According to the Centers for Disease Control and Prevention, about one-third of Americans age 65 and older who have completed their first round of vaccinations have not yet received their first booster immunization. The numbers are alarming for researchers, who point out that this age group remains the most vulnerable to severe illness and death from covid-19.
Failure to stimulate this group further has cost tens of thousands of lives, said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “The recall program was screwed up from day one,” Topol said. “This is one of the most important issues in the American pandemic, and it has been mishandled.”
“If the CDC said, ‘It could save your life,'” he added, “that would help a lot.»
Some seniors who were prioritized for their first vaccine in January 2021 are now more than a year away from their last vaccination. Adding to the confusion: The CDC defines a “fully vaccinated” as someone who completes an initial one or two doses, even though the initial booster dose is considered essential to expand immunity to the new coronavirus.
In contrast, 69 percent of older Americans received their first booster shot.
The disparity in older adults may be due to changes in how the federal government distributes vaccines, said David Grabowski, a professor of health care policy at Harvard Medical School. Grabowski noted that while the Biden administration coordinated the delivery of vaccines to nursing homes, soccer fields and other targeted sites early last year, the federal government has played a much smaller central role in delivering vaccines.
Today, nursing homes are largely responsible for growing residents, relying on the pharmacies they have traditionally hired to administer flu shots, Grabowski said. Outside of nursing homes, people often have to find their own boosters at clinics, local pharmacies, or primary care providers.
Former CDC director Dr. Thomas Frieden said that given the privatized design of U.S. health care, it seems logical in theory to shift the responsibility for ongoing vaccination from government-funded clinics to individual providers. In reality, Frieden said, this approach won’t work because “our primary health care system is anemic and deadly” and cannot take on public health tasks lightly.
Most healthcare providers don’t have the technology to safely track vaccinated patients and schedule follow-up shots, Frieden said. Physicians also have no financial incentives to vaccinate and empower their patients.
However, many health advocates agree that the country has lost momentum in the early months of the Covid-19 vaccination campaign.
“There doesn’t seem to be the urgency we saw at the first shot,” said Lori Smetanka, executive director of the advocacy group National Voice of Quality Long-Term Care Consumers.
Some researchers attribute the slowdown to an initial disagreement among health officials over the value of the recall, followed by a staggered rollout. Boosters are approved in stages for different age groups, without the fanfare that usually accompanies a single major policy change. The CDC recommends booster shots in August for people with weakened immune systems; then in October for the elderly; in November for all adults; and for children 12 and older.
Also, despite the seemingly ubiquitous vaccine advertisements a year ago, government agencies have been less vocal about encouraging recalls. “I feel like we all got hit in the head initially, and all roads lead to a vaccine,” Grabowski said. “Now you have to find your way.»
For many older adults, barriers to accessing private healthcare in non-pandemic times are also present in the recall. For example, many seniors prefer to come in by phone for injections, walk-ins or appointments, even as pharmacies increasingly move to online-only scheduling, which requires customers to navigate through a multi-layered system. Some seniors also lack readily available transportation, which can sometimes be a huge hurdle in rural areas, where medical clinics can be 20 to 30 miles apart.
“People are less likely to get vaccinated if they have to ride two buses or miss work or care for their family,” Smetanka said.
Dr. Latasha Perkins, a family physician in Washington, D.C., said she struggled to convince 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 asked people to be vaccinated twice, and then we were like, ‘Oh, by the way, you need a third,'” Perkins said. “It shocked a lot of the community. They were like, ‘You convinced me to join, and now you say two knocks on the door are not enough. « »
While national leadership is important, local relationships can be stronger, Perkins said. Perkins teaches about vaccines in his church. The congregation is more likely to believe her medical advice because she is a tithing member they see every Sunday, she said.
According to a KHN analysis of CDC data, Dakota County, Minnesota has a higher percentage of the population 65 and older who are vaccinated than any other county in the United States with at least 50,000 seniors.
Dakota County epidemiologist and public health director Christine Lees said her department hired an agency to provide reminders to residents and staff at nursing homes and assisted living facilities. The health department has vaccination clinics at noon and some evenings to accommodate workers.
The department used funds from the federal Coronavirus Aid, Relief, and Economic Security Act, or CARES, to purchase a mobile vaccination clinic to bring boosters to communities and parks in mobile homes. “We played last summer and we did it again,” Leith said. “We went to food shelters and libraries. We went out at least once a week to keep those numbers high. »
Community health workers have paved the way for vaccination clinics by visiting residents ahead of time and answering questions, Leith said.
Dakota County is also using funds from the American Rescue Program Act to offer $50 incentives to those who receive early and booster shots, Leith said. These incentives “are very important for people who may have to pay a little extra to get to the vaccination site,” Lith said.
Scripps’ Poplar said it wasn’t too late for federal leaders to see what worked — not what didn’t — and revive stimulus.
“It’s going to be difficult to reopen now. But it certainly shows an aggressive and comprehensive senior campaign — whatever the cost,” Topol said. “These people are sitting ducks. »
Philip Rees, assistant professor of journalism at California State University, Sacramento, contributed to this report.
KHN (Kaiser Health News) is a national newsroom that provides in-depth coverage of health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFC is a donating non-profit organization that provides information to the state on health issues.