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We Need a National Booster Campaign Aimed at Older Adults and Centered in Equity

The COVID-19 pandemic has disproportionately targeted older adults, taking the life of 1 in 100 Americans over 65. The impacts are much worse in communities of color, who, as a result of structural discrimination in the health care system and other facets of life, are at higher risk of infection and death. This is especially true for older adults of color living in nursing homes and other congregate settings, where over 140,000 residents died.  

Although the pandemic has wreaked havoc on older adults throughout the country, the arrival of COVID-19 vaccines were an opportunity to create equitable access among those most at risk. However, from vaccine scarcity to implementation, the rollout was a bumpy ride for many, and whether an older adult was able to get vaccinated sometimes seemed to come down to luck.

With the CDC recently expanding eligibility for boosters to all adults, a national campaign around COVID-19 boosters must include strategies tailored to and prioritizing older adults. As we brace for a winter with the Omicron variant, public health officials are understandably focused on getting unvaccinated children and younger adults their first doses, but data analyzed even before the rise of the Omicron variant show that hospitalization rates among vaccinated older adults can eclipse rates for younger adults and children. The message is clear: getting boosters to older adults will save lives.

Unfortunately, despite older adults being eligible for boosters for several months, CDC data show that only slightly more than half of people 65 years old or older who are eligible for the booster have received one, and some experts believe the actual numbers may be even lower. Unlike in the spring, vaccine scarcity is generally not a problem, but barriers persist that prevent older adults from getting boosted.

To save lives and protect those most at-risk, a national public health campaign for boosters must include older adult-specific strategies, incorporating valuable lessons learned during the pandemic thus far.

  • Focus on nursing facilities and other congregate settings. Despite the high-risk nature of congregate living, the rates of booster vaccination among residents and staff varies widely from facility to facility. Indeed, federal data show more work is needed to increase these rates across the country. During the spring, the federal government created a partnership with pharmacies to deploy vaccines in nursing facilities; although the exact details of the partnership have now changed, the federal government must continue to exercise a leadership and coordination role to get boosters administered quickly in 100% of facilities across the country.
  • Reach older adults in ways they like to receive information. The President has announced several measures to communicate with older adults about boosters, including tele-townhalls and mailers to all Medicare beneficiaries. While these efforts will reach many, overcoming vaccine barriers often requires work on an individual level and must account for racial and cultural differences in ways that a one-size-fits-all approach cannot. The Administration and public health officials must fully leverage the full network of trusted messengers in an older adult’s life, like home-delivered meal drivers, case managers, resident service coordinators, and more. Similarly, outreach should continue to be accessible and in-language, respecting the over 4 million Medicare beneficiaries who are limited English proficient.
  • Build a permanent, well-resourced public health outreach infrastructure that can be utilized moving forward. One reason for a slow uptake of boosters, in addition to the confusing and everchanging eligibility guidelines and public health messaging, is that the country is relying on a temporary hodgepodge of local, state, and federal efforts to vaccinate everyone at the same time. Not having a permanent infrastructure has made actually getting the vaccine or booster more confusing. For instance, if an older adult needs an in-home vaccination, navigating the myriad of resources to find a provider and schedule the vaccination can be daunting, even if Medicare will reimburse providers for the in-home service. Not knowing what the future holds in terms of variants and more, investing in and streamlining permanent structures now that facilitate access to boosters will be advantageous for future vaccine and public health efforts.
  • Improve efforts to capture and make transparent data, especially measuring equitable access. Given the disproportionate impact of COVID-19 on communities of color, equitable vaccine access is a priority. However, throughout the pandemic, incomplete and lagging data on vaccine recipients has made it difficult to determine whether access was equitable. Even now, CDC data does not, for example, provide race or sexual orientation/gender identity information among those 65+ who have received boosters, and only a few states report race and ethnicity. Lacking intersectional data of this nature continues to stymie efforts at targeted and equitable access. Furthermore, in the evolving COVID-19 landscape, federal, state, and local data must make it clear and easy to ascertain vaccination rates among older adults with respect to first dose, second dose, booster dose, and more as progress in the former can mask gaps in the latter.

The latest news about the Omicron variant in the United States suggests that COVID-19’s impact on our lives will remain significant for some time, but a national booster campaign, under the direction, coordination, and leadership of the federal government – which includes older adult-specific strategies – will help ensure those most at-risk are protected in the months to come.

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