The rationale behind this decision is understandable: guidelines that apply to nearly everyone are easy to understand and follow. It also aligns vaccine frequency with seasonal influenza flu frequency. Americans are accustomed to getting flu shots every fall, but will now get seasonal vaccinations twice a year.
But recommendations for an entire population lack nuance, and choosing simplicity over specificity has its drawbacks.Using new data presented at last week’s CDC meeting, there are two issues in particular that I want to highlight in this week’s newsletter.
First, the elderly continue to bear the brunt of severe COVID-19 illness: Of the roughly 50,000 COVID-19-related deaths in 2023, more than 44,000, or roughly 88 percent, were people aged 65 or older.
But vaccination rates among older people remain worryingly low: Even among those aged 75 and over, the highest-risk group, just 36% received a booster shot in the autumn and winter.
I wrote a series of columns last year about the woefully low COVID-19 vaccination rates in nursing homes. My biggest concern about a universal recommendation is that it doesn’t focus on the people who need it most. Put simply, vaccinating healthy young people is not as urgent as vaccinating nursing home residents.
Seniors, especially those who live in congregate living facilities, have had to hear the message over and over again that it is vital they get the updated booster shot this fall.
Second, messaging about vaccines needs to consider both their benefits and their limitations. I still get countless messages from readers asking why people can’t get vaccinated more frequently to prevent infection. People who go on cruises or family vacations want to be sure they won’t get COVID-19, so why can’t they get a booster shot whenever they want?
I have been against this for a long time and will continue to do so, because even though I have been recently vaccinated, it is still possible for me to become infected.
As we’ve written before, the effectiveness of coronavirus vaccines has changed over time. Early in the pandemic, the vaccines significantly reduced the chance of infection. But as the virus evolved and people developed immunity through infection, the added benefit of the vaccine in blocking infection diminished.
A new CDC analysis found that vaccination reduced symptomatic infections by only 44% in people over 50 — and that was only during the period between seven days and two months after vaccination, when the vaccine is most effective — and that reduction dropped to 30% four to six months after vaccination.
These figures are not meant to discourage people from getting a booster shot: the main aim of vaccination is to reduce severe illness, which again is most important for older people.
Moreover, a 44 percent reduction in symptomatic illness is still significant. Even if you don’t get severe COVID-19, it’s never a pleasant experience to have flu-like symptoms, and there’s always the possibility of developing long COVID-19 after infection. Reducing that chance, even for a short time, is a worthy goal. This is why I’ll be getting vaccinated against the coronavirus this fall.
It makes sense for people to try to time their booster shots to give them the most protection when they are most likely to be exposed to the virus. But getting the timing right isn’t easy. Multiple factors come into play, and there’s a fair amount of guesswork involved about when COVID-19 will surge.
In past years, COVID-19 infection levels have risen as temperatures have dropped, and the risk of infection was higher around the winter holidays as people gathered indoors when the virus was most active.
Some people may choose to wait until closer to the holidays to get their fall booster shot, especially if they recently received the spring vaccine or have just recovered from COVID-19. Those with high-risk events coming up may choose to get their booster shot earlier, knowing that the shot’s effectiveness will wane a bit before the holidays.
None of these choices are wrong, but they are nuanced questions that cannot, and should not, be answered by broad federal guidance. We are long past the point where decisions should be tailored to individual circumstances. Blanket recommendations from the CDC need to be focused and tailored to ensure that the most vulnerable have access to the tools they need to best protect themselves.
