I understand the rationale behind this decision. Guidance that applies to nearly everyone is simpler to understand and to implement. It also aligns the cadence of the vaccine with that of the seasonal flu. Americans are used to receiving a flu shot every fall; now, they can expect two seasonal shots a year.
But a population-wide recommendation is not nuanced, and there are downsides to choosing simplicity over specificity. There are two particular issues I want to highlight in this week’s newsletter, using new data presented at the CDC’s meeting last week.
First, the elderly continue to bear the brunt of severe illness due to covid-19. Of the approximately 50,000 covid-associated deaths in 2023, more than 44,000 — or about 88 percent — occurred in people 65 and older.
Yet, the vaccination rate among older individuals remains disturbingly low. Even among the highest-risk group, individuals 75 and older, just 36 percent received the booster shot in the fall and winter.
I wrote a series of columns last year about the dismal rates of coronavirus vaccination in nursing homes. My primary concern with a universal recommendation is that it does not focus on people who need the vaccine the most. Put simply, vaccinating a healthy adolescent is not as urgent as vaccinating an elderly nursing home resident.
Older individuals, particularly those residing in congregate living facilities, must hear this message over and over: It is essential for them to receive the updated booster this fall.
Second, the messaging around vaccines needs to account for both their benefits and limitations. I continue to receive countless messages from readers asking why they can’t get frequent vaccines to prevent infection. People going on cruises or family vacations want to be sure they won’t get covid, so why shouldn’t they get top-ups whenever they want?
I have long advised against this, and will continue to do so. That’s because it’s still possible to be infected despite being recently vaccinated.
As I wrote about before, the coronavirus vaccine’s effectiveness has changed over time. Earlier in the pandemic, it greatly reduced the chance of infection. But as the virus evolved, and as people gained immunity through infection, the added benefit of the vaccine at thwarting infection decreased.
The CDC’s most recent analyses show that in people 50 and older, the vaccine only reduced symptomatic infections by 44 percent. This was specifically for the seven days to two months after a shot was administered, which is when it is most effective. By four to six months after vaccination, it fell to 30 percent.
These numbers are not meant to dissuade people from getting the booster. The primary reason for the shot is to reduce severe illness, which — again — matters most for older adults.
Moreover, a 44 percent reduction in symptomatic illness is still significant. Even if someone doesn’t become severely ill with covid, it’s not pleasant to have flu-like symptoms, and there is always the chance of developing long covid after infection. Reducing that possibility, even for a short period, is a worthy goal. This is why I’ll be getting my coronavirus shot this fall.
It’s also reasonable for people to try to time their booster so that they have maximal protection for when they are most likely to be exposed to the virus. Getting the timing right isn’t easy, though. There are multiple factors involved and not a small amount of guesswork as to when covid will spike.
In past years, covid levels rose as the weather got cooler. Infection risks were high around the winter holidays, as people gathered indoors during times of higher virus activity.
Some people might choose to wait until a bit closer to the holidays before getting their fall boosters. This is especially advisable if they recently received a spring vaccine or have just recovered from covid infection. Others who have a higher-risk event coming up might choose to get their booster sooner, knowing that effectiveness will wane a bit before the holidays.
None of these choices are wrong, but they are nuanced and won’t be answered by broad federal guidance. Nor should they. We have long been in the stage of covid-19 when decisions should be personalized for individual circumstances. Blanket recommendations from the CDC need to be tailored with an emphasis on ensuring that the most vulnerable have access to the tools they need to best protect themselves.
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