Why won’t more older Americans get their Covid booster?

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Even as top US health officials say it’s time America learn to live With coronavirus, a chorus of leading researchers say flawed messages in booster shots have left millions of older people at grave risk.

According to the Centers for Disease Control and Prevention, about 1 in 3 Americans over the age of 65 who completed their initial round of vaccination have not yet received their first booster shot. The numbers have dismayed researchers, who note that this age group remains at the highest risk of severe illness and death from Covid-19.

People over the age of 65 account for about 75% of covid deaths in the US, and some risk remains, even for older people who completed an initial two-dose series of the Moderna or Pfizer vaccine or received one dose of the Johnson & Johnson vaccine. Among older people who died of covid in January, 31% had completed a first round of vaccination but had not been boosted, according to a KFF Analysis CDC data.

Failure to push this group further 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 flawed from day one,” Topol said. “This is one of the biggest issues in the American pandemic and it has been mishandled.”

“If the CDC said, ‘This could save your life,'” he added, “that would help a lot.”

Although the initial course of vaccination of one or two doses is effective in preventing hospitalization and death, immunity fades overtime. The boosters, renewing that protection, are especially important for older people now that Covid cases are rising again, more transmissible subvariants of omicron are proliferating, and Americans are taking off their masks, Topol said.

Some seniors, who were prioritized for initial vaccination in January 2021, are now more than a year since their last vaccination. Adding to the confusion: The CDC defines “fully vaccinated” as people who have completed an initial one- or two-dose course, 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. AN senior veterans study 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 just two injections.

A central question for scientists advocating boosters is why rates have plateaued among people 65 and older. Surveys have found that politics and misinformation play a role in vaccine hesitancy in the general population, but that has not been the case among older people who have the highest initial vaccination rate of any age group . More than 90% of older Americans had completed an initial course of one or two doses as of May 8.

Conversely, 69% of vaccinated older Americans have received their first booster shot.

Overall, less than half of eligible Americans of all ages They have received a reinforcement.

The discrepancy for older people is likely due to changes in how the federal government distributed vaccines, said David Grabowski, a professor of health care policy at Harvard Medical School. Although the Biden administration coordinated 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 boosters, Grabowski noted.

Today, nursing homes are largely responsible for driving their residents, relying on the pharmacies they traditionally contract with to administer flu shots, Grabowski said. And outside of nursing homes, people generally must find their own boosters, either through clinics, local pharmacies or primary care providers.

dr Thomas Frieden, former director of the CDC, said in theory shifting responsibility for ongoing Covid immunization from government-sponsored clinics to individual providers might seem logical, given the privatized design of US health care. In reality, Frieden said, that approach isn’t working because “our primary health care system has life-threatening anemia” and isn’t set up to easily 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 injections, Frieden said. There are also no financial incentives for doctors to vaccinate and boost their patients.

Even before the pandemic, 28% of Americans he had no regular source of medical 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 represent more than 20% of covid deaths. He would like to see the Biden administration resume coordinating the delivery of boosters to nursing homes through mass vaccination efforts. “It would bring these centralized clinics back to power residents and staff at the same time,” Grabowski said. “That seems like a no-brainer to me.”

The Biden administration has touted its continued efforts to vaccinate seniors. For example, him Centers for Medicare & Medicaid Services has sent out quality improvement teams to assess nursing homes with low vaccination rates. The Medicare program has mailed letters to all 63 million beneficiaries encouraging them to get backups and has sent out millions of reminder emails and text messages.

Still, many health advocates agree that the country has lost the momentum it had during the early months of the Covid vaccination campaign.

“There doesn’t seem to be the urgency that we saw with the initial shots,” 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 leaders about the value of boosters, followed by a staggered rollout. The boosters were approved in stages for different age groups, without the fanfare that normally comes with a single major policy change. The CDC recommended booster shots for people with weakened immune systems in August; then for seniors in October; for all adults in November; and for children 12 years and older in January.

Also, while vaccine announcements seemed to be everywhere a year ago, government agencies have been less vocal in encouraging booster shots. “I felt like we were all getting hit on the head originally and all roads led to vaccines,” Grabowski said. “Now, you have to find your own way.”

For many older people, the barriers that can make it difficult to access private health care in non-pandemic times also exist for boosters. For example, many seniors prefer to walk in for a shot, without an appointment, or make appointments over the phone, even as pharmacies increasingly turn to online-only scheduling that requires customers to navigate a multi-layered system. , a sometimes imposing hurdle in rural areas where health clinics can be 20 to 30 miles apart.

“If people have to take two buses or take time off from work or take care of 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 family in Mississippi to get vaccinated. Her grandmother agreed to get her first shots in the fall, just as the CDC approved boosters for all adults.

“We finally got to a place where we got people to get two shots, and then we said, ‘Oh, by the way, you need a third one,'” Perkins said. “That was jarring for a lot of communities. They’d say, ‘You talked me into buying and now you’re saying two drinks ain’t good enough.

Although national leadership is important, Perkins said, local connections can be more powerful. Perkins has given talks on vaccines at his church. Parishioners are more likely to trust her medical advice, she said, because she is a tithing member 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 any other state, According to the Centers for Disease Control and Prevention.

Minnesota’s Dakota County has increased a higher percentage of vaccinated people age 65 and older than any other US county with at least 50,000 older adults, according to a KHN analysis of CDC data.

Christine Lees, an epidemiologist and public health supervisor for Dakota County, said her department has contracted with an agency to provide booster shots to residents and staff of nursing homes and assisted living facilities. The health department runs immunization clinics at lunchtime and some nights to accommodate workers.

The department used money from the federal Coronavirus Aid, Relief and Economic Security Act, or CARES, to purchase a mobile vaccine clinic to bring boosters to neighborhoods and mobile home parks. “We ran it all last summer and got it back up and running,” Lees said. “We went to food shelters and libraries. We would go out at least once a week to keep those numbers up.”

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 who receive initial and booster shots, Lees said. The incentives “were really important for people who might have to pay a little more to travel to a vaccination site,” Lees said.

Scripps’ Topol said it’s not too late for federal leaders to analyze what works, and what doesn’t, and relaunch the enforcement effort.

“It will be difficult to restart now. But an aggressive and all-out campaign for older people, whatever the cost, 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.

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