December 7, 2023

Dr. Won Lee began her first visit to a new patient, Almeta Trotter, last month asking about her life, health, and how she was doing in her apartment in the Dorchester neighborhood of Boston, which she shared with her long-time partner and a parakeet.

Finally, Dr. Lee, the medical director of the Geriatrics Home Care Program at Boston Medical Center, asked a key question. “I said, ‘What do you think of the Covid vaccination?'”

“I heard I shouldn’t have it because I was taking blood thinners” because of a heart problem, replied Ms. Trotter, 77.

Not true. Whether Ms. Trotter had misunderstood what she had heard on the television news or had been misinformed: “I told her that I had many other patients with the same disease on exactly the same drugs that were vaccinated with no problem,” said Dr. Lee.

When Mrs. Trotter agreed to the shooting – partly because “the news said that all these people were dying,” partly because their two daughters had given them – Dr. Lee called a nurse to vaccinate her home. She is scheduled to have a second dose this month.

One failed and – of the program’s 563 frail patients, most of them aged 80 and over – about 80 will leave.

Efforts to vaccinate the country’s 65+ population have been both a success story and a source of intense frustration. It is the age group with the highest rate: 92 percent have had at least one vaccination and 82 percent are fully vaccinated. Yet so many remain unprotected.

“It’s damn good,” said William Schaffner, an infectious disease specialist at Vanderbilt University. “But we clearly need to do more in this exceptionally vulnerable population. They’re not safe enough. ”Since seniors are at a much higher risk of serious illness, hospitalization and death from Covid-19, he had hoped that their vaccination rate would now be over 90 percent.

Almost 10 million elderly people are not fully vaccinated. This not only endangers them, but also offers opportunities for the coronavirus to mutate in the body of people with weak immune systems. It could also complicate the planned distribution of third shots.

When vaccines became available last winter, the older cohort had a head start.

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

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

Statistics from the Centers for Disease Control and Prevention showed that vaccination rates for this population skyrocketed in the spring and then reached a plateau. Among the 65 to 74-year-olds, 80 percent were fully vaccinated on July 1st, gradually increasing to 84 percent by September 1st. Among those over 75, about 76 percent were fully vaccinated on July 1 and now about 79 percent.

There are enormous regional differences behind these numbers. Dane County, Wisconsin, which includes Madison, has achieved near universal vaccination for those over 65. But only 76 percent are fully vaccinated in Los Angeles County.


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In New York City, rates for over 65s range from 81 percent in Staten Island to 67 percent in Brooklyn. The rate falls below 50 percent in several counties of Alabama and below 40 percent in parts of New Mexico.

Older people who want the recordings can also face significant obstacles. Early on, when local health authorities were running mass vaccination sites, “some older adults couldn’t manage online registration or couldn’t reach a center,” said Dr. Grabowski.

Months later, with vaccines becoming widely available, people with disabilities, frail, or cognitively impaired people may still have difficulty getting their first or second vaccination.

This is especially true for the homebound, who are defined as people who leave their home once a week or less. According to a JAMA Internal Medicine survey published last month, their numbers have risen sharply during the pandemic.

Among the respondents over 70, around five percent were tied to home between 2011 and 2019. In 2020 – likely due to Covid-related public health recommendations – the proportion rose to 13 percent. More than a quarter of them did not have a cell phone; half didn’t have a computer.

But access is for Dr. Lee’s patient doesn’t have the problem; In February, nurses and doctors began bringing vaccines to their doors. Family practices like UCSF Care at Home in San Francisco and Bloom Healthcare in suburban Denver have also vaccinated their patients. According to estimates by the American Academy of Home Care Medicine, about a thousand such programs across the country serve home-bound seniors.

But even after much discussion, 14 percent of patients on the Boston Medical Center program either delayed or refused the vaccination.

Understand US vaccination and mask requirements

    • Vaccination rules. On August 23, the Food and Drug Administration fully approved Pfizer-BioNTech’s coronavirus vaccine for people aged 16 and over, paving the way for increased mandates in both the public and private sectors. Private companies are increasingly demanding vaccines for employees. Such mandates are legally permissible and have been confirmed in legal challenges.
    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in public places indoors in areas with outbreaks, reversing the guidelines offered in May. See where the CDC guidelines would apply and where states have implemented their own mask guidelines. The battle over masks is controversial in some states, with some local leaders defying state bans.
    • College and Universities. More than 400 colleges and universities require a vaccination against Covid-19. Almost all of them are in states that voted for President Biden.
    • schools. Both California and New York City have introduced vaccination mandates for educational staff. A survey published in August found that many American parents of school-age children are against mandatory vaccines for students but are more likely to support masking requirements for students, teachers and staff who are not vaccinated.
    • Hospitals and medical centers. Many hospitals and large health systems require their employees to have a Covid-19 vaccine, due to rising case numbers due to the Delta variant and persistently low vaccination rates in their communities, even within their workforce.
    • New York City. Proof of vaccination is required by workers and customers for indoor dining, gyms, performances, and other indoor situations, though enforcement doesn’t begin until September 13th. Teachers and other educational workers in the city’s vast school system are required to have at least one vaccine dose by September 27, without the option of weekly testing. City hospital staff must also be vaccinated or have weekly tests. Similar rules apply to employees in New York State.
    • At the federal level. The Pentagon announced that it would make coronavirus vaccinations compulsory for the country’s 1.3 million active soldiers “by mid-September at the latest. President Biden announced that all civil federal employees would need to be vaccinated against the coronavirus or undergo regular tests, social distancing, mask requirements and travel restrictions.

“Families said, ‘My grandmother won’t go out,'” said Dr. Lee. “But even if you don’t go out, a family member or a carer comes in and can bring diseases with them.” Before the vaccines arrived, her practice lost 28 patients to Covid, she said, and “it was heartbreaking”.

Why the footsteps in the population who, like Dr. Grabowski put it, has the most to win?

The political divide that has led many Americans to opt out of vaccinations is smaller in the older population than in younger groups, but it still persists. A survey by the Kaiser Family Foundation in July found that among those 65 and over, only three percent of Democrats said they “definitely won’t” get the vaccine, compared with 13 percent of Republicans.

It also plays a role in where seniors get information, according to a recent study by University of Iowa health researchers using a national survey of Medicare benefit recipients from late 2020.

At the time when vaccines were not available but were imminent, 13 percent of respondents said they would definitely or probably not get vaccinated. About a quarter were unsure.

“People who rely on social media, the internet, friends and family, and healthcare providers were more likely to express negative vaccination intentions than those who used ‘normal news”, “said Divya Bhagianadh, one of the study’s co-authors.

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

Now that the country is about to mobilize for third shots, “I am concerned about the potential of a free-for-all,” said Dr. Grabowski. “Will trying to give the booster crowd out the people who need their first or second shot? Will there be lines and schedules that make it difficult for seniors to get vaccinated?

Employer and school vaccination regulations do not affect most older adults. Closing this particular vaccination gap will require further efforts on the part of federal and local health authorities – bringing vaccines to individual homes and senior centers in the neighborhood, providing transportation to pharmacies or clinics, visiting nursing homes, and including their staff, including general practitioners Vaccines in their offices.

Ms. Trotter, for example, seems happy to have her injections. The first dose of the Moderna vaccine, she said, did not cause any side effects.

“My arm didn’t even hurt,” she said.