Even when senior U.S. health officials say it’s time for America he learns to live with the coronavirus, a chorus of leading researchers say that improper messaging of booster photos has put millions of older people at serious risk.
Approximately 1 in 3 Americans aged 65 and over who have completed their initial round of vaccination has not yet received their first booster vaccine, according to the Centers for Disease Control and Prevention. The figures have alarmed researchers, who note that this age group continues to have the highest risk of serious covid-19 illness and death.
People aged 65 and over account for about 75% of Covid deaths in the United States. And some risk continues, even for adults who have completed an initial series of two doses of Moderna or Pfizer or received one dose of Johnson & Johnson. Among the elderly who died of covid in January, 31% had completed the first round of vaccination but had not been stepped up, according to KFF analysis of CDC data.
Failure to promote 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 failed since day one,” Topol said. “This is one of the most important issues in the American pandemic and it has been mismanaged.
“If the CDC says, ‘This can save your life,'” he added, “it will help a lot.”
Although the initial course of one or two doses of vaccination is effective in preventing hospitalization and death, immunity fades over time. Boosters renewing this protection are especially important for older people now that Covid’s case is on the rise, more and more omicron sub-variants are spreading and Americans are throwing off their masks, Topol said.
Some older people who were given priority for initial vaccination in January 2021 are now more than a year old from their last vaccination. Add to the confusion: The CDC defines “fully vaccinated” as people who have completed an initial course of one or two doses, although the first booster is considered crucial to boost immunity against covid.
Numerous studies have confirmed that the first boost shot is a critical weapon against covid. A study of older veterans published in April found that those who received a third dose of mRNA vaccine were up to 79% less likely to die from covid than those who received only two vaccines.
A major question for scientists vying for boosters is why rates have stopped among people aged 65 and over. Studies have found that policy and disinformation play a role in vaccine fluctuations among the general population, but this is not the case among older people, who have the highest initial vaccination rates of each age group. more than 90% of older Americans completed an initial course of one or two doses by May 8.
The discrepancy for the elderly is likely due to changes in the way the federal government distributes vaccines, said David Grabowski, a professor of health policy at Harvard Medical School. Although the Biden administration coordinated the delivery of vaccines to nursing homes, football stadiums and other destinations early last year, the federal government played a much less central role in delivering boosters, Grabowski said.
Today, nursing homes are largely responsible for stimulating their residents, relying on pharmacies that traditionally hire to administer flu vaccines, Grabowski said. And outside of nursing homes, people usually have to find their own boosters, either through clinics, local pharmacies or primary care providers.
Dr Thomas Freedon, a former director of the CDC, said that in theory the transfer of responsibility for the current immunization against Covid from government-sponsored clinics to individual providers might seem logical, given the privatized healthcare design in the United States. In fact, Frieden said, this approach does not work because “our primary health care system is life-threatening anemia” and is not designed to take on a public health mission.
Most health care providers do not have the technology to securely track which patients have been vaccinated and are planning follow-up vaccinations, Freiden said. Nor are there financial incentives for doctors to vaccinate and empower their patients.
Even before the pandemic, 28% of Americans did not have a 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 life support facilities, they represent more than 20% of Covid deaths. He would like the Biden administration to resume coordination of booster supplies to nursing homes through mass vaccination efforts. “I would like these centralized clinics to return in order to strengthen the residents and staff at once,” Grabowski said. “That seems pointless to me.”
The Biden administration advertises its ongoing efforts to vaccinate the elderly. For example, on Medicare & Medicaid Service Centers send quality improvement teams to advise nursing homes with low levels of vaccination. The Medicare program sent letters to all 63 million beneficiaries to encourage them to receive boosters and sent millions of emails and text message reminders.
However, many health advocates agree that the country has lost the momentum it had in the first months of the COVID vaccination campaign.
“There doesn’t seem to be the urgency we saw in the initial photos,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.
Some researchers attribute the delay to initial disagreement among health leaders over the value of boosters, followed by phased implementation. The boosters were approved in stages for different age groups, without the fanfare that usually comes with a big change in policy. The CDC recommended booster vaccines for people with weakened immune systems in August; then for the elderly in October; for all adults in November; and for children over 12 in January.
In addition, although vaccine ads appeared everywhere a year ago, government agencies were less vocal about promoting boosters. “I had the feeling that initially we were all hit in the head and all roads led to vaccines,” Grabowski said. “Now you have to find your own way.”
For much older people, barriers that can make it difficult to access private healthcare in times without a pandemic also exist for boosters. For example, many older people prefer to come in to get vaccinated without an appointment or make appointments over the phone, even when pharmacies are increasingly turning to online-only planning, which requires customers to navigate a multi-layered system. Some older people also do not have ready transport, which sometimes raises an obstacle in rural areas, where health clinics can be 20 to 30 miles apart.
“If people have to take two buses or take a break from work or take care of their family, people are less likely to be vaccinated,” Smetanka said.
Dr. Latasha Perkins, a family doctor in Washington, D.C., said she worked hard to persuade her family in Mississippi to get vaccinated. Her grandmother agreed to receive her first vaccines in the fall, just as the CDC approved boosters for all adults.
“We finally got to a place where we got people to take two pictures, and then we said, ‘Oh, by the way, you need a third,'” Perkins said. “It was shocking for many communities. They would say, “You convinced me to buy, and now you’re saying two shots aren’t good enough.”
While national leadership is important, Perkins said, local ties can be stronger. Perkins gave speeches on vaccines at his church. Parishioners are more likely to trust her medical advice, she said, because she is a member of the tithe they see every Sunday.
Some communities have done better to overcome reluctance than others. Minnesota has increased 83% of vaccinated residents aged 65 and over, more than in any other state, According to the CDC.
Dakota County, Minnesota, has increased the percentage of people vaccinated to 65 and over from any other county in the United States by at least 50,000 adults, according to a KHN analysis from CDC data.
Christine Lees, an epidemiologist and public health supervisor in Dakota County, said her department has hired an agency to provide booster vaccines to residents and staff in nursing homes and life support facilities. The health department runs vaccine clinics at noon and some evenings to accommodate working people.
The department draws money from the federal Coronavirus Aid, Aid and Economic Security Act or CARES to purchase a mobile vaccine clinic to bring boosters to neighborhoods and mobile home parks. “We did it all last summer and we started it again,” Lees said. “We went to shelters for food and libraries. We went out at least once a week to keep those numbers high. ”
Community health workers paved the way for vaccine clinics by visiting residents in advance and answering questions, Lees said.
Dakota County is also using funds from the U.S. Rescue Plan Act to provide $ 50 incentives to people receiving initial vaccines and boosters, Lees said. Incentives were “really important for people who may have to pay a little more to get to a vaccine site,” Lees said.
Topol of Scripps said it was not too late for federal leaders to look at what was working – and not – and to resume efforts to accelerate.
“It will be difficult to restart now. But an aggressive, comprehensive campaign for adults – whatever is needed – has certainly been shown, “Topol said. “These people are sitting ducks.”
Philip Reese, an assistant professor of journalism at the California State University of Sacramento, contributed to the report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs in KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on the nation’s health issues.
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