Penn doctor worries patients are hesitant to get another COVID booster

It is once again that time of year when I bring up seasonal vaccines in most exam room conversations with my primary care patients.

When I mention flu shots, I hear enthusiastic appreciation for the reminder. Many patients bring it up before I even have a chance to. But when I follow up with, “and remember there is a new COVID-19 booster out to help protect against the newer strains,” I too often am met with either silence or outright refusal.

This has me worried.

The COVID-19 pandemic led to one of the most extraordinary medical innovations in history: the development and distribution of a life saving COVID-19 vaccine in record time using a novel mRNA technology for which University of Pennsylvania research pioneers Drew Weissman and Katalin Karikó won the Nobel Prize.

Many people eagerly rolled up their sleeves for the initial doses during the pandemic’s peak and immediate aftermath — before rampant misinformation, lackluster communication from federal agencies, access constraints, and divisive politics limited the reach of vaccination efforts.

» READ MORE: Some federal funding for COVID vaccines has been cut, but you can still get a free vaccine in Philly

Now the overall COVID threat has diminished, but negative views on COVID vaccination seem to have hardened. A 2023 research review looked at characteristics that predicted hesitancy to receive COVID vaccine booster doses. The authors cited several factors including personal demographics, geography, knowledge, perceived efficacy, and distrust. The traits associated with the highest acceptance of the shots were a history of chronic disease, trust that vaccines work, age greater than 45, and being male.

When I ask my patients why they don’t want more COVID vaccines, they usually say that they “have had enough,” are “no longer worried” about COVID, or “the pandemic is over.” Psychologists refer to this behavior as habituation or normalization, where we may become desensitized to a persistent threat. It can start to seem like just a normal part of life.

This same numbness can occur with other constant dangers like climate change or neighborhood violent crime. While these coping mechanisms can reduce anxiety, they also increase vulnerability. We are lured into letting our guard too far down.

Flu is not a perpetual worry for most of us. It is mostly seasonal. Flu shots have been a longstanding fall routine, generally without the political backlash seen around COVID vaccination. It’s still a challenge to get many patients vaccinated against flu, but I have fewer obstacles to overcome.

Fortunately, we are now at a place where hospitalization and death are much lower risks from COVID for most people, largely due to vaccination. But make no mistake — COVID is still out there and poses a very real danger to the unvaccinated, the elderly and those with chronic diseases. And the virus keeps changing and evolving, so the original vaccine doses you received have become less effective.

The CDC recommends almost everyone 6 months and older receive an updated COVID-19 vaccine and influenza vaccine (flu shot). A single dose of respiratory syncytial virus (RSV) vaccine is also recommended for all adults aged 75 and older, and adults aged 60-74 who are at higher risk from conditions like a weakened immune system or chronic illness.

Let’s not take chances with COVID this fall. Play it safe and get all of your recommended seasonal vaccines.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.