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Around 85% of recent Covid deaths were among people over 65. Why have so few gotten boosted?

Experts maintain that the new bivalent booster shot offers important protection. But less than a third of the most vulnerable age group has gotten it.
Image: A Jackson-Hinds Comprehensive Health Center nurse administers a Pfizer Covid-19 booster vaccine at an inoculation station next to Jackson State University in Jackson, Miss., on Nov. 18, 2022
A nurse administers a Pfizer Covid-19 booster shot in Jackson, Miss., on Nov. 18.Rogelio V. Solis / AP file

Around 85% of Covid deaths in the last four weeks were among people ages 65 and up, according to an NBC News analysis of data from the Centers for Disease Control and Prevention. But just 31% of that group has gotten updated booster shots.

That's the highest rate of any age group, but it pales in comparison to the 94% of the same population who got the primary series. Disease experts say the initial shots are no longer enough, given new variants and waning vaccine protection. Six in 10 adults who died of Covid in August had gotten at least the first two vaccine doses, according to a report published Wednesday by KFF, a nonprofit health think tank.

Hospital physicians, state public health officials and advocacy groups for older adults pointed to a variety of factors fueling the low booster uptake. They include feelings of fatigue at the pace of Covid shots and a lack of awareness that the new booster could make the difference between a mild case and a hospital visit.

"Many older adults, they’re still unaware of the booster or, frankly, its importance — that it’s an extra layer of protection different than those initial dosages," said Ramsey Alwin, the president and CEO of the National Council on Aging.

CDC data released last week shows the updated boosters are better at preventing Covid infections than the original shots. The day the results were published, the White House announced a six-week campaign to administer more boosters, particularly to older adults. The program includes funding for vaccination events at senior centers and transportation to vaccination sites.

Gerti Morell, 67, a marketing director in Cleveland, said she hasn't gotten the new booster because of worries about side effects. Morell said she experienced dizziness, blurry eyesight and heart palpitations after her first Covid booster in November 2021.

"It just scared me having that experience, and I don’t want to go through it again," Morell said, although she added that she is encouraging others to stay up to date on their shots.

Dr. Bob Wachter, the chair of the University of California, San Francisco’s department of medicine, said he has heard of other people waiting to get boosted until they're preparing to travel.

"The most common issue I hear about timing is ‘I’m planning a trip to Europe in February, and I hear the booster reaches its maximum effect a few weeks after I get it, so I’ll get it in January,’" he said.

"I liken that to amateurs' trying to time the stock market. Usually doesn’t work out well," Wachter added.

Experts think the U.S.'s relatively flat case curve could be leading some people to hold off on boosters, as well.

Average daily Covid cases hovered around 42,000 in November — less than half the number at the same time last year, according to NBC News' tally. The data isn't representative of the virus's true spread, however, given that most people use at-home tests.

"When people hear that cases are rising, they’re more likely to go out and get vaccinated. With Covid, it’s been relatively flat, and people have been hearing about it for going on three years. It’s hard to remain vigilant about something that is a constant, ever-present threat," said Dr. Manisha Juthani, the commissioner of the Connecticut Public Health Department.

Lower hospitalization and death rates most likely play a role in the trend, too, said Ashley Clark, the press secretary at the California Office of Community Partnerships and Strategic Communication, which manages the state’s vaccination campaign. But she also noted that compared to booster uptake among other age groups, "we continue to see the 65-plus population being the most responsive to booster doses."

Yet another reason for the low booster rate could be a lack of trust in the shots, experts said.

"You hear periodically that people say, 'Well, this one is still too new and still hasn’t been tested,'" Wachter said.

The Food and Drug Administration authorized the reformulated shots, which target both the BA.5 omicron subvariant and the original strain, before they were tested on people. The agency relied on data from mice, in addition to human trials using a similar omicron-specific vaccine — an approach like the one for the annual flu shot.

Katherine Jackson, 72, a writer in Montgomery, Alabama, said she'd intended to get the first booster last winter but then got Covid in December 2021. The infection led to long-term brain fog, fatigue and trouble sleeping, she said. Her cousin also died of Covid, despite having been vaccinated. Because of those experiences, she said, she doesn't feel a sense of urgency to get boosted.

"I don’t have the illusion that it would necessarily prevent me from contracting all Covid variants. I don’t know that it really is altogether a magic pill, so to speak," Jackson said.

But advocacy groups are hopeful they can still help more older adults get boosters by offering transportation to vaccination sites and addressing people’s concerns one on one.

Alwin said the Council on Aging is focusing on “that movable middle, a population that maybe feels too busy, feels overwhelmed, doesn’t see the need, needs help with transportation or hasn’t really received the message in a way that resonates — to help them pause, see the value, take the time, get the extra help.”

All the doctors, officials and advocates interviewed for this article said stronger public health messaging would be beneficial. A September survey by KFF found that 27% of respondents ages 65 and up said they had heard "a little" about the updated boosters and that 12% said they had heard "nothing at all."

Why older adults are still so vulnerable to Covid

In November of last year, people ages 65 and up represented a smaller share of Covid deaths than they do now — about two-thirds.

Hospital physicians say older people face a higher risk because they are more likely to have underlying health issues and because a lot of time has passed since their last shots.

"We’re seeing definitely the more severe cases in those that haven’t been boosted in a while," said Dr. Liron Sinvani, a geriatric hospitalist at Northwell Health in Long Island, New York and assistant professor at the Feinstein Institutes for Medical Research.

Wachter said the majority of people who have gotten the new booster get mild Covid, even if they’re older or have risk factors. By contrast, he said, if someone's "immune system has not seen this virus or the vaccine in over a year, their protection against severe infection has waned considerably."

Many people wish they'd gotten boosters once they wind up in the hospital, Wachter said: "I’ve certainly seen people who regret their decision not to get boosted and feel like they just got confused or thought they were well-protected because they got vaccinated a year and a half ago."

But others, he added, "just made a decision that they know maybe they’ll get burned by."

"It’s not that different than someone who chooses to keep smoking or ride a motorcycle," he said.

Jackson said she will probably get the new shot eventually.

"At an opportune time, when I don’t have any immediate plans for anything, I believe I will do it," she said.