current knowledge, all of the vaccines approved in Germany are highly effective and provide good protection against severe COVID-19 disease.

All of the vaccines approved so far are highly effective and provide good protection against severe COVID-19 disease.

Two vaccine doses are required for primary immunization. The length of time for which this protection remains effective is not yet entirely clear and depends on the dominant virus variant. The latest research indicates that a booster vaccination is needed for optimum protection, especially against variants such as Omicron.

The Standing Committee on Vaccination in Germany (Ständige Impfkommission, STIKO) recommends a booster dose following double vaccination for everyone over the age of 12, as well as for children aged 5 to 11 who have a pre-existing health condition. For information about the precise recommendations, please see the section dealing with the booster vaccine.

Infection and transmission even if a vaccine has been administered

People who have been vaccinated against COVID-19 can still become infected with SARS-CoV-2. The latest data indicates that vaccinated individuals who become infected with the Omicron variants are very likely to be contagious to a similar degree as unvaccinated individuals.

Similarly, a booster vaccine doesn’t appear to significantly reduce the risk of passing on the infection to others but it does offer discernibly better protection compared with primary immunization alone. Study results suggest that boosters prevent 1 to 2 out of 10 infections with the Omicron variant.

Important: To prevent potential infections, STIKO recommends still following the hands, face, space, ventilation (“AHA+L”) guidance, i.e. wearing a mask during everyday life, observing hygiene guidelines, physical distancing and regular ventilation.

Protection against variants of the virus

The genetic material in viruses changes over time – mutations occur and new variants develop. As a result, the effectiveness of vaccination may decline. Whether and to what extent this occurs depends, in particular, on the degree to which the spike protein changes and the specific sites where this happens.

To date, experts are unable to definitively say how effective the available COVID-19 vaccines are at protecting against the Omicron variant, which is currently the dominant variant in Germany. However, study results suggest that the protective effect of primary immunization against Omicron is significantly lower than against Delta – which was previously the dominant variant. A booster vaccination can significantly improve protection against serious illness due to infection with Omicron.

In addition, vaccine manufacturers are already working on mRNA vaccines that are adapted to the Omicron variant. Experts expect the first “variant vaccines” to be approved in early autumn 2022.

What reactions to vaccination and side effects might occur?

Vaccine safety is defined by the number and type of symptoms that occur following vaccination. These are classed as reactions to vaccination or side effects. 

Reactions to vaccination

Vaccinations against SARS-CoV-2 coronavirus are often followed by mild symptoms that appear quickly and only last a few days. These are referred to as reactions to vaccination. They include pain, reddening or swelling at the injection site and flu-like symptoms such as shivering, high temperature, headaches and aching muscles. People may also feel generally unwell or nauseous.

A reaction to a vaccination is not usually a cause for concern, and is instead an indication that the immune system has been stimulated as expected. In most cases a reaction to vaccination disappears after just a few days.

A reaction to a vaccination is not usually a cause for concern, and is instead an indication that the immune system has been stimulated as expected.

Safe reactions to vaccination are fairly common after administration of all the COVID-19 vaccines used so far. However, some people do not experience any reaction. This does not mean, though, that the vaccination is less effective.

Side effects

There have been rare cases of blood clots (thromboses) following administration of the viral vector vaccines made by AstraZeneca and Janssen Cilag International/Johnson & Johnson. Some of these blood clots formed at unusual sites, such as in the brain’s venous sinuses (as a cerebral venous sinus thrombosis or CVST). These were accompanied by a drop in the platelet count, referred to by specialists as thrombocytopenia.

The combination of blood clots and thrombocytopenia is a severe adverse effect which may be life-threatening. Potential signs are:

  • shortness of breath
  • abdominal pain
  • swelling in arms or legs
  • severe, persistent headaches
  • petechiae (pinpoint, round spots that appear on the skin as a result of bleeding)

Particular caution is advised if these symptoms occur after the reaction to vaccination has cleared up, i.e. 4 to 16 days after vaccination. If this is the case, medical assistance should be sought immediately.

