Why do so few in Southern California get updated COVID vaccinations? – Orange County Register


People check in to get their COVID-19 vaccine at UCI Health Family Health Center in Anaheim, CA in April 2021. (Photo by Paul Bersebach, Orange County Register/SCNG)

The buds are blooming, the grass is green, the orange and palm trees sway — and those spring COVID vaccines are rolling out yet again.

This spring, the COVID booster is aimed at folks 65 and older and those who are immunocompromised, but we mostly stink at staying up-to-date on these vaccinations. Cutting-edge Californians are remarkably under-vaccinated — only 13.7% of Golden Staters are up to date, and that percentage shrinks as poverty levels increase.

In Orange County, 12.6% of folks were up-to-date on their COVID vaccines, compared to 12% in Los Angeles County, 8% in Riverside County, and 6.8% in San Bernardino County.

The most at-risk group is folks 65 and older, so it’s good that it’s also the most up-to-date age group. Still, the overwhelming majority of seniors are avoiding the shot: Statewide, 34.1% of folks 65 and older have had the most recent vaccine, compared to 32.2% in Orange County, 28.5% in Los Angeles County, 26.2% in Riverside County and 24.3% in San Bernardino County.

What gives?

“The messaging from the CDC is horrible,” said Eva Kohn of San Clemente. “Most people think COVID is over. As of late, the mRNA vaccines have some issues that can keep away potential takers.”

Among them, rare cardiac issues in young men. She opted for the Novavax shot, which is not an mRNA vaccine like Pfizer and Moderna. Novavax is a protein-based vaccine built on older technology; it includes protein fragments from the virus that can’t cause disease, but fire up the immune system.

Her college-aged kids got the Novavax shot as well, and they’ve been COVID-free this season.

“People are treating COVID-19 like the flu at this point; there are those who get flu shots every year and then there are the vast majority who don’t,” Julie Huniu Nolte said via Facebook. “People no longer view COVID-19 as a major threat.”

Fatigue

There’s little doubt that people are suffering from vaccine fatigue, even though the COVID-19 virus is still circulating and is probably here to stay, Dr. Daisy Dodd, an infectious disease specialist with Kaiser Permanente Orange County, said by email.

“The good news is that hospitalizations and deaths directly tied to COVID-19 are low, mainly due to initial vaccinations and herd immunity. Following the pandemic, most people were either vaccinated or were infected by the virus. Nevertheless, it’s important for seniors and immunocompromised individuals to get the COVID-19 booster vaccine at least once a year, as is the case with the flu shot, so that their protection remains high.”

Andrew Noymer, an epidemiologist and demographer at UC Irvine, lays much of the blame for low uptake on the Centers for Disease Control.

“You ask rhetorically, is COVID just flu now?” he said. “I think most Americans think so. Hard to blame them; this is what CDC has been telegraphing. Unfortunately, COVID is still more deadly on a case-by-case basis than influenza, and it has more severe sequelae. It ain’t flu.”

The CDC consistently minimizes COVID, data dashboards have been dismantled, briefings discontinued, and, “Most egregiously, its official guidance is not to let a positive COVID at-home test result keep us from going to work or school, as long as we are asymptomatic. Because, let’s infer, COVID is no big deal,” Noymer continued. “Yet some people are advised to re-up their vaccines every four months. While new guidance on a cadence of every-four-months vaccines for 65+ may make sense in light of data on fading antibodies, it’s not going to do anything to help vaccine uptake. Name another vaccine with a four-month cadence; I’ll wait.”

The federal government’s decision to stop buying COVID vaccines last year also has not helped, said Richard Carpiano, a public and population health scientist and medical sociologist at UC Riverside.

“This meant that the manufacturers sold directly to insurers, which shifted the cost to them,” he said. “This made it more likely that people who were under- or uninsured were less likely to get vaccinated. … Even for those with insurance, this policy change also made it more complicated to get vaccinated when the updated booster became available.”

The Biden administration created the Bridge Program to cover the cost for uninsured people, partnering with providers including pharmacies and public health departments, he said. That program rolled out in September, but the disparity data suggest it’s unclear how effective it has been, or what else may be at work (funding for targeted campaigns, education, outreach and community clinics).

Skepticism about vaccines in general is on the rise.

“During COVID, we were told that vaccines would end the pandemic. When breakthrough infections became apparent in July 2021… the CDC director at the time made great effort to stress that breakthroughs are unusual,” Noymer said. “Now we know that breakthrough infections are commonplace. ‘Why bother?’ many Americans are asking, and the CDC hasn’t made the case that we should bother.”

Politics

In December, a Gallup poll found that while 47% of adults said they’d gotten the flu shot, only 29% said they got the new COVID-19 shot.

Even though COVID is more dangerous and deadly than flu. State data show that:

• In mid-March, 158 Californians were hospitalized with COVID. Only 28 were hospitalized with flu.

• In the first three weeks of March, 138 Californians died of COVID. Only 10 died of flu.

Public health has become sadly politicized.

Nearly half of Democrats (48%) got the updated COVID-19 shot, while only 20% of independents and 10% of Republicans did. A stunning 82% of Republicans said they would not get the updated shot.

Flu shots are more popular, but politics is at work here as well: 61% of Democrats, 38% of independents and 35% of Republicans got the flu shot this year. More than half of Republicans, 52%, said nuts to that.

Why? Folks’ primary reason for skipping the COVID shot was because they had COVID-19 and believe they still have protective antibodies (27%), and because they have safety concerns about the vaccine (24%), Gallup found.

The effectiveness of the vaccine was questioned by 18%, and another 16% said they don’t believe they’d suffer serious health consequences from the coronavirus.

Smaller groups, less than 10%, say they distrust vaccines in general or are concerned about an allergic reaction.

FILE - A pharmacist injects a patient with a booster dosage of the Moderna COVID-19 vaccine at a vaccination clinic in Lawrence, Mass., on Wednesday, Dec. 29, 2021. U.S. regulators have authorized updated COVID-19 boosters, the first to directly target today's most common omicron strain. The move on Wednesday, Aug. 13, 2022, by the Food and Drug Administration tweaks the recipe of shots made by Pfizer and rival Moderna that already have saved millions of lives. (AP Photo/Charles Krupa, File)
FILE – A pharmacist injects a patient with a booster dose of the Moderna COVID-19 vaccine in 2021. (AP Photo/Charles Krupa, File)

The Orange County Health Care Agency said it continues to monitor COVID-19 vaccination coverage, and that the CDC continues to find that immunized folks are far less likely to need emergency care or hospitalization.

“Despite clear evidence pertaining to efficacy, we recognize vaccination coverage rates remain too low,” Dr. Regina Chinsio-Kwong, county health officer, said by email. “Contributing factors include vaccine fatigue, misinformation, and difficulty in accessing COVID-19 vaccine.  As an agency, we remain steadfast in our commitment to address these challenges through ongoing education and outreach efforts.

“We continue to collaborate with stakeholders such as community-based organizations, medical professionals, and the Orange County Immunization Coalition, as well as through social media, to emphasize the benefits of COVID-19 vaccination as well as other vaccines. All these efforts are integral to disseminating accurate information and promoting vaccination uptake.”

UCI’s Noymer recommends a book on the American experience of the 1918 flu, called “America’s Forgotten Pandemic.” One of its themes is that people in the U.S. just wanted to turn their back on the whole painful experience. A similar social force is at work here, he said.

“Unfortunately,” he said, “we are throwing out the baby with the bathwater, and we have measles epidemics as a result.”


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