Why Seniors Should Still Get Their Covid-19 Booster

Photo by SEM VAN DER WAL

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We all need to play a role—from families to community leaders to health care professionals to policymakers—to ensure the protection of our nation’s seniors from this ever-changing virus.

With the hypertransmissible XBB.1.5 variant making waves across the country, seniors remain the most vulnerable, representing the vast majority of Covid-19 deaths and hospitalizations. While 94% of seniors have received their primary vaccination series, only 39% have received an updated bivalent booster dose. Coupled with the underutilization of the antiviral medicine Paxlovid, this winter could be another one filled with preventable death.

Safety and effectiveness of boosters

A study of approximately 22.6 million booster doses administered late last year showed that reported adverse events were consistent—and no different—than those reported after the original vaccine. Last week, federal agencies announced an investigation into a potential safety concern for ischemic stroke within three weeks among people ages 65 and older who received the Pfizer-BioNTech booster vaccine. However, based on a review of multiple safety systems and further analyses (continued evaluation will occur), the agencies believe that it is “very unlikely” that a true clinical risk exists and thus their vaccination recommendation stands. This example provides two take-aways: our safety surveillance systems work, and transparency should build public trust.

The effectiveness of the booster, especially in the elderly, is robust. A December 2022 study of hospitalized patients aged 65 and older demonstrated that the booster dose provided 73% additional protection against Covid-19 hospitalization compared with the original vaccine only. Last week, a real-world study (still awaiting peer-review) published from Israel found that patients 65 and older who received the updated booster were 81% less likely to be hospitalized with Covid-19 and 86% less likely to die from the virus than those who did not.

Consistent messaging, increasing access will increase senior vaccination rates

Clear messaging to our nation’s seniors is crucial: a robust surveillance system continues to evaluate and ensure the safety of vaccines, and boosters further reduce hospitalizations and deaths, even in those who have received a primary vaccination series. Beyond these messages, there’s a lot of noise—from questioning the efficacy of our current tools in the context of new variants (they work) to whether Covid-19 deaths are being overestimated (the majority of Covid-19 deaths are due primarily to the virus).

Increasing access relies on meeting seniors where they reside. Beyond prioritizing nursing homes as the administration is doing, bringing vaccines to seniors through mobile vans and administering them at senior centers, area agencies on aging, YMCAs, community health centers, retirement communities, and assisted living facilities is critical. This is especially necessary in southern and southeastern states that have yet to face the full brunt of XBB.1.5 and where booster uptake is uniformly less than 20% (as opposed to New England, the Upper Midwest, and West Coast which boast uptake rates above 50%).

In addition to suboptimal booster rates, seniors may be underutilizing Paxlovid. One study recently found that adults with Covid-19 who were prescribed Paxlovid within five days of diagnosis had a 51% lower hospitalization rate than those who were not prescribed the drug. The effectiveness of Paxlovid in the over 65 age group is well known, especially among unvaccinated individuals. Unfortunately, a study last year found only 20% of adults over 65 took antivirals. While medication interactions and assessing kidney function can be time-intensive, health care professionals would benefit from taking more time to assess whether Paxlovid is indicated, particularly in the elderly population.

After nearly three years, pandemic fatigue plagues the entire nation. While we may be close to the end of the pandemic, too many Americans continue to die preventable deaths with the brunt falling on our nation’s seniors. We all need to play a role—from families to community leaders to health care professionals to policymakers—to ensure the protection of our nation’s seniors from this ever-changing virus.