With virus season looming and awareness campaign funding slashed, experts see a scattered Covid-19 vaccine rollout ahead

As of Thursday, only about 3% of the US population — about 10 million Americans — have gotten an updated Covid-19 vaccine since their approval in mid-September, according to the latest numbers from the US Department of Health and Human Services.

The slow penetration of the new vaccines — which lower a person’s risk of hospitalization, death and long Covid — comes at a time when funding for public education around the updated shots has been slashed.

This summer, as a result of budget negotiations between the White House and Republicans in Congress, HHS lost $150 million that had been allocated to a public education campaign that put ads on TV, websites and radio, in newspapers and outdoors in places like bus stops to increase awareness of the need for vaccination. The effort was also conducting research on drivers of vaccine confidence and vaccine hesitancy in different groups.

Since the loss of that program, the US Centers for Disease Control and Prevention has scrounged up some funding to educate the public about the availability of new vaccines for RSV, Covid-19 and influenza, but the budget for that campaign doesn’t approach the scale of the effort that was lost, according to a source familiar with the effects of the cuts, who spoke on the condition that they not be named because they weren’t authorized to talk about the loss of the program.

The CDC recommended updated vaccines from Moderna and Pfizer/BioNTech for everyone 6 months and older on September 12. An updated vaccine from Novavax became available this month and is recommended for people 12 and over.

Through October 13, about 31 days into the rollout of the updated vaccines, about 10 million Americans have received a shot, according to HHS. But that number is probably an underestimate because the vaccines are now commercialized, so the government can no longer track vaccination data as closely as it did when it was the distributor of the vaccines.

At 31 days into last year’s rollout of the Covid-19 bivalent vaccines, about 12 million doses had been given, according to CDC data.

That pace puts this year’s rollout on par with the dismal uptake of last year’s shots. By the end of official reporting, in May, only 17% of the US population had gotten a bivalent vaccine.

The reasons for this year’s slow rollout aren’t entirely clear. Spotty supply and insurance snafus created hurdles for many who tried to get vaccinated during the first few weeks the shots were available. But experts say there’s another, perhaps less appreciated issue: communication.

A lack of public education funds

Many Americans simply may not know that there are new Covid-19 vaccines available or that they’d benefit from getting another shot.

“I’m actually not too surprised,” said Dr. Peter Hotez, a molecular virologist and microbiologist who co-directs the Texas Children’s Center for Vaccine Development and designed a vaccine against Covid-19.

Based on his recent conversations, Hotez said that even doctors and other more educated people are confused about the need for annual Covid-19 vaccines.

“They don’t quite understand what this new booster is about,” he said. “They don’t even understand that it’s specifically targeted for currently circulating variants.”

There’s also a lot of confusion about the need to keep topping off our immunity against Covid, Hotez said.

“There’s kind of that buzz out there that you’re already protected against hospitalization and severe illness through previous immunizations, which I don’t think is true, but that’s a common belief or misunderstanding,” he said.

The general public doesn’t seem to understand that immunity against Covid-19 wanes and that even previously vaccinated people can see their risk for severe disease and hospitalization rise over time.

He said people also don’t seem to be aware that vaccination cuts the risk for long Covid and protects pregnant women and their newborns, who are especially vulnerable in their first six months of life because they are too young to be vaccinated.

“The message hasn’t gotten out enough,” Hotez said.

There’s some speculation that communication about the vaccines is lacking partly because of the previous budget cuts.

Jen Kates, a senior vice president at the nonprofit health policy think tank KFF, says she’s also not surprised by the low uptake numbers.

“There’s not funding really to support promoting and educating about this vaccine, the updated vaccine,” she said. In addition to the cuts, she said, the Biden administration repeatedly asked Congress for more funding for its Covid-fighting efforts and was turned down for those requests, too.

In May, during the budget negotiations between Republicans and the White House, the administration agreed to give back $27 billion that had been allocated to efforts to fight Covid-19.

