More than 80% of the elderly are vaccinated. It’s ‘not sure enough.’

Dr Won Lee began her first visit to a new housebound patient, Almeta Trotter, last month asking her about her life, health and how she was doing in her apartment in Boston’s Dorchester neighborhood, shared with her longtime partner and a parakeet. .

Finally, Dr. Lee, medical director of the Boston Medical Center Geriatric Home Care Program, raised a key question. “I said, ‘What do you think of the Covid vaccination?’ “

“I’ve heard that I shouldn’t be taking it because I’m taking blood thinners” for a heart problem, Ms. Trotter, 77, replied.

Not true. Whether Ms. Trotter misunderstood what she heard on the TV news or was misinformed, “I told her that I had many other patients with the same problem who were taking the exact same medication and who had been vaccinated without a problem, ”said Dr Lee. .

When Ms Trotter agreed to the injections – partly because “the news was about all these people dying”, partly because her two daughters had received them – Dr Lee sent a nurse home to vaccinate her. She is planning a second dose this month.

One downstairs and – of the 563 frail patients confined to the house, most aged 80 and over – about 80 to come.

The effort to immunize the country’s population over 65 is both a success and a source of intense frustration. This is the age group with the highest rate: 92% have received at least one injection and 82% are fully vaccinated. Yet many remain unprotected.

“That’s pretty darn good,” said William Schaffner, infectious disease specialist at Vanderbilt University. “But we clearly need to do more for this extremely vulnerable population. They are not safe enough. With older people at much higher risk of serious illness, hospitalization and death from Covid-19, he had hoped to see their vaccination rates surpass 90 percent to date.

Almost 10 million older people are not fully immunized. This not only puts them at risk, but also provides opportunities for the coronavirus to continue to mutate in the bodies of people with weakened immune systems. It could also complicate the planned distribution of the third shots.

Last winter, when vaccines became available, the older cohort got a head start.

“They were the first,” said David Grabowski, a health policy researcher at Harvard Medical School. Seniors were among those given priority for appointments, while a federal program brought immunization clinics directly to nursing homes. And many were inclined to roll up their sleeves.

“A lot of older people have realized they are at risk,” said Dr. David Nace, a geriatrician at the University of Pittsburgh Medical Center, who studies infections in older people. “We have an older population who remembers what it was like before the polio vaccine or the diphtheria vaccine.”

Statistics from the Centers for Disease Control and Prevention showed that vaccination rates for this population skyrocketed in the spring and then plateaued. Among those 65 to 74 years old, 80 percent were fully immunized by July 1, rising gradually to nearly 84 percent by September 1. Among those over 75, about 76 percent were fully immunized by July 1, and about 79 percent now.

These figures hide enormous regional variations. Dane County, Wisconsin, which includes Madison, has achieved near universal immunization for those over 65. But only 75 percent are fully vaccinated in Los Angeles County.

In New York, rates for those over 65 range from 80% in Staten Island to just 67% in Brooklyn. The rate falls below 50 percent in several counties in Alabama and below 40 percent in parts of New Mexico.

Even older people who want to get vaccinated can face substantial barriers. In the beginning, when local health authorities ran mass vaccination sites, “some older people could not handle online registration or could not come to a center,” said Dr Grabowski.

Months later, with vaccines widely available, people with disabilities, frailty or with cognitive impairment may still have difficulty accessing the first or second vaccine.

This is especially true for people confined to the house, defined as people who leave their homes once a week or less. Their numbers have risen sharply during the pandemic, according to a JAMA Internal Medicine survey released last month.

Of those surveyed over 70, around 5% were homebound from 2011 to 2019. By 2020 – likely due to public health recommendations related to Covid – the proportion has risen to 13%. More than a quarter of them did not have a cell phone; half did not have a computer.

But access is not the problem for Dr. Lee’s patients; in February, nurses and doctors began bringing vaccines to their doors. Home-based medical practices like UCSF Care at Home in San Francisco and Bloom Healthcare in suburban Denver have also vaccinated their patients. About a thousand of these programs serve homebound seniors across the country, according to estimates from the American Academy of Home Care Medicine.

Yet even after long discussions, 14% of homebound patients in the Boston Medical Center program delayed or refused immunizations.

“Families were like, ‘My grandmother is not coming out of the house,’” said Dr Lee. “But even if you don’t go out, a family member or caregiver comes in and can bring the disease.” Before the vaccines arrived, her practice lost 28 patients to Covid, she said, and “it was heartbreaking.”

Why the drag on the population who, as Dr Grabowski said, has the most to gain?

The political divide that has led many Americans to resist vaccination is weaker in the older population than in younger groups, but still exists. A July survey by the Kaiser Family Foundation found that among those over 65, only three percent of Democrats said they “definitely” would not get vaccinated, compared to 13 percent of Republicans.

According to a recent study by health services researchers at the University of Iowa, using a national survey of Medicare beneficiaries in late 2020.

At that time, when vaccines were unavailable but imminent, 13% of those polled said they definitely would not or probably not get vaccinated, the survey found, citing mainly fear of side effects and distrust of the government. About a quarter were uncertain.

“People who rely on social media, the Internet, friends and family and health care providers were more likely to express a negative intention to vaccinate, compared to those who used ‘regular news'” said Divya Bhagianadh, one of the study’s co-authors. .

Health care providers? At the time, “there was great indecision among the healthcare providers themselves,” said Kanika Arora, the other co-author of the survey.

Now, as the country is about to start rallying for the third shootout, “I’m worried about the potential for a free-for-all,” Dr Grabowski said. “Does the effort to give the recall crowd out people who need their first or second shot?” Will there be queues and times that make it more difficult to vaccinate older people?

Vaccination mandates from employers and schools will not affect most older people. Filling this particular immunization gap will require continued efforts from federal and local health officials – getting vaccines to individual homes and neighborhood senior centers, providing transportation to pharmacies or clinics, revisit nursing homes and include their staff, allow primary care physicians to offer vaccines in their offices.

Ms Trotter, for her part, seems happy to be vaccinated. The first dose of Moderna vaccine, she reported, did not cause any side effects.

“My arm didn’t even hurt me,” she said.