Maintaining the Momentum for COVID-19 Vaccination

Jennifer Middleton, MD, MPH
Posted on January 30, 2023

An expert advisory committee to the U.S. Food and Drug Administration (FDA) voted last week to recommend phasing out the use of the original COVID vaccines developed in the first two years of the pandemic in favor of the bivalent booster vaccines. The committee also discussed (but did not vote on) moving to an annual COVID-19 vaccination schedule, similar to the U.S. strategy for influenza. Both changes, if eventually approved by the FDA, would simplify the current complicated COVID-19 vaccine strategy that relies on the original vaccines for the initial series and then the bivalent as a booster. Simplifying recommendations may help to increase uptake of the bivalent booster; only 15.5% of the U.S. population has received the bivalent booster, although 40.1% of those 65 years and older have.

Thanks in part to Operation Warp Speed, the original U.S. FDA–approved COVID-19 vaccines, developed by Pfizer/BioNTech and Moderna/NIH, rolled out at the end of 2020 for health care personnel and was available to the U.S. public in early 2021. The Janssen (Johnson & Johnson) vaccine also arrived in 2021 as an alternative to the novel mRNA technology of the Pfizer and Moderna offerings, although the Janssen vaccine is now “only recommended in certain limited situations due to safety considerations.” These vaccines reduced rates of hospitalization and death from COVID-19 infection and have saved millions of lives:

[T]he U.S. has administered more than 655 million doses — 80 percent of the population has received at least one dose — with the cumulative effect of preventing more than 18 million additional hospitalizations and more than 3 million additional deaths. The swift development of the vaccine, emergency authorization to distribute widely, and rapid rollout have been instrumental in curbing hospitalization and death.

The bivalent booster has continued this success story as it remains effective against the current dominant Omicron subvariant in the United States, XBB.1.5. Immunocompromised people especially should avail themselves of the bivalent booster,and continue to mask and social distance, as tixagevimab/cilgavimab (Evusheld) does not provide effective preexposure prophylaxis against any of the newer Omicron subvariants.

Sadly, hundreds of thousands of more lives could have been, and could further be, saved with higher vaccination rates. In the United States, more than 80% of the 500+ people who die every day of COVID-19 are unvaccinated. In a recent poll, more than half of those eligible for the bivalent booster in the United States are either apprehensive about it or unwilling to receive it; in the same poll, fewer than half of surveyed parents plan to get their children the bivalent vaccine. The most common reasons cited for not getting the bivalent booster were not thinking it necessary, not believing the benefits were worth it, and fear of reprising unpleasant adverse effects from previous COVID-19 vaccines.

The pandemic has taken its toll on many of us; we are tired, overwhelmed, and burned out. The stakes are too high, though, for us to turn away from the opportunity to guide ambivalent patients toward reconsidering vaccination. A conversation with a physician has been shown to help hesitant persons choose to get the COVID-19 vaccine. This AFP Lown Right Care article from 2021 provides multiple strategies, including identifying patients’ intrinsic values in the context of motivational interviewing. This AFP editorial from 2022 includes pragmatic ways to effectively counter misinformation, both in our practice settings and online. And, you can read more at the AFP By Topic on COVID-19.