Among Seniors, a Declining Interest in Boosters

Linda Brantman, a retired membership salesperson at a health club in Chicago, was noticed last month when the Centers for Disease Control and Prevention proposed new divalent booster protects against two variants of Covid-19. She went online and booked an appointment at a Walgreens near her home.

Ms. Brantman, 65, who has been vaccinated and boosted twice, has struggled with persistent asthma for many years; she always has an inhaler on hand, even for the common cold. If she got sick with Covid, she said, “I’m definitely going to have breathing problems.” Within two weeks of the CDC announcement, she received the latest boost — and public health officials hope all Americans over the age of 5 will roll up their sleeves, too.

But many older Americans were more reactive like Alan Turner, 65, who lives in New Castle, Del. And recently quit at an industrial design company. He received the initial two doses of the vaccine but stopped updating his immunity after the first recommended booster. “I became such a hermit,” he said. “I hardly interact with people, so I never get used to it. I don’t see any particular need. I’m betting my time.”

Although Americans over the age of 65 are still the demographic most likely to have received the primary vaccine, at 92%, their interest in vaccine updates is dwindling, data from CDC shows. To date, about 71 percent have received the first suggested booster, but only about 44 percent have received the second.

Young people are also less likely to receive vaccinations than they were with initial immunizations, and only about a third of people of all ages have received any vaccinations, vaccine follow-up reported by The New York Times. But the elderly, who make up 16% of the population, are more vulnerable to the impact of the virus, accounting for three-quarters of the nation’s 1.1 million deaths.

Mollyann Brodie, executive director of public opinion at the Kaiser Family Foundation, has tracked vaccination rates and attitudes.

Now the most recent of Kaiser vaccine surveillance survey, published last month, found that only 8% of seniors said they had received the updated bivalent booster, and 37% said they plan to receive it “as soon as possible.” . According to one group, older adults are better informed than younger people, but nearly 40% said they had heard little or nothing about the updated bivalent vaccine, and many were unsure if the CDC had recommend this vaccine to them or not.

(Currently CDC recommends that individuals over 5 years of age receive a bivalent vaccine, effective against the original Covid-19 strain and the Omicron variant, if it has been two months since the last vaccination or booster.)

“The rocket booster message has been very mixed,” said Anne N. Sosin, a public health researcher at the Center for Public Policy and Social Sciences at Dartmouth College. So, in part, she added, “older people are entering winter with less protection than at earlier times during the pandemic.”

Sosin and other experts note that older Americans have some reason to be wary. Their immunity from previous vaccinations and boosters may have weakened; Mitigation policies such as mandatory mask wearing and vaccination have largely disappeared; and public testing and vaccination sites have closed.

Ms. Sosin said early on, many older people changed their behavior by staying at home or wearing masks and getting tested when they went out. Now, they face more exposure because “they have resumed their pre-pandemic activities”.

“Many people don’t care about Covid anymore,” she said.

Public opinion polls bear that out. Older adults may also reason that improved treatments for Covid infections make the virus less dangerous.

But deaths in this age group doubled from April to July, exceeded 11,000 in both July and August, largely due to the increased transmission capacity of the Omicron variant. Deaths began to decline again last month.

William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center, said that for older adults, the risk of contracting Covid “diminished, but it didn’t go away”. “You can’t forget it. You can’t put it in the rearview mirror”.

Two factors make the elderly more susceptible to the virus. “Their immune systems become weaker as they age,” says Dr. Schaffner. “And they accumulate underlying conditions, including heart and lung disease, smoking history, diabetes and obesity, which increase the risk of the disease.

“If you get infected, you run the risk of a more serious outcome,” he said. “All the more reason to protect yourself as best you can.”

Studies have shown that vaccinations and boosters protection from serious illness, hospitalized and died, though that immunity wanes over time. “The data is very solid,” says Dr. Schaffner.

The Department of Health and Human Services estimated this month that among seniors and other Medicare beneficiaries, Vaccinations and boosters reduce hospital admissions by 650,000 for Covid and saved 300,000 lives by 2021.

But even in nursing homes, where the early months of the pandemic took a heavy toll, uptake of boosters “has been very sluggish,” said Priya Chidambaram, senior policy analyst at the Kaiser Family Foundation and co-author of a survey published this month.

As of September, an average of 74 percent of nursing home residents received one or more boosters, but that number ranges from 59 percent in Arizona to 92 percent in Vermont. This rate is much lower among nursing home workers; Nationwide, only about half received booster shots, and in Missouri, Alabama, and Mississippi, only one-third received them.

The federal order requiring nursing home workers to be vaccinated still applies, but it does not include boosters. A federation on-site vaccination campaign for residents who rely on CVS and Walgreens, bringing vaccines to nursing homes has worked but for boosters has not been repeated.

“That impulse is dead,” said Ms. Chidambaram. “The federal government has taken its foot off the pedal.”

Some older adults who do not live in a nursing home may stay at home or have difficulty getting to the pharmacy. But their sense of urgency also seemed to lessen. “Most of the older people are vaccinated,” Ms. Sosin said. “They didn’t hesitate or object.” But when it comes to boosters, she says, “they’re not very motivated and they don’t give a reason. There’s more of a sense of, “Why bother?”

Some public health experts are now calling for an all-out crusade – including mass media campaigns; social media and digital communication; pop-up and drive-through websites; mobile trucks; and home visits – to raise vaccination rates among seniors and everyone else, before a winter superbug surge is likely.

“We have never seen a joint approach to increase distribution,” Ms. Sosin said. “We should flood people with information, to the point where it becomes annoying.”

The Biden Administration Fall Covid Plan, published early last month, incorporated many of these ideas. But Dr. Schaffner argues that it doesn’t explain in detail or take a sufficiently aggressive approach to nursing homes.

Ms. Sosin was similarly skeptical. “I don’t see the elements of the plan coming to fruition,” she said. “They’re not reflected in the numbers we’re seeing,” she said, referring to the number of people receiving boosters.

Individuals can play a role in this effort. Kaiser’s surveys found that doctors and other health care professionals were reliable sources of information and that older adults were in frequent contact with them.

“If more providers realize that 4 out of 10 older adults don’t realize there is a new booster and they should be taking it, that is a huge opportunity to make an impact,” says Dr. Brodie said.

Family members, friends, co-workers, and neighbors also influence health decisions and behaviors, and Kaiser studies show they can help increase vaccination rates.

Dr Brodie said for those who are on the fence, “ask or remind your parents or grandparents about the new booster can make all the difference.”


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