Bypassing the Bivalent Booster

If the Great City were granted one holiday wish it should probably be this: All we want for Christmas is for everyone to get the bivalent COVID booster.

Unfortunately, New Yorkers, and Americans in general, are bypassing this obvious stocking stuffer in droves, just as holiday gatherings energize the tripledemic of flu, RSV and the new variants of COVID-19.

“We are at a very significant moment right now,” Mayor Eric Adams said as he urged health precautions for the holidays.

The Health Department says only one New Yorker in ten has gotten the new booster, redesigned to counter the Omicron variants that wreaked havoc a year ago, even though new research shows it significantly reduces the risk of serious illness or death.

Among seniors, the most at-risk group, one in five has gotten the new booster, better, but still below both the national averages, which aren’t very good, or the goals health experts have set to deter the pandemic after three years.

“We are at a place where we are lucky enough to have very effective tools capable of preventing COVID hospitalizations, deaths and long covid,” said Denis Nash, a public health consultant and professor at the CUNY school of public health. “But our public health and health care systems can’t seem to execute/implement a plan that gets the coverage and uptake that is needed.”

Officials are certainly saying the right thing.

“It’s crucial to make sure that you are vaccinated and you are taking your booster shots,” Adams said at a news conference he convened to urge New Yorkers to adopt protections so “we enjoy the holidays and spread love without spreading the virus.”

“Get Vaccinated”

His health commissioner, Ashwin Vasan, said this was the chance to snatch back the holidays after two years of disruptions.

“It’s clear,” the mayor said. “The direction is: Get vaccinated. Get boosted. Stay safe and make sure you enjoy a safe holiday season.”

The other guidance included stay home if you feel ill, and wear a face covering in crowded situations, especially indoors or in unfamiliar surroundings.

While these directions may be clear, the uptake of the booster vaccine has been disappointing.

“Something uniquely American is happening,” Nash observed.

He noted that eight other developed countries all had lower COVID death rates over the past year, a period in which vaccines and other medical interventions were widely available. This, he said, “speaks volumes about how ineffective our public health systems are.”

“I think the COVID vaccination campaigns have never done a really good job at targeting those most at risk (e.g. the elderly) for receipt of booster doses,” Nash added. “It also hasn’t helped that messaging from other older people,” like President Biden, “has been along the lines of ‘the pandemic is over’. How do you square that with other messaging telling people to get boosted? It is at best a mixed message.”

Even Adams may have taken his eye somewhat off the ball of emphasizing boosters for those at greatest risk. He announced at his news conference that the latest booster would now be available at the 11 city hospitals for the youngest New Yorkers, those between six months and four years of age.

“We know the virus mutates and this is going to allow us to deal with how this virus is mutating,” Adams explained.

Texts and Emails

Vasan noted some of the other efforts the city was making to get New Yorkers to take their booster. He said the department was texting New Yorkers and that the hospital system had sent out some two million emails to get boosted. The city has also urged medical providers to speak to their patients about getting boosted, Vasan said.

“I am not sure how aggressive providers are at encouraging boosting,” said Nash. “I went to see my provider for an annual checkup in October. He didn’t ask me about COVID boosters or my history of COVID infection.”

The new boosters, made by both Pfizer and Moderna, are called bivalent because they are designed to act effectively against both the original SARS-CoV-2 variant that emerged in 2020 and the Omicron variants that were dominant at the end of last year and the beginning of 2022.

These Omicron variants have since been superseded by newer variants that are even more effective at evading the immune system.

This may be contributing to a view the boosters are not necessary or won’t work.

New Studies

But the Centers For Disease Control posted two new studies this week demonstrating the value of the bivalent booster .

For patients over 65, one of the studies concluded, “a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination only.” The other study looked at all adults and also found the booster provided additional protection.

“To maximize protection against severe COVID-19 this winter season, all eligible persons, especially adults aged ≥65 years, should receive a bivalent booster dose and consider additional prevention strategies, including masking in indoor public spaces,” the CDC recommended.

Vasan also stressed the effectiveness of COVID vaccines. He said that 80 percent of COVID deaths in New York were among patients who were unvaccinated or who had failed to complete their basic two dose course.

In urging safety precautions this holiday season Adams noted that conditions are “a far different cry” from this time last year. But vigilance is still called for, the mayor said.

“Where’s your mask,” the mayor demanded of one of the reporters covering his news conference.

He and his top medical aides all wore masks as they urged others to consider doing so, too. He credited the wiliness of New Yorkers to adopt safety measures and get vaccinated to the taming of Covid to its present levels.

“New Yorkers,” the mayor said, “don’t like people telling them what to do,” which could help explain the current resistance to new boosters, too.

“But we were able to state to them we needed you to wear your mask, we needed you to get vaccinated. We needed for you to social distance. And they complied. They understood the urgency of the moment and they stood up,” Adams said about the past three years.

“Its crucial to make sure that you are vaccinated and you are taking your booster shots,” the mayor said about now.