By Lisa Jarvis / Bloomberg Opinion
Around this time last year, I lauded the arrival of a simple strategy for the fall covid booster campaign. After months of staged rollouts that left many confused over whether they were eligible or even due for another shot, the idea was to send a single, clear message: Everyone who completed the first series of shots should get a shot tailored to then-circulating variants of omicron.
In theory, this streamlined approach was setting us up to manage winter waves while also moving the U.S. toward an annual vaccine schedule for covid that mirrors that of the flu. People could get their flu shot and their covid booster at the same time.
In practice, the strategy fell flat.
And this year, the Centers for Disease Control and Prevention won’t be able to lean on that single, simple message; this year, the rollout will be much more nuanced, covering not only covid boosters but the flu shot and a brand-new vaccine for respiratory syncytial virus, RSV. These virus-fighting tools are only helpful if put to use. So how can public health authorities make sure people really hear what’s right for them?
A new form of simple might be the best we can do. And that is, “If you become eligible for a vaccine, you should get it,” says Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health. “If you are high risk and there is a form of insurance that can keep you out of the hospital, use it.”
Yet last fall, only 17 percent of the population got the covid booster. And while the oldest, most vulnerable folks were more inclined to roll up their sleeves, less than half of them (43.3 percent) did. In Pfizer’s second-quarter earnings call this week, the chief executive officer noted that uptake of boosters fell far below expectations: it had expected to sell roughly 60 million doses of its shot this year; so far, just 12.4 million have been administered.
Forgoing the booster wasn’t a terrible choice for low-risk people with protection conferred by previous vaccines and infections. But that still left a lot of vulnerable people exposed; older people now account for the majority of covid deaths, and the infection continued to prove deadlier than the flu last winter. The vaccination data suggest one reason for that trend: many of the people over the age of 65 who skipped their covid booster still opted for a flu shot.
The scenario could easily play out again this year. A team of researchers that models the impact of covid found that in every situation they tested (in particular, whether the updated vaccine ends up being a good match for the circulating variant), getting that older population vaccinated “would significantly reduce disease burden.” That could translate into hundreds of thousands of fewer hospitalizations and tens of thousands of lives saved over the next two years.
If we’re going to avoid the worst of another potential winter tripledemic, public health authorities need to figure out how to persuade those at highest risk to get onboard with whatever fall vaccine shots they are eligible for.
But adding to the complexity, this year’s fall shots — for covid, flu and RSV — will all have slightly different eligibility guidelines. Although the CDC has yet to make their recommendation for that updated covid shot, some infectious-disease experts suspect the agency will focus its use on the most vulnerable, meaning people over 65, the immunocompromised, or people who have an underlying condition. Some (but not all) people older than 60 or with certain health conditions might be a good candidate for one of the new RSV vaccines. Meanwhile, we’d still want everyone, everywhere, to get a flu shot.
Even those who are always eager to roll up their sleeves might need some coaching this year on when to make their appointment. Last year, some tried to delay their flu vaccine to time its peak protection for when the virus is at full force. In many years, that might mean seeking out the shot in late October for the best coverage later in the winter. But last year, the flu season peaked early, catching many people unprepared. The lesson: “Just get it when you can,” Nuzzo says. “That’s better than trying to play the timing game.”
Planning for fall vaccine campaigns is taking place during yet another summertime bump in covid cases. But this time around, the lack of up-to-the-minute data is making it hard to gauge whether the mini-wave is swelling, cresting or even falling. What we do know is that hospitalizations and emergency room visits were rising in July, and that many of us have anecdotal evidence in the messages from friends and family members reporting a positive test.
It’s yet another reminder that covid will keep burbling up, and we need to remain vigilant to protect the most vulnerable. But our concept of what “vigilant” means keeps shifting, and public health officials need to strike the right tone to convince at-risk groups that vaccinations really are a matter of life and death; without pushing so hard that a pandemic-fatigued country tunes out the message entirely.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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