Although top US health officials say it’s time for America to learn how to live with the coronavirus, a chorus of top researchers say the wrong messaging on booster shots has left millions of elderly people in grave danger.
Nearly 1 in 3 Americans 65 and older who completed the initial round of vaccination did not receive the first booster shot, according to the Centers for Disease Control and Prevention. The figures dismayed researchers who note that this age group remains at risk of serious illness and death from COVID-19.
People 65 and older account for about 75% of COVID-19 deaths in the United States. Some risks remain, even for older adults who have completed an initial two-dose series of Moderna or Pfizer vaccines or received a single dose of Johnson & Johnson. Of the elderly who died of COVID-19 in January, 31% completed the first vaccination round but were not boosted, according to a KFF analysis of CDC data.
Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, said failure to further promote this group resulted in tens of thousands of lives lost. “The reinforcement program failed from day one,” Topol said. “This is one of the most important issues for the US pandemic, and it has been poorly managed.”
“If the CDC says, ‘This could save your life,’ that would help a lot,” he added.
Although an initial course of vaccination with one or two doses is effective in preventing hospitalization and death, immunity wears off over time. Topol said boosters, which renew that protection, are especially important for older adults now that COVID-19 cases are up again, more transmissible omicron subvariants proliferate, and Americans are dropping their masks.
Some older adults, who were prioritized for the initial vaccination in January 2021, are now over a year since their last shot. Adding to the confusion: The CDC defines a “full vaccination” as people who have completed an initial course of one or two doses even though the first booster dose is considered necessary to expand immunity to COVID-19.
Several studies have confirmed that the first shot is a critical weapon against COVID-19. A study of war veterans published in April found that those who received a third dose of the mRNA vaccine were 79% less likely to die from COVID-19 than those who received only two doses.
A central question for scientists defending reinforcers is why rates have stopped among people 65 and older. Surveys have found that policy and misinformation play a role in vaccine hesitancy in the general population, but this has not been the case among the elderly, who have the highest initial vaccination rate of any age group. More than 90% of older Americans have completed an initial course of one or two doses as of May 8.
By contrast, 69% of older Americans who were vaccinated got their first booster dose.
Overall, less than half of eligible Americans of all ages received a booster dose.
The discrepancy among older adults is likely due to changes in the way the federal government distributes vaccines, said David Grabowsky, professor of health care policy at Harvard Medical School. Although the Biden administration coordinated the delivery of the vaccine to nursing homes, football stadiums and other targeted locations early last year, the federal government played a less central role in providing the boosters, Grabowski noted.
Today’s nursing homes are largely responsible for boosting their population, Grabowski said, as they rely on pharmacies they traditionally rent to give their flu shots. And outside of nursing homes, people generally must find their own boosters, either through local clinics, pharmacies, or primary care providers.
In theory, said Dr. Thomas Frieden, former director of the Centers for Disease Control and Prevention, shifting responsibility for ongoing immunization against the coronavirus from government-sponsored clinics to individual providers would make sense, given the privatized design of health care in the United States. In fact, Frieden said, this approach doesn’t work because “our primary health care system has life-threatening anemia” and isn’t prepared to take on the public health task lightly.
Most healthcare providers don’t have the technology to securely track vaccinated patients and schedule follow-up shots, Frieden said. There are also no financial incentives for physicians to vaccinate and boost their patients.
Even before the pandemic, 28% of Americans did not have a regular source of medical care.
Grabowski said nursing homes in particular need more support. Although less than 1% of Americans live in nursing homes or assisted living facilities, they account for more than 20% of COVID-19 deaths. He would like the Biden administration to resume coordinating enhanced delivery in nursing homes through mass vaccination efforts. “I was going to get these central clinics back to boost the population and staff all at once,” Grabowski said. “It amazes me because it is so thoughtless.”
