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This column has been updated.
For the first time, the United States is rolling out Covid vaccines updated to match variants that are currently dominant, as well as the original strain. This bivalent character will provide a better response to the most threatening variants today but probably to future variants, too, because when the immune system faces different versions of the same virus it generates broader protections overall.
This is terrific news, and there’s more. Not only will a booster with the new vaccines decrease the likelihood of infection and severe illness and help reduce transmission of the virus; it could also decrease the likelihood of developing long Covid.
The bad news? The boosters are getting so little fanfare, and so much unfounded skepticism, that too few people might get them, and lots of people who need not get sick, suffer or die will get sick, suffer or die.
The Centers for Disease Control and Prevention has said that a national survey found that 72 percent of respondents said they were likely to receive an updated booster. But to actually get them vaccinated requires making the boosters easily accessible and making sure people know about their benefits.
The White House coronavirus response coordinator, Ashish Jha, said last week that people might consider getting the booster when they get flu shots, which many do in October and, barring a new variant curveball, think of it as an annual shot going forward. That’s fine if people do that, especially since many immunologists say it’s best to wait three to six months after one’s last vaccination or infection, and many people have had recent infections.
However, only about half of adults in the United States get the flu vaccine, and most haven’t gotten the earlier Covid boosters. Without a vigorous outreach program and promotion, millions of Americans who are not anti-vaxxers but could use a powerful nudge won’t get this helpful dose.
While booster rates have been dismal among Republicans, many of whom have adopted anti-vaccine stances, it is also many of the most vulnerable Americans, even those who got initial doses of vaccines, who are likely to be left behind. Those who haven’t gotten earlier booster shots despite having gotten earlier doses were more likely to lack health insurance, be Black or Hispanic, or be poorer and be less educated.
Meanwhile, funding for distributing these vaccines has dried up amid congressional gridlock — Democrats did not put new pandemic funding in the March spending package because it could cut into stimulus funds for states, and they now face Republican resistance to new pandemic funding. There will most likely be fewer of the dedicated vaccine outreach centers that were set up before.
Benjamin Mueller reported in The Times that local health departments are battling staffing shortages and the monkeypox outbreak, and playing catch-up with childhood immunizations. Plus, some health officials seem to believe that it’s enough to leave it up to individuals to seek these vaccines, mostly at private sites like pharmacies — there is only $550 million in vaccination spending allocated through FEMA so far this year, compared with $8.5 billion last year.
Boosters are especially helpful for older adults or those with existing health issues — but such groups often face challenges navigating access. Last year, there were campaigns to bring vaccination to senior centers and convenient community locations, and to help people make it to vaccination centers and even get vaccinated at home. White House officials tell me they will keep trying to carry out such campaigns, but acknowledge it will be only to the extent that dwindling resources allow. Without such support, how many of those at most risk, who would otherwise be willing, will fail to get the booster?
While young, healthy people who have been vaccinated and had an uneventful breakthrough infection are at much less risk of severe illness even without a booster, they might prefer to avoid getting sick or reduce their risk of long Covid. But beyond the personal benefits: Despite common claims to the contrary, vaccines still help dampen spread, and boosters can further reduce transmission of the disease, including by reducing infections in the first place, and thus help protect especially the more vulnerable.
Another survey conducted by the Kaiser Family Foundation found that about a third of people who got vaccinated but not boosted said they had “not had the time to get it” as a reason. That response was highest among Hispanic adults, with 41 percent citing it. About another quarter of respondents mentioned side effects.
Paid time off following vaccination campaigns in workplaces, combining flu and Covid vaccines, could overcome this obstacle. Jha tells me that the administration is already asking employers to carry out such steps, and it remains to be seen how many step up.
Then there’s the information gaps. Most of those who got vaccinated but not boosted (and about a third of those who don’t plan to get the updated booster) said they had enough protection from previous doses or past infections.
Many who did not get the previous booster, and many who don’t plan to get the updated one, say that they did not believe the boosters to be effective — a claim that is routinely made because Omicron caused a lot of breakthrough infections among the vaccinated.
A straightforward message could rebut all of this: It’s true that variants can cause breakthroughs, but vaccines still prevent serious illness and death, and even more so with boosters.
