Covid-19: Vaccine hesitancy and access affect uptake of new boostersBMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2271 (Published 02 October 2023) Cite this as: BMJ 2023;383:p2271
The US Centers for Disease Control and Prevention (CDC) has encouraged all Americans aged 6 months and older to get the new covid-19 booster amid indications that vaccine hesitancy and availability may be hindering uptake.
CDC especially encouraged pregnant women to get covid-19, flu, and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines, after data from earlier this year showed that uptake has been disappointing.12 A CDC report found that about half of pregnant women surveyed between 28 March and 16 April 2023 said they had not had either a flu or a Tdap vaccine. Only a quarter had had both vaccines, and about three quarters had not had the previous bivalent booster covid-19 vaccine.
The report showed increasing hesitancy among pregnant women to receive vaccines, with hesitancy higher among black women. CDC said that when healthcare providers recommended the vaccines and offered them or offered a referral, pregnant women were more likely to accept the vaccines. “Culturally relevant vaccine recommendations” would improve uptake, CDC said.
CDC recommendations for updated covid vaccines
On 15 September CDC recommended that all Americans aged 5 and older have one dose of the updated (2023-24 formula) mRNA covid-19 vaccine, either Moderna or Pfizer-BioNTech.
For children aged 6 months to 4 years who are receiving their initial vaccination, CDC recommended either two doses of the updated Moderna vaccine or three doses of the updated Pfizer BioNTech vaccine. Children who had previously had a covid-19 vaccine should get one or two doses of the updated vaccines, depending on how many shots they had previously had.
It advised that people who are moderately or severely immunocompromised and have not previously had a covid-19 vaccine should get three doses of either the updated Moderna or the updated Pfizer BioNTech vaccine. And people who have had a previous covid-19 vaccine should receive one or two doses of the updated Moderna or the updated Pfizer vaccine, depending on how many doses they had previously received.
Vaccine hesitancy, confusing availability
A poll by the Kaiser Family Foundation found that the percentage of adults who said they would “definitely” or “probably” get a vaccine was lower for the covid booster (46%) than for the flu vaccine (58%) and the respiratory syncytial virus vaccine (also 58%). Most parents said they will probably not get their child the new covid vaccine. Older adults, previously vaccinated adults, and Democrats were more likely to get the new covid vaccines. Some 42% of Democrats said they would “definitely” get the new covid-19 vaccine compared with only 8% of Republicans.34
Rollout of Moderna and Pfizer BioNTech’s updated vaccines has been complicated and confusing. Covid-19 vaccines had been available free, paid for by the US government. But the situation is different with the new vaccines. “I think we got spoiled in terms of vaccine access. When the government is not footing the bill, it’s harder,” said John Brownstein, chief innovation officer at Boston Children’s Hospital, in an interview.5
Now the vaccine must be paid for by a person’s private health insurance—often related to their employment—or by government insurance plans such as Medicare (for those over 65) and Medicaid (for those on low incomes).
Vaccine availability at drug stores and other sites is often a problem. One search for the new covid-19 vaccine in New York City said no appointments were available within 100 miles, while a drugstore website said to check back for when the vaccine would be available. The CVS drugstore chain said it was experiencing delays in shipments.6 Doctors’ offices and independent pharmacies may wait longer to get the vaccines.
This article is made freely available for personal use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage