Health Care

Vulnerable Americans are going into the holiday season without COVID-19 protections

Health and Human Services Secretary Xavier Becerra receives an updated COVID-19 booster and a flu shot at a local CVS Pharmacy September 20, 2023 in Washington, DC. (Photo by Drew Angerer/Getty Images)

The U.S. is heading into peak respiratory virus season, and some of the most vulnerable Americans are unprotected against COVID-19.   

Only 27 percent of nursing home residents and just 6 percent of staff have been vaccinated since the updated version of the shot became available in September, according to the Centers for Disease Control and Prevention (CDC).  

Nursing homes have been devastated by COVID-19. Residents make up only about 1 percent of the U.S. population and have accounted for more than 20 percent of all deaths nationwide. 

Throughout the pandemic, nursing homes have been trying to persuade residents and staff to get vaccinated with yet another round of shots. But there is no longer any federal mandate for workers to be vaccinated against COVID-19.  

Additionally, since the public health emergency ended in May, the federal government is no longer responsible for purchasing vaccines, which could have made it more difficult for some facilities to access the shots initially.  


Health experts are concerned low vaccine uptake among staff could leave residents vulnerable to a resurgence of the virus. 

“It’s really important that this group gets boosted because there they are the group that will be hospitalized with illness and can have severe infection and poor outcomes,” said Preeti Malani, a clinical professor and infectious disease physician at the University of Michigan Health. 

Malani said in the absence of mandates, there needs to be some persuasion effort in nursing homes to convince them about the importance of the shots. If empathy for vulnerable residents doesn’t work, an economic message might.  

“You’re going to miss time at work” because there’s likely no paid COVID leave, she said.  

The numbers for nursing homes reflect an overall low vaccination rate among the rest of Americans.  

According to the most recent agency estimates, only 16 percent of all adults have received the updated shot for the week ending Nov. 25.  

While experts say there will likely be an increase, getting to that point will be a challenge.   

“Here’s the bottom line: COVID-19 vaccine uptake is lower than we’d like to see, and most people will be without the added protection that can reduce the severity of COVID-19,” the CDC wrote in an update on its website last month. 

CDC Director Mandy Cohen told a House panel last week that despite relatively low levels of infection, COVID-19 is killing about 1,000 people every week.  

COVID-19 remains “the primary cause of new respiratory hospitalizations and deaths” in the country, Cohen said.  

Cohen repeatedly noted the U.S. is in a much different place than during the peak pandemic, but experts said continued low vaccination rates could lead to a backslide and leave the country open to another surge if a more immune-resistant variant emerges. 

“My concern for COVID-19 is that we’re not ready for any variants that this virus will produce,” said Ali Mokdad, a professor of health metrics sciences and chief strategy officer for population health at the University of Washington. 

Mokdad said he’s concerned about two things: that people who are vulnerable will not be protected during the holiday season, and that a new variant could come up — something he described as a big if. “Right now, we’re not ready and many people may not rush and get the vaccine,” Mokdad said. 

Vaccination rates have fallen steadily since the first iteration of the shots was rolled out in 2020. According to the CDC, 79 percent of adults received the primary series of shots. But only 20.5 percent of adults received the bivalent booster. 

As the public heads into the fourth holiday season with the virus, a survey from health policy research group KFF found the vaccine was just not a priority for people. 

About half of those who were previously vaccinated but haven’t gotten the latest shot said lack of worry about COVID-19 was a reason why they haven’t gotten it. About 37 percent said they’ve been too busy, and 32 percent said they are waiting to get it later. 

“The sense of worry or concern is much lower. And therefore that seems to be what is likely driving people’s action. Or in this case, inaction,” said Jen Kates, a KFF senior vice president. 

“It’s kind of a perpetual problem in health prevention in general, if prevention efforts are working, people don’t see the problem, and then stop taking the measures that prevent the problem,” Kates added. 

There’s also a significant partisan divide. The poll found only 23 percent of Republican respondents had or would get the latest shot, compared to 40 percent of independents and 74 percent of Democrats.