Research Exposes Why Many Are Skipping the Bivalent COVID Booster
The fight against COVID-19 has witnessed a remarkable milestone with the development and distribution of vaccines and booster shots. These tools have played a critical role in reducing hospitalizations, mitigating disease severity, and even preventing fatalities caused by SARS-CoV-2. However, it’s crucial to acknowledge that the efficacy of vaccines and boosters can decline over time. This decline in effectiveness has led to the development and recommendation of updated booster shots, which have become a cornerstone of public health strategies to protect against the most severe outcomes of COVID-19.
In response to the evolving landscape of the pandemic, bivalent COVID boosters have emerged as a promising solution. These boosters are carefully designed to enhance protection not only against the original SARS-CoV-2 strain but also the highly transmissible omicron variant. Consequently, both Pfizer and Moderna have received emergency use authorization (EUA) from the Food and Drug Administration (FDA) and have been endorsed by the Centers for Disease Control and Prevention (CDC) for administration to the general public.
Recent research has yielded encouraging findings regarding the benefits of these bivalent COVID boosters. However, despite the clear advantages they offer, there has been a persistent challenge: the uptake of these boosters remains significantly lower than expected. As of May 2023, less than 20% of eligible individuals in the United States had received these updated boosters, highlighting a critical public health issue.
To delve deeper into the reasons behind this lower-than-anticipated uptake of bivalent COVID boosters, researchers turned to the Arizona COVID-19 Cohort (CoVHORT), a longitudinal study dedicated to understanding the acute and long-term effects of SARS-CoV-2 infection. The study, which commenced in May 2020, recruited participants from various sources, including COVID-19 testing sites, health department collaborations, vaccination sites, and postcard mailings across the state of Arizona.
Participants, regardless of their previous COVID-19 infection status, provided informed consent, and ethical approval was obtained. A survey was administered electronically to 4827 CoVHORT participants between February 13 and March 29, 2023. This survey aimed to collect information about demographics, pre-existing health conditions, acute COVID-19 symptoms, health behaviors, and COVID-19 test results.
The pivotal question posed in the survey was simple yet critical: “Have you received the updated (bivalent, omicron) mRNA booster from Pfizer or Moderna?” Those who responded negatively were provided with a list of potential reasons for not receiving the booster. These response options encompassed factors such as lack of awareness about eligibility, doubts regarding the booster’s benefits, logistical concerns, and safety apprehensions. Participants also had the option to provide “other” responses to capture unique reasons not covered in the predefined list.
Of the 4827 participants who received the survey, 2298 completed it, yielding a response rate of 47.6%. However, to focus on individuals eligible for the bivalent COVID booster, those who had not previously been vaccinated were excluded, resulting in 2196 participants for analysis. Notably, the characteristics of respondents who completed the survey closely mirrored the overall population of the Arizona CoVHORT study.
Among the eligible respondents, 74.5% had received the bivalent vaccine booster. To comprehend why the remaining individuals had not, the survey results unveiled a range of reasons. The most frequently cited explanation, accounting for 39.5% of responses, was that participants had already experienced a prior SARS-CoV-2 infection. This suggested a belief among some that natural immunity provided sufficient protection.
Other commonly mentioned reasons included concerns about side effects (31.5%), skepticism that the booster would add significant protection beyond prior vaccinations (28.6%), and worries about the booster’s safety (23.4%). Interestingly, the survey results indicated that knowledge gaps about eligibility and availability of the booster, previously common reasons for not getting vaccinated, were now less frequently cited (11.8% and 10.0%, respectively). These findings suggest that awareness about the bivalent COVID booster may have improved over time, but certain misconceptions and concerns still persist.
The study’s results underscore the need for ongoing efforts to promote SARS-CoV-2 vaccinations and boosters. While the rapid development of vaccines was a significant achievement, the implementation phase presents one of the most formidable public health challenges. As updated boosters continue to be developed and made available, boosting vaccination rates remains a top priority.
One critical message to convey is the effectiveness of bivalent COVID boosters in preventing severe outcomes. Recent research has demonstrated their ability to reduce the risk of hospitalization and severe disease for up to 120 days post-vaccination. This information should be highlighted in communications to healthcare providers and patients alike. The study also emphasizes the risks associated with reinfection, which can result in higher hospitalization and mortality rates. Therefore, the benefits of maintaining immunity through boosters should be communicated clearly to the general public and healthcare providers.
Furthermore, the study’s findings shed light on demographic differences in reasons for not receiving the bivalent COVID booster. Tailored strategies may be required to address these disparities. For instance, younger individuals may benefit from improved messaging about booster availability, while older age groups should receive information about safety and benefits. Additionally, efforts should be made to address logistical barriers, particularly among Hispanic populations. Clearer communication about vaccine sites, infrastructural support (such as paid time off for vaccination and potential side effects), and improved accessibility can help overcome these challenges.
In conclusion, this research highlights the ongoing struggle to promote SARS-CoV-2 boosters and the importance of personalized approaches to ensure optimal protection for the population. Boosters remain a crucial tool in the fight against COVID-19, and efforts to address barriers and enhance education are essential. By tailoring strategies to specific demographics and effectively communicating the benefits and safety of boosters, public health officials can contribute to achieving higher vaccination rates and, ultimately, a safer and healthier community.