Many European countries and Canada, for example, did a better job of making sure more of their population got boosters. Their cumulative death and illness tolls from the Omicron wave are sharply lower than those of the United States, where only about a third of eligible adults had gotten boosters, compared with two-thirds of adults in many European countries. The United States has had a death rate 80 percent greater than Canada’s from the Omicron wave — a similar pattern holds globally. Countries like Japan, South Korea and Taiwan have about 80 percent or more of their adult population boosted, and their death tolls are even lower.
Many might also be wondering why bother with one more shot since 68 percent of Americans have had two initial vaccination shots, some of those have had booster shots already, and most likely about 60 percent of the country got some level of immunity from an Omicron infection.
Deepta Bhattacharya, an immunologist, told me that variants evolved to evade the first line of antibody protection generated by earlier vaccines or past infections, even though protections against severe disease remained fairly strong. But the new boosters can greatly decrease that evasion. When the initial vaccines were trialed, matching the strain that was then in circulation, they reported 90 percent to 95 percent protection against any symptomatic infection, which then declined against variants and with time. While exact numbers remain to be seen, all the immunologists I spoke with told me the updated boosters should again increase such protections.
Vaccines (and boosters) have already been shown to greatly reduce rates of long Covid among the infected, but obviously, if infection is avoided completely, that would directly sidestep the risk of long Covid. Shane Crotty, an immunologist, also noted that these boosters will probably further reduce the chances of more severe disease complications, which include long Covid, and says “the higher your level of immunity, the less viral replication you’re going to have, the less viral damage, the less likelihood of long Covid.”
And these new boosters can be expected to do even more going forward — including providing better protection against future variants, by better training both antibodies and memory cells, which are different parts of the immune system. As Bhattacharya told me, being exposed to different versions of the virus (as will happen with these updated boosters) further deepens and broadens the kind of antibodies that get generated, including ones that can work against future variants. Marion Pepper, an immunologist, told me a new variant vaccine can also “create new, more diverse memory cells that will help protect from Omicron variants and new variants that we have yet to encounter.”
Unfortunately we may face another problem we have witnessed throughout the pandemic: public health officials or prominent media doctors casting doubt on the boosters by focusing on their imperfections rather than their immense benefits and worrying about public reaction — like concerns about “vaccine fatigue.”
When I hear that phrase, I wonder how it would have sounded in the spring of 2020 when we had field hospitals in Central Park, bodies were stacked in trailers as funeral homes ran out of space and hospitals ran out of body bags.
I’ve never understood the second-guessing by public health authorities and doctors about how the public may or may not react. Why not just provide accurate, detailed information and make it easy to get vaccinated? That’s the best response to “vaccine fatigue,” even if committed anti-vaxxers might remain hard to reach.
And some writers and scientists have said the boosters should not have been offered until their specific human trials were complete. But there have already been extensive human trials for this vaccine and some of its updates, and it is not unusual to tweak a vaccine using data from sources like lab work or mice. That’s similar to what’s done every year for influenza vaccines.
It’s likely that last fall and winter, fewer people got boosters at least partly because some well-known scientists unfairly questioned the usefulness of the shots. There’s now a similar dynamic, with disproportionate attention on minor issues, like booster mandates in colleges. Blanket mandates are now less necessary for college students, though some dorms may apply them to protect medically frail students or to provide other students with options. But young people should still be informed of the benefits of boosters, and older and medically frail people should still be strongly reminded of the continuing risks posed by Covid-19. White House officials say they will roll out their own messaging campaign to counter the confusion — let’s hope it works.
There’s much research on vaccine messaging, but most of it comes down to establishing trust, being honest and transparent, and making vaccination easier. Our terrible health care system is a major impediment: Having a regular relationship with a doctor can be a key factor, but many Americans don’t have one. It’s not surprising that among all groups, it’s the uninsured who remain least likely to be vaccinated and boosted.
As has been shown throughout the pandemic, it’s vaccination, not vaccines, that saves lives — and many more would be vaccinated if given information and easy access. Not having tools against diseases that cause so much suffering is one tragedy, but having them remain unused should be an unacceptable one.
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