Nursing homes scramble to get residents boosted

Nursing homes are scrambling to get residents vaccinated with coronavirus booster shots, as the looming omicron wave brings new urgency to the effort.

According to data from the Centers for Disease Control and Prevention, only about 55 percent of nursing home residents have received a booster shot, despite being eligible for more than two months. Officials more recently said the number has risen to 60 percent.  

Infections among nursing home residents have been rising in recent weeks, averaging close to 4,000 new cases a week. According to experts and federal officials, many of these outbreaks are occurring in facilities that have yet to administer booster doses.

“When we compare rates of COVID-19 disease between those who are vaccinated with two doses and those who received a booster dose, the rate of disease is markedly lower for those who received their booster, demonstrating our booster shots are working,” said CDC Director Rochelle Walensky at a White House briefing last month.

Studies show the protection against infection from the initial series of vaccines starts to wane after about six months. While younger, healthier people are still well protected against severe disease, that hasn’t been the case for nursing home residents.

This past week, Walensky presented new data showing nursing home infections rising steadily since the beginning of November among residents who received the primary series but not a booster. 

Unvaccinated residents still had the highest weekly rate of infections, but the rate among boosted residents has remained “stable and low,” Walensky said. 

Fully vaccinated and boosted residents are 10 times less likely to contract COVID-19 than those who are unvaccinated, or even fully vaccinated but not boosted, she said.

Nursing homes say there’s a new sense of urgency to get residents boosted, and that they are working as quickly as possible.

David Gifford, the chief medical officer at the American Health Care Association, the major nursing home trade group, said he thinks the messaging on the need for booster shots could have contributed to a slower start.

Third doses of some vaccines were authorized for people with weakened immune systems in August, but it took until late September for the booster dose of the Pfizer-BioNTech vaccine to be authorized by federal regulators. Boosters for Moderna and Johnson & Johnson followed in late October. By that time, many nursing home residents, who were among the first to be vaccinated last winter, had begun to lose some of the protection from the initial vaccines.

“When the booster came out, it was recognized as recommended. There was some waning immunity, but it wasn’t like being an unvaccinated state with a raging pandemic that was happening,” Gifford said. “Omicron is changing the dynamic. The omicron spread is going to make it really urgent to get the boosters.”

Gifford said the nursing home industry began planning over the summer, assuming boosters would be needed by fall. He said the rollout so far has been ahead of where they were with the initial vaccines, which took three months to get first doses into the arms of nursing home residents.

But unlike with the initial vaccination series, the boosters are not being administered through the federal pharmacy partnership with CVS and Walgreens. That effort led to 8 million vaccine doses administered, but it took some time to get up and running.

Now, facilities are doling out boosters through long-term care pharmacies. Gifford said the approach is working better because it’s more streamlined. Nursing home providers are getting the shot from their on-site clinics, rather than relying on the federal government to distribute to a state, which allocated to CVS or Walgreens. 

But some critics say the current system has led to a scattershot approach with some states and facilities succeeding while others lag behind. 

“We offloaded the responsibility to the facilities, much like we do with flu vaccination clinics every year,” said David Grabowski, a health policy professor at Harvard Medical School who studies nursing homes. 

“We assumed this would be relatively seamless or at least kind of orderly and somewhat consistent and it’s really been quite variable.”

West Virginia has been one of the success stories.

Martin Wright Jr., CEO of the West Virginia Health Care Association, credited the state’s efforts to partner facilities with locally based, independent pharmacies. 

It was the same planning that worked with the initial vaccine effort — West Virginia did not participate in the federal partnership program.

“We were able to have shots in arms the day after it was fully approved federally,” Wright said. 

The rollout has been moving smoothly, “but we’re seeing an uptick right now of those wanting to get the booster. Because of omicron,” he said.