After the BioNTech and Moderna mRNA vaccines were administered, there were very rarely cases of heart muscle and pericardial inflammation. These generally occurred within 2 weeks of the vaccine being administered, usually after the second vaccination and mostly in younger men.

To date, there are no known serious side-effects to the protein vaccine from Novavax. As this vaccine has only been approved since the end of 2021, sufficient data has not yet been collected to identify any rare or very rare side effects.

In addition, all vaccines have the potential to cause an allergic reaction. Depending on the severity of the reaction, this may be classed as a mild or severe adverse effect. 

Allergic reactions generally occur very rapidly. An observation period of at least 15 minutes is required following all vaccinations to allow targeted treatment to be provided where necessary. If an allergic reaction occurs after a vaccine dose, an alternative vaccine should be considered for the next dose.

Important: People who are known to be allergic to particular substances can seek advice from an allergy center before getting a COVID-19 vaccination.

What causes breakthrough infections of COVID-19?

The term breakthrough infection is applied when a person becomes ill with COVID-19 (i.e. has symptoms) despite being fully vaccinated. It does not apply when a vaccinated person tests positive for a SARS-CoV-2 infection but does not display any symptoms.

Breakthrough infections are not uncommon. While vaccines against coronavirus provide effective protection against developing the severe form of the disease by inhibiting replication of the SARS-CoV-2 virus, they do not stop people from contracting the virus. The protective effect of a vaccine also declines over time. By receiving a booster vaccine, people can effectively top up their protection against a severe infection for a period of at least 3 months.

Important: Overall, people who have been vaccinated against COVID-19 are less likely to be infected with coronavirus than people who have not received a vaccine. They are also far less likely to become seriously ill with the virus and to require treatment in hospital or in an intensive care unit.

The Robert Koch Institute (RKI) publishes weekly reports on the COVID-19 situation in Germany. These offer the latest facts and data about infections and the situation in local hospitals.

Who can get vaccinated against COVID-19?

In Germany, anyone aged 5 or above can now be vaccinated against COVID-19. The following vaccines are available, depending on the person’s age: the two mRNA vaccines Comirnaty (BioNTech/Pfizer) and Spikevax (Moderna), the protein vaccine Nuvaxovid (Novavax) and the viral vector vaccine JCOVDEN (previously COVID-19 Vaccine Janssen). 

For people aged between 5 and 30 and for pregnant women of all ages, the Standing Committee on Vaccination (STIKO) recommends vaccination with the BioNTech/Pfizer vaccine. For adults aged over 30, STIKO recommends the BioNTech/Pfizer or Moderna vaccine.

Alternatively, STIKO recommends the Novavax vaccine for people aged over 18. People aged 60 and over can opt for the Janssen vaccine for primary immunization. Moderna presents an alternative vaccine option for children aged between 6 and 11.

Important: People who have received the COVID-19 Vaccine Janssen still require a second vaccination with an mRNA vaccine in order to be considered fully vaccinated. This is possible 4 weeks after vaccination with the Janssen vaccine. To be regarded as boosted, a further mRNA dose is required. 

Recommendations for children under 12

For healthy children aged 5 to 11, SIKO recommends a single vaccine shot to build up primary immunity. Children in the same age group with pre-existing health conditions are advised to have 2 vaccine doses for primary immunity. This also applies to children who don’t have a pre-existing health condition but are close contacts of people who are at high risk of developing the disease and are not fully protected by immunization. These include people taking medication that weakens the immune system, for example.

Vaccine recommendations for pregnant and breastfeeding women

STIKO recommends that previously unvaccinated women who are pregnant or breastfeeding should be vaccinated with the mRNA vaccine from BioNTech/Pfizer vaccine as of their second trimester of pregnancy. In this way, expectant mothers can protect themselves not only from developing a severe case of COVID-19 but also from any complications of pregnancy that could be triggered by a coronavirus infection. 

Important: Women trying for a baby but who are not yet pregnant need not have any concerns about being vaccinated against COVID-19. The vaccination does not affect fertility and also offers the best possible protection when trying to conceive.

Where can I get a vaccine?