The Biden administration has promoted its ongoing efforts to vaccinate the elderly. For example, the Centers for Medicare and Medicaid Services has dispatched quality improvement teams to provide counseling for nursing homes with low vaccination rates. Medicare mailed all 63 million beneficiaries encouraging them to get reinforcements and sent millions of emails and text reminders.
However, many health advocates agree that the country has lost the momentum it had during the early months of the coronavirus vaccination campaign.
“There doesn’t seem to be an urgency as we saw in the initial shots,” said Laurie Smitanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.
Some researchers have attributed the slowdown to an initial disagreement among health leaders over the value of boosters, followed by a sporadic subtraction. The reinforcements were approved in phases for various age groups, without the fuss that usually comes with a single major policy change. The CDC recommended booster doses for people with weakened immune systems in August. then for the elderly in October; For all adults in November; And for kids 12 and up in January.
Plus, even though vaccine ads have been popping up everywhere a year ago, government agencies have been less vocal about promoting boosters. “It felt like we were all getting hit on our heads originally and all roads led to vaccinations,” Grabowski said. “Now, you have to find your own way.”
For many older adults, the barriers that can make access to private health care difficult in non-pandemic times are also there for reinforcement. For example, many older adults prefer to go for their vaccination, without an appointment, or to make appointments over the phone, even as pharmacies increasingly switch to online-only scheduling that requires customers to navigate a multi-tiered system. Some seniors also lack ready transportation, which is a big hurdle sometimes in rural areas where health clinics can be 20 to 30 miles away.
“If people have to take two buses or take time off work or take care of their families, they are less likely to be vaccinated,” Smitanka said.
Dr. Lacha Perkins, a family physician in Washington, D.C., said she worked hard to get her family in Mississippi to get vaccinated. Her grandmother agreed to get the first shots in the fall, just as the CDC approved boosters for all adults.
“We finally got to a place where we got people getting two shots, and then we said, ‘Oh, by the way, you need a third one,’” Perkins said. They’d say, ‘You convinced me to buy, and now you’re saying the shots aren’t good enough. “
Perkins said that while national leadership is important, local links could be even more powerful. Perkins gave lectures on vaccines at her church. She added that devotees likely trust her medical advice, as she is a member of the tithing system they see every Sunday.
Some societies have done a better job of overcoming reluctance than others. Minnesota has boosted 83% of the vaccinated population age 65 and older, a larger share than any other state, according to the CDC.
Dakota County in Minnesota has boosted a greater proportion of vaccinated people age 65 or older than any other U.S. county with at least 50,000 seniors, according to a KHN analysis of CDC data.
Kristen Liss, an epidemiologist and public health supervisor for Dakota County, said her department has hired an agency to provide booster shots to residents and employees of nursing homes and assisted living facilities. The Ministry of Health runs vaccination clinics at lunchtime and some evenings to accommodate staff.
The department has relied on money from Federal Coronavirus Aid, Relief, and Economic Security, or CARES Act, to purchase a mobile vaccine clinic to bring boosters to neighborhoods and mobile home parks. “We had it all done last summer, and we started it up again,” Liz said. We went to food shelters and libraries. We went out at least once a week to keep those numbers high.”
Lis said community health workers cleared the way for vaccine clinics by visiting residents in advance and answering questions.
Lees said Dakota County has also used money from the US Rescue Plan Act to provide $50 incentives to people who receive their initial vaccinations and boosters. The incentives “have been really important for people who might have to pay a little extra to travel to a vaccine site,” Lis said.
Topol, of Scripps, said it’s not too late for federal leaders to consider what works — and not — and to relaunch supportive efforts.
“It will be difficult to restart now. But there is certainly a sign of an aggressive and all-out campaign of the elderly – whatever the cost -.” “These people are the sitting ducks.”
(Philip Reese, associate professor of journalism at California State University-Sacramento, contributed to this report. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is an operating program The KFF (Kaiser Family Foundation) is a non-profit organization that provides information on the nation’s health issues.)