Even as top US health officials say it’s time America learned to live with the coronavirus, a chorus of leading researchers say faulty messages about booster shots have left millions of elderly people in grave danger.
According to the Centers for Disease Control and Prevention, about 1 in 3 Americans age 65 and older who have completed their first round of vaccinations have yet to receive a first booster. The figures have appalled researchers, who note that this age group continues to be most at risk of serious illness and death from Covid-19.
The recall program was botched from day one.
Dr. Eric Topol, Scripps Research Translational Institute.
People 65 and older account for about 75% of Covid deaths in the United States. And some risk remains, even for older people who have completed an initial two-dose series of the Moderna or Pfizer vaccine or who have received a dose of the Johnson & Johnson vaccine. Of the elderly who died of Covid in January, 31% had completed a first round of vaccination but had not been boosted, according to a KFF analysis of CDC data.
Failure to further stimulate this group has resulted in the loss of tens of thousands of lives, said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “The recall program was botched from day one,” Topol said. “This is one of the most significant issues of the American pandemic, and it has been mishandled.”
“If the CDC said, ‘It could save your life,'” he added, “that would help a lot.”
Although the initial one- or two-dose vaccination schedule is effective in preventing hospitalization and death, immunity wanes over time. The boosters, which renew that protection, are especially important for older people now that Covid cases are rising again, more transmissible omicron subvariants are proliferating and Americans are ditching their masks, Topol said.
Some seniors, who were prioritized for the first 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 one- or two-dose course, even if an initial booster is considered crucial for extending Covid immunity.
Many studies have confirmed that the first booster shot is a critical weapon against Covid. 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 than those who received only two injections.
A central question for scientists advocating for recalls is why rates have stagnated among people age 65 and older. Surveys have shown that politics and misinformation play a role in vaccine hesitancy in the general population, but this is not the case among the elderly, who have the highest initial vaccination rate of all age groups. More than 90% of older Americans had completed a one- or two-dose first course by May 8.
In contrast, 69% of older Americans vaccinated received their first booster.
Overall, less than half of eligible Americans of all ages have received a booster.
The gap for seniors is likely due to changes in how the federal government distributed vaccines, said David Grabowski, professor of health care policy at Harvard Medical School. Although the Biden administration coordinated the delivery of vaccines to nursing homes, football stadiums and other targeted locations early last year, the federal government has played a much less central role in delivering vaccines. reminders, Grabowski noted.
Today, nursing homes are largely responsible for increasing their residents, relying on the pharmacies they traditionally hire to administer flu shots, Grabowski said. And outside of nursing homes, people usually have to find their own boosters, either at clinics, local pharmacies or primary care providers.
Dr. Thomas Frieden, former CDC director, said that in theory shifting responsibility for ongoing Covid vaccination from government-sponsored clinics to individual providers might seem logical, given the privatized design of health care at the United States. In reality, Frieden said, that approach doesn’t work because “our primary health care system is anemic and deadly” and not set up to easily take on a public health mission.
Most health care providers don’t have the technology to safely track patients who have been vaccinated and schedule follow-up shots, Frieden said. There are also no financial incentives for doctors to vaccinate and boost their patients.
Even before the pandemic, 28% of Americans had no regular source of medical care.
Grabowski said nursing homes in particular needed more support. Although less than 1% of Americans live in nursing homes or assisted living facilities, they account for more than 20% of Covid deaths. He would like the Biden administration to resume coordinating booster delivery to nursing homes through mass vaccination efforts. “I would like these centralized clinics to come back so residents and staff would be strengthened at the same time,” Grabowski said. “It seems like a no-brainer to me.”
Loss of vaccine momentum
The Biden administration has touted its ongoing efforts to vaccinate the elderly. For example, the Centers for Medicare & Medicaid Services sent quality improvement teams to advise nursing homes with low immunization rates. The Medicare program sent letters to all 63 million beneficiaries encouraging them to get reminders and sent millions of emails and text reminders.
Yet many health advocates agree the country has lost the momentum it had in the early months of the Covid vaccination campaign.
“There doesn’t seem to be the urgency we’ve seen with the first knocks,” said Lori Smetanka, executive director of National Consumer Voice for Quality Long-Term Care, an advocacy group.
Some researchers attributed the slowdown to initial disagreement among health officials over the value of recalls, followed by a staggered rollout. The boosters were approved in stages for different age groups, without the fanfare that usually accompanies a single major policy change. The CDC recommended booster shots for people with weakened immune systems in August; then for the elderly in October; for all adults in November; and for children 12 years and older in January.
Also, although vaccine ads seemed to be everywhere a year ago, government agencies have been less vocal in encouraging recalls.
“I felt like we were all hit in the head originally and all roads led to vaccines,” Grabowski said. “Now you have to find your own way.”
For many seniors, the barriers that can make private health care difficult to access in non-pandemic times also exist for recalls. For example, many seniors prefer to come in for a shot, walk-in, or book appointments over the phone, even as pharmacies increasingly shift to online-only scheduling that requires customers to navigate a multi-level system. Some seniors also lack ready transportation, a sometimes daunting obstacle in rural areas where health clinics can be 20 to 30 miles away.
“If people have to take two buses or miss work or take care of family, people are less likely to get vaccinated,” Smetanka said.
Dr. LaTasha Perkins, a family physician in Washington, DC, said she worked hard to persuade her family in Mississippi to get vaccinated. Her grandmother agreed to get her first shot in the fall, just as the CDC approved boosters for all adults.
“We finally got to a place where we were asking people to get their shots twice and then we were like, ‘Oh, by the way, you need a third one,'” Perkins said. shocking to a lot of communities. They were like, ‘You convinced me to join, and now you’re saying two knocks isn’t enough.’
While national leadership is important, Perkins said, local relationships can be more powerful. Perkins lectured on vaccines at his church. Congregants are more likely to trust her medical advice, she said, because she is a member of the tithe they see every Sunday.
Some communities have been more successful in overcoming resistance than others. Minnesota has increased 83% of vaccinated residents age 65 and older, a larger share than any other state, according to the CDC.
Dakota County in Minnesota has increased a greater percentage of vaccinated people age 65 and older than any other US county with at least 50,000 seniors, according to a KHN analysis of CDC data.
Christine Lees, an epidemiologist and public health supervisor for Dakota County, said her department hired an agency to provide reminders to residents and staff at nursing homes and assisted living facilities. The health department holds vaccination clinics at noon and some evenings to accommodate workers.
The department tapped into money from the federal Coronavirus Aid, Relief, and Economic Security Act, or CARES, to purchase a mobile vaccination clinic to bring boosters to neighborhoods and parks in mobile homes. “We raced it all last summer, and we started it again,” Lees said. “We went to food shelters and libraries. We were going out at least once a week to keep those numbers high.
Community health workers paved the way for vaccination clinics by visiting residents ahead of time and answering questions, Lees said.
Dakota County also used funds from the American Rescue Plan Act to provide $50 incentives to people receiving early and booster shots, Lees said. The incentives “were really important for people who might have to pay a little extra to get to a vaccination site,” Lees said.
Topol at Scripps said it’s not too late for federal leaders to look at what’s working — and not — and reinvigorate the stimulus effort.
“It will be difficult to restart now. But an aggressive and all-out campaign for the elderly – whatever the cost – is certainly indicated,” Topol said. “These people are the sitting ducks.”