Anyone wanting to get a vaccination for themselves or their child can do so at a practice of their family doctor, dentist, pediatrician or specialist. Company doctors are also allowed to vaccinate employees against COVID-19. It is now also possible to be vaccinated by trained personnel in pharmacies. Vaccination centers and mobile vaccination teams are also being used in some places.

Points of contact are listed by federal state on the Kassenärztliche Vereinigung (Association of Statutory Health Insurance Physicians) website.

Should people who have recovered from COVID-19 get vaccinated too?

STIKO recommends that unvaccinated people who have previously been infected with SARS-CoV-2 – as demonstrated by a positive PCR test – should receive a single COVID-19 vaccine dose as primary immunization. This is recommended 3 months after recovery from the infection.

If the infection has been confirmed by a COVID-19 antibody test, the vaccine dose can be administered from as early as 4 weeks after the laboratory diagnosis.

Important: In the case of people with an immune deficiency, a doctor must decide the number of vaccine doses required on a case-by-case basis.

For more information about which vaccines are recommended for which vaccination and recovery statuses, refer to the Epidemiological Bulletin of the Robert Koch Institute (RKI).

When is it beneficial to get a booster vaccine?

Administration of a booster vaccine comes into play if the immunity provided by primary immunization against COVID-19 declines over time or if the standard vaccination series does not offer sufficient protection.

STIKO recommends booster vaccines for all double-vaccinated people aged 12 years and over, as well as for children aged between 5 and 11 who have a pre-existing health condition. People aged 18 years and over should have their booster from 3 months after their primary immunization; children and adolescents aged 12 to 17 should have theirs after 3 to 6 months. Children and adolescents with pre-existing health conditions should have their booster as soon as possible, whereas those without pre-existing conditions should leave it as long as possible within the recommended period. Children aged 5 to 11 with a pre-existing health condition should receive a booster vaccine at the earliest 6 months after primary immunization.

In the case of people who have recovered from a SARS-CoV-2 infection and received their first vaccine dose for primary immunization, STIKO recommends a booster dose as of 3 months after the initial vaccine. This recommendation applies to all recovered people aged 18 and above. For people who have recovered from a COVID-19 infection and for adolescents aged between 12 and 17, STIKO recommends an interval of between 3 and 6 months between primary immunization and a booster dose. For younger children, this interval should be at least 6 months. 

Currently, an mRNA vaccine from BioNTech/Pfizer or Moderna is generally given as a booster. 

Important: Healthy children with primary immunization should not receive a booster vaccine at the present time.

Who should get a second booster vaccine?

STIKO recommends that certain groups of people should boost their immunity against coronavirus with a second booster dose. These include, for example:

  • people aged 70 and older
  • residents of residential care facilities and people who receive care in care facilities
  • people with disabilities in institutions providing social integration assistance for the disabled who are at an increased risk of developing a severe form of the virus
  • people aged 5 and older who have a weakened immune system
  • staff working in medical and care facilities

At-risk patients should receive a second booster dose 3 months after the first. Staff should receive their second booster 6 months after the first. An mRNA vaccine is used for this purpose.

Important: STIKO does not currently recommend a second booster vaccine for people from the groups listed above who contract a coronavirus infection 3 months or more after the first booster dose.

Further answers to questions about the topic of booster vaccination are available on zusammengegencorona.de, a website provided by the Federal Ministry of Health (BMG).

Where else can I get information from?

For detailed information on the COVID-19 vaccination, visit zusammengegencorona.de, a website provided by the Federal Ministry of Health (BMG).

The website of the Robert Koch Institute (RKI) provides answers to frequently asked questions about COVID-19 and vaccinations.

“Das Impfbuch für alle” (“The Vaccination Book for Everyone”) – a brochure produced by the Robert Koch Institute (RKI) and the Federal Center for Health Education (BZgA) provides detailed information on vaccinations, vaccine research, and COVID-19 vaccinations. It can be obtained for free from pharmacies and online.

People from Ukraine can find essential information about COVID-19 and vaccination in their first language on infektionsschutz.de.

In cooperation with the Robert Koch Institute (RKI). As at:

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