Vaccinated Americans aren’t lining up for the latest booster the way they did for their first few jabs.

It has been more than six weeks since the Food and Drug Administration granted emergency use authorization for Pfizer and Moderna’s omicron-resistant boosters—the second set to gain approval since the initial coronavirus vaccines. As of October 7, 68% of the U.S. population had been vaccinated with a primary series, but fewer than half of those have heeded official guidance and received a booster.

According to the Centers for Disease Control and Prevention (CDC), 11.5 million Americans received a second booster dose in the first five weeks of the rollout, among more than 200 million who are eligible—anyone who received the primary series at least two months ago and is at least 12 years old. And only 38% of Americans 50 and older have received the updated booster.

“The vaccines that we’ve been using so far are effective in stopping some transmission and reducing the worst disease of the virus,” says epidemiologist Brian Labus, assistant professor at UNLV’s School of Public Health. “There’s limited information, though, on the most recent booster that we can point to and say the exact numbers. … The numbers, of course, are lower than we want them to be for a lot of groups, especially younger people who are in contact with a lot more people.”

With the new bivalent boosters having been available to the public since the start of September, there’s little data thus far about boosted rates among different age groups. Information about the first delta-resistant booster released in fall 2021, however, provides an idea of how much of the vaccinated population will get the shot in the coming months.

According to the CDC, rates for the 2021 booster range from 49% to 52% for all eligible age groups (5 years and older), except for the 65 and older group, which has a boosted rate of 71%.

As for general vaccination rates, October 5 data from the American Academy of Pediatrics shows that, among all U.S. children 6 months to 17 years old, 41% have received at least one dose of the COVID-19 vaccine. According to the Southern Nevada Health District, nearly 61% of Clark County’s population is fully vaccinated compared to 68% of the total U.S. population.

“You have half the people willing to get the vaccine and the other half not willing,” Labus says of the bivalent booster, adding that the availability of a new booster isn’t going to change many minds about the vaccine.

“We also have to take into account natural infection. With the omicron wave, we saw so many people get sick that there is a lot of immunity overall in the population, which is why we’re seeing low levels nationwide,” he says. “ A lot of people had to die for us to get there. But right now we’re at the point where there is some resistance in our population to this disease.”

At press time, the U.S. was seeing more than 41,000 reported new coronavirus cases per day, low compared to the height of the highly contagious omicron surge in January, when new case averages topped more than 800,000 per day. And although President Joe Biden recently said that “the pandemic is over” on CBS’ 60 Minutes, health officials and doctors stress that staying up to date on vaccinations is critical to keeping case numbers at bay.

A recent CDC study of nursing home residents at 196 U.S. facilities found that the bivalent booster was 74% effective at 60 days in preventing severe outcomes (hospitalization or death) and 90% effective in preventing death alone, compared with a single booster dose.

“There [are] two things to keep in mind: Are you fully vaccinated, and are you up to date?” Labus says. “Fully vaccinated means that you’ve gotten the initial two-shot series. Up to date means you’ve gotten the appropriate number of booster shots for your given age and underlying health conditions.”

According to the latest data from the Southern Nevada Health District, nearly 57,300 bivalent boosters have been administered, meaning about 4.6% of Clark County’s fully vaccinated population 12 and older (approximately 1.25 million) is up to date.

Know before you go

The FDA has not yet authorized a bivalent booster for children ages 5-11, but Pfizer and Moderna are working on it. In September, the companies submitted applications for emergency use authorization for children as young as 5 and 6 years old, respectively. Approval is expected to come later this year.

Aside from meeting the minimum age requirements—12 years old for Pfizer’s and 18 for Moderna’s—patients should have received a primary or booster vaccination at least two months prior to getting the bivalent booster. Official guidance also suggests those who recently had COVID might want to consider delaying their next vaccine dose by three months from when their symptoms started, since infection provides a natural immune response.

Some patients choose to time their shot with an event—like air travel, a music festival or family gathering—when they’ll be around crowds and at higher risk of exposure. But keep in mind, sooner is better than later; and it takes about one week for the immune response to kick in.

“The best time to get it is before you’re exposed. And we don’t know when that next [case] increase is going to come,” Labus adds. “The strongest response will be two to four weeks after that vaccination. [And that] varies from person to person.”

Also, don’t expect it to be your last COVID booster shot. Because the immune response wanes over time, the updated boosters will likely become as routine as annual flu shots—or at least “the hope is there,” Labus says. “I expect to see the same thing that happens with flu shots, where older people and people with serious underlying health issues are more likely to get it than those who are otherwise healthy.”

There’s also the ever-present threat of new, resistant variants emerging, which would call for the booster to be updated and administered again in the community. During a recent event at USC, Dr. Anthony Fauci, Biden’s chief medical adviser, said that, “We should not be surprised” if another immune-resistant variant emerges this winter and causes cases to surge.

Taking action and getting boosted is the best preparation to help reduce hospitalizations and deaths in such a scenario.

“There’s two ways to stop a fire,” Labus says. “You either put it out or you let it burn everything down. Either way, the fire stops.

“If the goal is ultimately to stop COVID, you either do it by preventing it by vaccinating everybody, or everyone gets it.”

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