According to the Centers for Disease Control and Prevention, approximately 1 in 3 Americans age 65 or older who have completed their initial round of vaccination have not yet received a first booster vaccine. The figures have shocked researchers, who point out that this age group continues to have the highest risk of serious illness and death from COVID-19.
People aged 65 and over account for about 75% of COVID-19 deaths in the United States. And some risk persists, even for seniors who have completed an initial two-dose series of the Modern or Pfizer vaccine or who have received a dose of the Johnson & Johnson vaccine. Among the elderly who died of COVID-19 in January, 31% had completed a first round of vaccination but had not recovered, according to a KFF analysis of CDC data.
The failure to drive more of this group has resulted in the loss of tens of thousands of lives, said Dr. Eric Topol, founder and director of the Scripps Research Translation Institute. “The reinforcement program has failed since day one,” Topol said. “This is one of the biggest problems for the US pandemic and it has been mismanaged.”
“If the CDC said, ‘This could save your life,'” he added, “it would help a lot.”
Although the initial one- or two-dose vaccination course is effective in preventing hospitalization and death, immunity fades over time. Reinforcements, which renew this protection, are especially important for the elderly now that COVID-19 cases are on the rise again, more transmissible omicron subvariants are proliferating, and Americans are dropping masks, Topol said.
Some seniors, who were prioritized for the initial vaccination in January 2021, are now more than a year away from their last vaccination. Adding to the confusion: The CDC defines “fully vaccinated” as people who have completed an initial course of one or two doses, although a first boost is considered crucial to extend immunity to COVID-19.
Numerous studies have confirmed that the first reinforcement blow is a critical weapon against COVID-19. A study of older veterans published in April found that those who received a third dose of an mRNA vaccine were up to 79% less likely to die from COVID-19 than those who received only two injections.
A central question for scientists advocating reinforcements is why rates have stagnated among people 65 and older. Surveys have found that politics and misinformation play a role in vaccinating 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 had completed an initial one- or two-dose course on May 8th.
In contrast, 69% of large vaccinated Americans have received their first booster vaccine.
Overall, less than half of eligible Americans of all ages have received a booster.
The discrepancy for seniors is likely due to changes in the way the federal government has distributed vaccines, said David Grabowski, a professor of health policy at Harvard Medical School. Although the Biden administration coordinated the delivery of vaccines to nursing homes, football stadiums and other specific sites earlier last year, the federal government has played a much less central role in provide reinforcements, Grabowski noted.
Today, nursing homes are largely responsible for boosting their residents, depending on the pharmacies they traditionally hire to administer flu vaccines, Grabowski said. And outside of nursing homes, people generally have to find their own reinforcers, whether through clinics, local pharmacies, or primary care providers.
Dr. Thomas Frieden, a former CDC director, said that in theory it might seem logical to shift the responsibility for current immunization against COVID-19 from government-sponsored clinics to individual providers, given the privatized design of the United States health care. In fact, Frieden said, this approach does not work because “our primary health care system is life-threatening anemic” and is not set up to easily take on a public health mission.
Most health care providers do not have the technology to keep track of which patients have been vaccinated and schedule follow-up vaccines, Frieden said. There are also no financial incentives for doctors to vaccinate and empower their patients.
Even before the pandemic, 28% of Americans did not have a regular source of health 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 deaths from COVID-19. He would like the Biden administration to resume coordination of the delivery of reinforcements to nursing homes through mass vaccination efforts. “It would vary that these centralized clinics would come back to increase residents and staff at the same time,” Grabowski said. “That seems obvious to me.”
The Biden administration has promoted its ongoing efforts to vaccinate the elderly. For example, Medicare and Medicaid Service Centers have sent quality improvement teams to advise nursing homes with low vaccination rates. The Medicare program has sent letters to 63 million recipients to encourage them to receive reinforcements, and has sent millions of emails and text message reminders.
However, many health advocates agree that the country has lost momentum during the first months of the COVID-19 vaccination campaign.
“There doesn’t seem to be the urgency we saw with the initial shots,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long Term Care, a advocacy group.
Some researchers attributed the slowdown to initial disagreement among health leaders over the value of drivers, followed by a staggered rollout. The reinforcements were approved in stages for different age groups, without the fanfare that usually entails a single major policy change. The CDC recommended booster injections for people with weakened immune systems in August; then for the elderly in October; for all adults in November; and for children from 12 years in January.
In addition, although vaccine advertising appeared to be widespread a year ago, government agencies have been less vocal in encouraging reinforcements. “I felt like we had all hit our heads originally and all roads led to vaccines,” Grabowski said. “Now, you have to find your own way.”
For many seniors, barriers that can hinder access to private health care in non-pandemic times also exist for reinforcements. For example, many seniors prefer to come in to receive a vaccine, without an appointment, or to make appointments over the phone, even when pharmacies are increasingly resorting to online-only scheduling that requires customers to browse a multilayer system. Some seniors also do not have prepared transportation, a sometimes high hurdle in rural areas where health clinics can be 20 or 30 miles away.
“If people have to take two buses or take time off from work or caring for their family, people are less likely to get vaccinated,” Smetanka said.
Dr. LaTasha Perkins, a family physician in Washington, DC, said she has worked hard to persuade her Mississippi family to get vaccinated. Her grandmother agreed to receive her first injections in the fall, just as the CDC approved reinforcements for all adults.
“We finally got to a place where we got people to shoot twice, and then we said,‘ Oh, by the way, you need a third one, ’” Perkins said. “That was annoying for a lot of communities. I was told, “You convinced me to buy it, and now you’re saying two shots aren’t good enough.”
While national leadership is important, Perkins said, local connections can be more powerful. Perkins has given vaccine talks at his church. Congregants are more likely to rely on his medical advice, he said, because he is a member of the tithe whom they see every Sunday.
Some communities have done a better job of overcoming reluctance than others. Minnesota has increased 83% of vaccinated residents age 65 and older, a higher proportion than in any other state, according to the CDC.
Minnesota’s Dakota County has a higher percentage 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.
Dakota County Christine Lees, an epidemiologist and public health supervisor, said her department hired an agency to provide reinforcing injections to residents and staff of nursing homes and assisted living facilities. . The health department runs vaccination clinics at lunch and some nights to accommodate working people.
The department took money from the Federal Coronavirus Aid, Relief and Financial Security Act, or CARES, to buy a mobile vaccine clinic to bring reinforcements to neighborhoods and mobile home parks. “We ran it all last summer and started it again,” Lees said. “We went to food shelters and libraries. We go out at least once a week to keep those numbers high.”
Community health workers paved the way for vaccine clinics by visiting residents in advance and answering questions, Lees said.
Dakota County also used funds from the American Rescue Plan Act to provide $ 50 incentives to people receiving vaccines and initial reinforcements, Lees said. The incentives “were very important for people who might have to pay a little more to travel to a vaccination site,” Lees said.
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