This review critically examines the safety and efficacy of mRNA vaccines from mechanistic, preclinical, clinical, and public health perspectives, synthesizing evidence from randomized trials, post-authorization surveillance, and pharmacovigilance systems across diverse populations including pregnant individuals and immunocompromised groups.
Accumulated evidence from billions of doses administered globally affirms mRNA vaccines as safe and effective, with transient cytoplasmic expression, no genomic integration, and rapid clearance distinguishing them from gene therapies; real-world effectiveness was demonstrated across age groups, pregnancy, and immunocompromised populations.
As a narrative review, it may reflect selective synthesis of evidence; post-authorization surveillance data quality varies by country and reporting system; long-term durability and breadth of immunity from current mRNA platforms remain areas of ongoing study.
Clinicians can reassure patients that mRNA vaccines do not integrate into the genome and have a well-characterized safety profile supported by large-scale global surveillance. Special populations—including pregnant individuals and immunocompromised patients—are covered by available real-world effectiveness data.
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