Omicron Boosters Could Save 90,000 Lives This Winter—But Only if People Get Them

The new bivalent vaccines were authorized in August, but many Americans have yet to get one.

close-up of person getting vaccine in arm

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As U.S. public health measures continue to adapt in the face of COVID-19, it seems the country has reached a new phase of the pandemic—one where the virus is taking more of a backseat in daily life. But this new, more relaxed pandemic attitude may also be hindering vaccination efforts.

The latest data from the Centers for Disease Control and Prevention (CDC) show that only about 14.8 million Americans have received an updated booster shot—a number that pales in comparison to the more than 226 million Americans who have completed a primary series of the vaccine, which is still only about 68% of all Americans. 

With the U.S. lagging so far behind on booster shots, there’s the possibility of a future COVID wave putting a strain on an already fragile healthcare system, causing tens of thousands of unnecessary deaths and costing billions of dollars.

“As population immunity wanes and new variants capable of evading protection from earlier vaccines and natural infection continue to emerge, surges in hospitalizations and deaths during the upcoming fall and winter are increasingly likely,” according to the authors of a new report from the Commonwealth Fund.

But all of that could be avoided. That same report shows that, if up to 80% of eligible adults were to receive their booster shots, the U.S. could prevent about 90,000 deaths from COVID. Ultimately, a more robust vaccination campaign could “avert a surge of hospitalizations and deaths, and save money in the process,” the authors said.

Here’s where the U.S. currently stands with booster vaccinations, why experts say low rates could be a problem, and how to get more people on board before an expected winter surge in COVID cases. 

Bivalent Vaccines Slipping Under the Radar 

Bivalent vaccines were authorized for all adults on August 31 and have been available ever since, but unlike with past COVID shots, fewer Americans have sought out a new booster vaccine right away

A September Vaccine Monitor survey from the Kaiser Family Foundation, found that only about a third of all adults had gotten their bivalent COVID booster or were planning to as soon as they could. For people over 65, that number was closer to half.

The KFF survey also showed that there was a lack of knowledge about booster shots in general. One in five people had heard “nothing at all” about the new booster shots, and four in 10 people who are vaccinated said they weren’t sure if the booster was recommended to people like them. 

The reason for this could, in part, be attributed to a lack of information about boosters, according to Jill Foster, MD, director of the division of pediatric infectious diseases at the University of Minnesota Medical School. 

The logistics of who can get the vaccine or when are much simpler for the bivalent shot than other COVID vaccines in the past, she added. But despite the message's simplicity, the public in large part hasn't acted on it. 

"Unless you just had COVID or just got a shot, go get your booster," Dr. Foster told Health. "I don't think that message has gotten out there."

Just anecdotally, Dr. Foster added that, compared to the early days of the pandemic, there seems to be less conversation about the new boosters in general, whether that be fewer billboards and TV ads, less advertising about COVID vaccine availability at pharmacies, or just people talking and reading less about the vaccines. 

Though booster information may not be as widely publicized, some of the confusion about vaccines could be attributed to those who choose to ignore information about the bivalent booster because they’re truly vaccine hesitant, or feel uncomfortable with getting any kind of COVID shot, explains Mireille Jacobson, PhD, economist at the Davis School of Gerontology and the Schaeffer Center for Health Policy and Economics at the University of Southern California. 

The KFF survey found that 18% of people eligible to get the bivalent vaccine said they wanted to “wait and see” about getting the shot, and another 10% and 12% said they would get it “only if required,” or not at all, respectively. 

But aside from those who were never vaccinated in the first place or who are explicitly opposed to getting the new vaccine, Jacobson guesses that many of those who haven’t yet gotten the bivalent shot aren’t necessarily vaccine hesitant, but rather just want to put COVID behind them. 

“It's not a strong belief, like ‘I'm not going to get boosted’ is my sense,” Jacobson told Health. “You definitely don't have that kind of ease that you had at the beginning. And I just think a lot of people are done with it—a lot of people don't go rush out and get their flu shot either, so I see it as a very similar thing.”

Harder to Find A Shot, Fewer Incentives to Seek One Out

In addition to a lack of strong messaging about bivalent boosters, it’s just not as simple anymore for people to get a COVID shot, either. 

When the original shots were being rolled out, rideshare companies were offering free rides for people to go get a shot, stadiums and gathering spaces were turned into convenient mass vaccination sites, and some employers were mandating vaccination. Most of that has since gone away. 

Yet another nudge for vaccines could also be disappearing soon—the Department of Health and Human Services (HHS) said in August that as early as January 2023, the federal government may no longer have the funding to make COVID vaccines free to the public. 

Whether it be that people are, understandably, just tired of hearing about COVID, or the government and media have dropped the ball on spreading the word about the bivalent shots, the end result is the same—the U.S. is behind where it should be on Omicron boosters. 

And with the threat of a winter surge, experts are concerned about what may lie ahead. 

“I'm very worried about the variants that are currently circulating in Europe,” Dr. Foster said. “The ones that are in Europe tend to be more evasive of the immune protection that we would give them, from either vaccine or prior infection…everyone is depending on the herd immunity that is not going to be as strong.”

Mitigating New Pandemic Attitudes With Good Vaccination Habits

Though COVID’s newfound position on the backburner in many people’s lives is likely creating some issues with the bivalent booster rollout, the news isn’t all dire. 

While projections from the Commonwealth Fund say that the U.S. is looking at tens of thousands of otherwise preventable COVID deaths if vaccine rates don’t increase before the end of the year, there’s still plenty of time before the end of December 2022 for people to go get their boosters. 

Though experts said getting 80% of eligible people boosted with the bivalent vaccine seems unlikely, the Commonwealth Fund’s other projection of 75,000 lives saved with booster rates at pace with those from last year’s flu season could be a more attainable goal. 

“Presumably anyone who is amenable to getting a flu shot should be amenable to getting a COVID-like booster,” Saahir Khan, MD, assistant clinical professor of infectious diseases at the Keck School of Medicine at the University of Southern California, told Health.

Adding back some kind of incentive for people to get bivalent boosters could also be another measure to implement to convince people who aren’t against vaccines to get the shot, Jacobson said. She and her team are currently in the planning stages of an experiment to see if reminders, small financial incentives, or a combination of both might help increase booster rates. 

The biggest thing is just finding a happy medium between COVID paranoia and ignoring the problem completely, Dr. Khan added. 

“People are just tired of hearing about it. They sort of have this PTSD thinking that if they start hearing about COVID, that means we're gonna go back to the days of shutdown,” Dr. Khan said. “There's a middle ground here where maybe we're not going to go back to the days of the early pandemic, but we still need to take precautions and we still need to get vaccinated.”

Treating the bivalent vaccine more like a flu shot—like linking the two together and advertising both—is probably a good step, Dr. Foster said. 

Other strategies like traditional advertising campaigns—TV ads, social media ads, billboards—and celebrities or officials sharing their experiences with vaccination could also help, Drs. Foster and Khan said. 

It’s also important to remind people that, in addition to the potential negatives the U.S. could see with stagnant booster rates, an increase would provide myriad benefits. In addition to the tens of thousands of lives saved, more boosters would mean billions of dollars saved in healthcare costs and hospitals that aren’t overrun, and therefore, ones that can provide better care to everybody, Dr. Khan said. Higher rates of bivalent vaccination would also lessen the chance of another variant—potentially more deadly or evasive—cropping up, he added.

“The messaging around COVID needs to be a bit more accurate in the sense that this is an endemic disease, and we are going to have to live with it,” Dr. Khan explained. “We're going to have to adapt to it and getting a booster is part of that.”

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