Even as top U.S. health officials say it’s time America learns to live with the coronavirus, a chorus of leading researchers say faulty messaging on booster shots has left millions of older people at serious risk.
Approximately 1 in 3 Americans 65 and older who completed their initial vaccination round still have not received a first booster shot, according to the Centers for Disease Control and Prevention. The numbers have dismayed researchers, who note this age group continues to be at the highest risk for serious illness and death from Covid-19.
People 65 and older account for about 75 percent of U.S. Covid deaths. And some risk persists, even for seniors who have completed an initial two-dose series of the Moderna or Pfizer vaccine or gotten one dose of the Johnson & Johnson vaccine. Among older people who died of Covid in January, 31 percent had completed the first vaccination round but had not been boosted, according to a KFF analysis of CDC data.
The failure to boost 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 Translational Institute. “The booster program has been botched from Day One,” Topol said. “This is one of the most important issues for the American pandemic, and it has been mismanaged.”
“If the CDC would say, ‘This could save your life,’” he added, “that would help a lot.”
Although the initial one- or two-dose vaccination course is effective at preventing hospitalization and death, immunity fades over time. 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 dropping their masks, Topol said.
Some older people, who were prioritized for initial vaccination in January 2021, are now more than a year from their last shot. Adding to the confusion: The CDC defines “fully vaccinated” as people who have completed an initial one- or two-dose course even though a first booster is considered crucial to extending Covid immunity.
Numerous 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 the third dose of an mRNA vaccine were as much as 79 percent less likely to die from Covid than those who received only two shots.
A central question for scientists championing boosters is why rates have stalled among people 65 and older. Surveys have found politics and misinformation play a role in vaccine hesitancy in the population at large, but that’s not been the case among older people, who have the highest initial vaccination rate of any age group. More than 90 percent of older Americans had completed an initial one- or two-dose course as of May 8.
By contrast, 69 percent of those vaccinated older Americans have gotten their first booster shot.
Overall, fewer 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 care policy at Harvard Medical School. Although the Biden administration coordinated vaccine delivery to nursing homes, football stadiums, and other targeted venues early last year, the federal government has played a far less central role in delivering boosters, Grabowski noted.
Today, nursing homes are largely responsible for boosting their residents, relying on pharmacies they traditionally hire to administer flu shots, Grabowski said. And outside of nursing homes, people generally must find their boosters, either through clinics, local pharmacies, or primary care providers.
Dr. Thomas Frieden, a former CDC director, said that, in theory, shifting responsibility for ongoing Covid immunization from government-sponsored clinics to individual providers might seem logical, given the privatized design of U.S. health care. In reality, Frieden said, that approach is not working because “our primary health care system is life-threateningly anemic” and not set up to readily take on a public health mission.
Most health care providers don’t have the technology to securely track which patients have been vaccinated and schedule follow-up shots, Frieden said. Nor are there financial incentives for doctors to get their patients vaccinated and boosted.
Even before the pandemic, 28 percent of Americans didn’t have a regular source of medical care.
Grabowski said nursing homes, in particular, need more support. Although fewer than 1 percent of Americans live in nursing homes or assisted living facilities, they represent more than 20 percent of Covid deaths. He would like the Biden administration to resume coordinating booster delivery at nursing homes through mass vaccination efforts. “I would have these centralized clinics go back to get residents and staff boosted all at once,” Grabowski said. “That strikes me as a no-brainer.”