One of the programs that was affected was a $150 million effort by HHS called “We Can Do This,” which was in the midst of planning a fall education campaign to boost awareness of the Covid-19 vaccines. As a result of the rescission, HHS lost that entire program, which was launched in 2021. Some of the people working on the project were reassigned within the agency, while others were laid off, according to sources familiar with the cuts.

In addition to the CDC’s efforts, there are other ways consumers are hearing about the vaccines. Companies that make the updated vaccines — Pfizer/BioNTech and Moderna – and the pharmacy chains administering the shots, such as CVS and Walgreens, are running their own ads to promote vaccination using high-profile celebrities like NFL player Travis Kelce and businesswoman Martha Stewart. But experts say these types of campaigns don’t help people navigate the complexities of insurance coverage or direct them to government resources to help them find available shots.

“It’s not replacing what was in place before,” Kates said.

Difficulty tracking doses

With this year’s vaccine rollout, “every state has gotten at least some supply of vaccine,” said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials.

But as the vaccine transitioned this year from being distributed by the government to being made available on the commercial market, “the big issue is, we just don’t have any visibility about what’s going on in the commercial system,” Plescia said. “We kind of got used to having good visibility on this during the pandemic because the government was the supplier of the vaccine.”

But now there’s a lack of clarity around how many people are getting vaccinated and where.

Plescia added that this is also an issue outside of Covid-19 vaccinations. For instance, the problem emerges when there are shortages of certain medications, such as the syphilis antibiotic Bicillin or chemotherapy treatments for cancer.

“There aren’t the checks and balances that we need there or the ability to monitor, and it’s really kind of concerning,” Plescia said. “I hope that maybe this Covid vaccine will shed some light on the problem, and we can have some further solutions or oversight or required reporting.”

Some states require that each Covid-19 vaccination be recorded in the state’s immunization information system, but not all states have that protocol, said Dr. Michelle Fiscus, chief medical officer at the Association of Immunization Managers.

“It’s difficult to know how we’re doing with vaccinations right now as data capture is very fragmented,” Fiscus wrote in an email, adding that getting vaccinated remains important as the nation approaches the winter respiratory virus season, when a surge of infections is anticipated.

Worry grows around low uptake

There is growing concern that vulnerable older adults and young children are not receiving the updated Covid-19 vaccinations ahead of the upcoming virus season.

“The real problem we’re finding with the Covid vaccine – and this is incredibly variable across the country – is uptake and demand for the vaccine,” said Dr. Jesse Hackell, chair of the American Academy of Pediatrics’ Committee on Practice and Ambulatory Medicine.

Before the latest shot was rolled out, only about 13% of eligible children under age 5 had received at least one dose of a Covid-19 vaccine, Hackell said.

“So we found that there was very little parental demand for it and very few of those kids got it, and we’re seeing the same pattern with the new Covid vaccine, that there’s not a huge demand,” Hackell said. “Parents are not stepping up and asking for it in large numbers, and that’s a problem for susceptibility to the illness, and it’s also a problem for the pediatricians who are having to buy the vaccine out of pocket and then watch it sit in their refrigerators and potentially expire.”

He added that expired vaccines can be returned to the manufacturer.

“I have not heard that they’ve been expiring yet,” Hackell said. “But there’s a lot of different issues involved with the vaccine – with buying and with paying for it – that did not happen with the original Covid vaccines because those were all provided by the government.”

If more people don’t get the updated Covid-19 vaccines – along with new vaccines against RSV and influenza – experts say we could be looking at a fall and winter respiratory virus season on par with what the nation experienced last year.

That’s what government experts are predicting, too. In an October 4 stakeholder meeting, Dr. Dylan George, director of the CDC’s Center for Forecasting and Outbreak Analytics, said he expects a moderate Covid-19 wave along with a typical burden of RSV and influenza.

As a result, he said, “we’re likely to have a similar number of total hospitalizations as we had last year.”

Hotez said that although Covid-19 hospitalizations are dropping now, we still have a lot of the fall and winter left to go. Travel around the holidays tends to bump up the circulation of all kinds of respiratory illnesses, including Covid-19.

“It could start ramping up again as we head into the colder months of the winter,” he said. “And I think some people will get caught off-guard and will wind up being hospitalized.”


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