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.
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.”
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 though an initial booster is considered crucial for extending covid immunity.
In contrast, 69% of older Americans vaccinated received their first booster.
The gap for the elderly 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. in the USA. 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.
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 that we saw with the first shots,” said Lori Smetanka, executive director of the 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 apart.
“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 vaccinated twice and then we were like, ‘Oh, by the way, you need a third one,'” Perkins said. “It was 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.
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 did it again,” Lees said. “We went to food shelters and libraries. We went 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 senior campaign – whatever it takes – is certainly indicated,” Topol said. “These people are the sitting ducks.”
Phillip Reese, assistant 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 polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.