Vaccinating special populations

*This advice is current as of March 15, 2021.Content is subject to change as new information becomes available. Please check back regularly.

There are some groups where there are specific concerns due to lack of evidence to make a recommendation. This page will summarize a framework for vaccine decision-making, and considerations where advice is available, in the absence of evidence.

The COVID-19 vaccine may be considered for individuals who are pregnant or breastfeeding, immunosuppressed or who have an autoimmune disorder if a risk assessment deems the benefits outweigh the potential risks for the individual. It is recommended, but not required, that these individuals discuss immunization with their health care provider prior to receiving the COVID-19 vaccine.

When presenting for vaccination, these individuals will be asked to provide verbal consent following their acknowledgment of the risks and benefits of immunization, and the absence of evidence on the use of COVID-19 vaccine in these populations.

A framework for considerations when making a recommendation for or against the COVID-19 vaccine in these populations is below. Use your clinical experience, relationship with the patient, and knowledge of the risks vs benefits in their specific circumstance.

  • Discuss the patient’s specific circumstances when making a recommendation.
    • What is their risk of contracting COVID-19? What is their risk of poor outcomes if they do contract COVID-19? What is their risk of transmission to others?
    • Consider their comorbidities, living situation and if they work outside the home.
    • What is their risk of serious adverse events post immunization?
  • Balance the risk of vaccine side effects against risk of contracting COVID and having poor outcomes.
  • What are your peers recommending?
  • Document your conversation in the EMR

Here is an example of the application of a decision framework, specifically for pregnant or breastfeeding patients.

To consider when weighing the risks and benefits of vaccination

Should pregnant or breastfeeding individuals be offered the vaccine?

Should individuals who are immunosuppressed or have an autoimmune disorder get the vaccine?

Will children be offered the vaccine?


If you have any questions about this toolkit, please email

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