The vaccines for COVID-19 used in Iceland are safe and provide the best possible protection against the disease. The object of the vaccination is to protect individuals from contracting COVID-19 and prevent the spread of the pandemic.
Four different vaccines from four different manufacturers are being used in Iceland. The Directorate of Health website has further information on the efficacy of the vaccines. Þroskahjálp (National Association of Persons with Intellectual Disabilities) has prepared a pamphlet in easy-to-read language on the use of vaccines for COVID-19.
AstraZeneca (Vaxzevria)
Used in primary vaccinations in 2021, two doses at a 12-week interval. The AstraZeneca vaccine contains a cold virus that has been inactivated so that it cannot reproduce and genetic material has been added for the same protein as our bodies produce after the mRNA vaccination.
Allergic reactions are not as common for this vaccine as for the mRNA vaccines. An unusual type of blood clot is a serious but rare side effect, which is why its use has been discontinued for women under 55 and for people with a previous history or risk of blood clots.
AstraZeneca is registered for individuals aged 18 and over.
Not used for booster vaccinations.
Janssen
Used through April 2022. The Janssen vaccine contains a cold virus that has been inactivated so that it cannot reproduce and genetic material has been added for the same protein as our bodies produce after the mRNA vaccination.
Allergic reactions are not as common for this vaccine as for the mRNA vaccines. Blood clots of the same type as known with the AstraZeneca vaccine have occurred where millions of doses have been used but are extremely rare.
The vaccine has a marketing authorisation license as a one-shot vaccine and is the only such vaccine used in Iceland. One dose of Janssen significantly reduced the risk of infection, serious illness and death from COVID-19 disease due to the original virus but proved less effective against the Delta and Omicron variants. A booster dose significantly enhances efficacy, but after the second dose, protection is similar to two doses of other vaccines.
Registered for ages 18 and over. The vaccine is not recommended for severely immunocompromised people or pregnant women.
Can be used for post-vaccination booster vaccinations with another vaccine if the individual can not tolerate the mRNA vaccine.
Moderna (Spikevax)
The Moderna vaccine is a so-called mRNA vaccine. It contains no virus but rather genetic material in a lipid particle. The body reads the genetic material and produces proteins that the immune system learns to recognise.
Allergic reactions are more common than with some other vaccines.
The drug can be used for those 12 years and older but is not used for ages 12–17 in Iceland. Discontinuation of use for 18- to 39-year-old men in autumn 2021 due to myocarditis, which is more common with Moderna vaccination than other COVID vaccines.
Four weeks should elapse between the primary vaccination doses and no more than five weeks.
Used for booster vaccination for women from 18 years of age and men from 40 years of age.
Pfizer/BioNTech (Comirnaty)
The Pfizer/BioNTech vaccine is a so-called mRNA vaccine. It contains no virus but rather genetic material in a lipid particle. The body reads the genetic material and produces proteins that the immune system learns to recognise.
Allergic reactions are more common than with some other vaccines.
Used for those aged 5 years and older. A minimum of three weeks must elapse between doses for primary vaccination, but longer intervals also provide good protection.
The most widely used vaccine in Iceland, both for primary and booster vaccinations.
Novavax (Nuvaxovid)
Used from March 2022. The Novavax vaccine contains the S protein found in the SARS-CoV-2 virus and does not need to be produced in the body after vaccination. It is therefore a protein vaccine similar to influenza vaccine or hepatitis B vaccine. An innovative adjuvant, Matrix M, made from soaptree, is in the vaccine and therefore there is relatively little S protein in each dose.
Allergies have an unknown frequency.
The vaccine has marketing authorisation for ages 18 and over. A minimum of three weeks must elapse between two doses for primary vaccination.
There is no marketing authorisation for booster vaccination, but studies from the UK support that it be used for booster vaccination if the mRNA vaccine is not considered safe.
Side-effects after COVID-19 vaccination:
All immunizations can cause discomfort that are called adverse effects or more commonly side-effects. Most side-effects are a result of the activation of the immune system, which is the purpose of the immunization. These symptoms are usually the same for all vaccines:
- Fever >38°, chills, body aches
- Local symptoms at injection site
- Tiredness, feeling unwell, headache, stomach/intestinal symptoms
These symptoms usually arise within 24 hours of the vaccination and rarely last longer than 24-48 hours except for local symptoms and lymph node swellings (see below). Symptoms often arise more quickly after a repeat dose of the same vaccine. Local symptoms can be simple ache but sometimes include itching, redness or swelling. These symptoms often last longer than 24 hours, even up to a week. It is not necessary to report these symptoms to the primary health care or the institution that performed the immunization, or to the Icelandic Medicines Authority (IMA), unless they are unusually severe. Paracetamol or ibuprofen can be used in the package recommended doses for those individuals who can tolerate those medicines, if necessary to reduce discomfort after vaccination.
Lymph nodes nearest to the injection site, usually under the injected arm, are a well known but rare side effect related to the activation of the immune system. If they are more widespread it is advisable to contact a health care provider, for example in primary care, who will assess whether an examination or treatment is necessary and report to the IMA.
Possible side-effects of COVID-19 vaccines apart from immune activation:
These side-effects should be reported to the IMA in all cases because of the additional monitoring in effect for these new products. Be aware that connection to the vaccination has not been confirmed for all such symptoms but if occurrences are well documented it may be possible to confirm or refute a causal relationship with the vaccination. When causal relationships are confirmed it may be possible to define those who are at risk of such side-effects and plan for appropriate response or make additional recommendations regarding vaccination of such individuals.
Comirnaty/Pfizer BioNTech vaccine: (see product information)
- Anaphylaxis or other acute allergic symptoms
- Facial nerve palsy (Bell palsy)
- Other sudden, new onset symptoms that may be related to the vaccine
Moderna vaccine: (see product information)
- Anaphylaxis or other acute allergic symptoms
- Facial nerve palsy (Bell palsy)
- Other sudden, new onset symptoms that may be related to the vaccine
Astra Zeneca vaccine: (product information is being updated)
- Anaphylaxis or other acute allergic symptoms
- Blood clots with low platelets (Thrombosis with Thrombocytopaenia Syndrome; TTS) – rare but believed truly related to vaccination although the mechanism is still unknown. New onset symptoms that should prompt an urgent medical assessment if arise within 14 days of vaccination include:
- Difficulty breathing/dyspnoea
- Sudden new and severe pain in the head, chest or abdomen
- Pain and swelling of a limb other than the one injected with the vaccine, without preceding injury
- Neurological symptoms such as blurry vision
- Petechiae and purpurae/blood spots or bruises on the skin other than around the injection site
- Other sudden, new onset symptoms that may be related to the vaccine
Janssen vaccine
- Anaphylaxis or other acute allergic symptoms
- Other sudden, new onset symptoms that may be related to the vaccine
Notification to the Icelandic Medicines Authority:
Anyone can notify the IMA of a suspected adverse effect of a medicine, including vaccines. Family members or staff in long-term care facilities can send notifications on behalf of vaccinated inhabitants of such facilities. It is most important to notify the IMA if suspected side-effects are new (not included in the product information above), previously described but of uncertain incidence (according to the product information) or serious (requiring treatment beyond the simple fever reducing pain medicines discussed above). Notifications can be made to health care providers who then report to the IMA, by email or directly on the IMA website.