Once a week, typically on the day that the Centers for Disease Control updates its COVID data tracker, I send my dad a text: “Did you make an appointment to get your booster?”
Yes, I’m a nudge. But the data for people his age are unambiguous: A second booster helps keep them alive and out of the hospital. Each new variant of omicron, currently the worrisomely contagious BA.5, provides fresh kindling for infections. And even though fewer people are dying these days compared with earlier waves, hospitalization rates are ticking up — most dramatically among people 70 and older.
My father is hardly the only one in that group not up to date on COVID vaccines. While public health experts have been debating the makeup of fall booster shots, they seem to be overlooking a concerning trend: a growing lack of enthusiasm for more shots. Very few of those eligible have received their second boosters, and many have missed even the first one. Most children under 12 remain unvaccinated. COVID shots are being thrown out in the U.S. at an accelerating pace; since May, some 12 million doses have expired, the Wall Street Journal reported.
The White House is reported to be considering making second booster shots widely available for all adults. It should also be carefully planning how to better sell the value of those vaccines before the U.S. heads into the first winter COVID season with little mask-wearing or other protective measures in place.
People are tired of the pandemic, and persuading them to get more shots keeps getting harder. Easy-to-understand guidelines for vaccination could help get people back on track — especially if they’re paired with evidence-backed messaging. Here are a few ideas worth considering:
The share of elementary school-aged kids who have received their first two COVID shots has been stuck at around 30%. “We expected uptake to be slow in the 5-to-11 age group, but we didn’t expect it to be this slow,” said E. Adrianne Hammershaimb, a research fellow at the University of Maryland’s Center for Vaccine Development and Global Health. Only 1.5% of children under 5 had received their first shot by July 7.
When Hammershaimb and her colleagues surveyed parents last fall about COVID vaccine attitudes, they identified a few potential strategies for improving uptake of the shots. Their survey showed, for example, that many parents would be more likely to accept a vaccine that has full approval from the Food and Drug Administration — rather than the emergency use authorization that vaccines for younger kids currently have. Last week, the FDA gave Pfizer’s vaccine full approval for kids 12 to 15 — more than a year after the shots were initially authorized, and full approval for younger kids’ shots seems a long way off.
Most parents also said they would be less likely to get their children a COVID shot if its side effects appeared to be greater than those from other childhood vaccines. Clearly, public health officials and pediatricians will need to emphasize that most kids experience only mild, short-lived symptoms from the shots.
Parents are also weighing the risks of the vaccine against those of COVID itself, which underlines the need for public health officials and pediatricians to explain why vaccinating children matters. Sean O’Leary, a pediatric infectious diseases specialist at the University of Colorado who studies barriers to vaccination, gives families a pitch that goes something like this: Although adults stand a greater risk of serious outcomes from COVID than children do, infections are not benign in kids. More than a thousand have died from COVID in the U.S.. And if that sounds like a small number in the larger context of COVID deaths, well, it should — because the death of any child is rare and uniquely tragic. Just as we would leap at the chance to prevent other causes of childhood deaths, things like pediatric cancer or drownings, so should we leap at the chance to vaccinate against COVID.
O’Leary’s research suggests that pediatricians should be even more nuanced when talking with reluctant families. One is to make a “presumptive recommendation.” That is, rather than ask parents their preference, state that the child is due for the vaccine. Another is called “motivational interviewing,” a method that has been effective in persuading people to stop smoking. By this approach, the doctor doesn’t tell patients what to do, O’Leary explained, but instead has a guided conversation “so they understand why a behavior change is important to their own internal values.”
Communicating the importance of vaccination to adults is tougher. People who happily got their initial shots may no longer be keeping track of when they are due for the next one. Or they may be concerned that if they get one now, they’ll miss out on an updated vaccine in the fall. Some are questioning the need for any more shots because they’ve had COVID, maybe more than once, and have recovered just fine.
At this stage, anyone making a case for more shots needs to lead with empathy. “People are not in the mood to be pushed,” said Heidi J. Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.
Heading into fall, when new boosters tailored to omicron variants are expected to arrive, the challenge will be to recapture the high percentage of adults who got their first round of shots. Ideally, people of all ages will be able to get vaccinated at once — as they are with flu shots.
Restoring people’s enthusiasm for vaccines will require nuanced messaging as well as plain honesty around what the FDA and CDC know and don’t know about how well the shots protect people. The ground campaign needs to ramp up now.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.