5 ways to increase COVID-19 booster uptake: Analysis

Although the Food and Drug Administration recently recommended a second COVID-19 vaccine booster dose for older Americans, the country has had to confront an ongoing struggle -- problems getting initial vaccination series, let alone first booster shots into arms.

Solutions to the issue of uptake are critical because they not only affect us now, but are a problem that we will likely have to confront for years to come as COVID becomes endemic in the population. This may mean more frequent boosters until we are able to develop an annual multiple-part immunization package, having a combined COVID and influenza vaccine, for instance.

Here are the five things to know about boosters and what we can take to increase uptake nationally:

First, the science clearly shows boosters are effective. Data released last month from the L.A. County Department of Public Health shows that individuals who were vaccinated but not yet boosted had six times the protection from a COVID-19 ICU admission compared to the unvaccinated. Yet, for individuals who had the booster, this protection increased to ninefold. This translates to a 50% increased risk of an ICU stay for those fully vaccinated yet without their booster compared to those who received their booster. The bottom line here is clear: booster doses offer critical additional life-saving protection from COVID.

Second, the science only goes so far. Oftentimes it’s more the messenger than the scientific message that matters. A new study on societal trust from the Ad Council showed that when it comes to COVID-19, Americans trust their partners (61%), medical professionals (61%), scientists (54%) and close family members (52%) most. The COVID-19 Community Corps program by the U.S. Department of Health & Human Services and the ThisIsOurShot-VacunateYa coalition, which we are involved with, are two examples of efforts to mobilize trusted messengers. These initiatives provide support, training, and messaging resources to on-the-ground trusted voices such as healthcare workers, parent and family organizations, faith leaders and Black and Latino focused community groups to tackle difficult vaccine conversations. Such efforts to enlist and empower trusted messengers with the knowledge and tools necessary toward having successful vaccine conversations will be essential to increasing booster uptake.

Such efforts will be essential to increasing booster uptake. Unless we actively enlist and mobilize those closest to our lives whom we trust most to encourage and recommend the booster, we will find success hard to come by.

Third, we must normalize boosters as an expected and routine part of vaccination. Indeed, boosters are a way of life now. Just like it’s necessary to keep one’s home or car in good condition through regular upkeep and maintenance, so too does the human body require regular maintenance. The fact is that immune protection fades over time for most vaccines. Regular maintenance includes updates to the immune system in the form of regular and frequent vaccinations. For example, a typical American by age 90 will have received 14 tetanus doses between their primary series and boosters altogether. This has helped lead to a 99% decrease in the deaths from tetanus since 1947 in the United States. Today, we average just 30 cases of tetanus annually. The take home message is clear: ongoing booster doses are critical updates to the human immune system, and this keeps the body healthy and functioning.

Fourth, the low-income and underserved communities we practice in as primary care physicians have lower primary series vaccination rates compared to the average. So we need to get individuals not only vaccinated but also boosted to provide an additional layer of protection for the immunocompromised and children who are left behind by lifting public health mitigation measures. We need to continue to make booster access as easy and convenient as possible. One way to do this would be to make paid sick leave for workers to complete their booster doses a permanent federal policy so that the busy work lives of Americans do not come at the expense of wellbeing and health. In fact, the United States is the only wealthy country currently without this federal policy instead depending on states or employers for this worker benefit.

We should also encourage local health partnerships with schools and workplaces to bring the booster to the very doorsteps of Americans. This alone would reach the more than 230 million Americans who are either enrolled in school or working. We also know mandates work. There are other novel approaches as well. For instance, The city of Chicago collaborated with artists to creatively fuel the vaccination effort. VaxChiArt 2.0, an extension of a campaign originally launched last summer, features original art from more than 80 local artists displayed in some of the lowest-vaccinated neighborhoods across the city.

Fifth, mandates work and improving booster messaging is critical particularly for Americans with poor health literacy. Mandates worked to increase vaccination rates for the country, and they work to increase booster rates too. John Brownstein, Ph.D., chief innovation officer at Boston Children's Hospital and an ABC News Contributor said that booster messaging has "lacked clarity from the start."

"Now with a second optional booster, it is not surprising that many Americans are left confused about need, eligibility, and timing," Brownstein added. "Educational strategies must focus on building trust and informing the public about the science. Vaccination campaigns must not only address concerns about product safety but must also provide clear guidance about vaccine benefits.”

In conclusion, as boosters become available for older Americans, let’s not forget that we still have much work to be done to help Americans receive even their first booster dose. If we focus efforts and energy on the five steps laid out above, we have a chance to move the needle forward, help protect human life and prevent another surge too.

Dr. Jay Bhatt is an internist, instructor at UIC School of Public Health and an ABC News contributor. Dr. Atul Nakhasi is a primary care physician and policy adviser for the LA County Department of Health Services, the nation's second-largest public health system. The opinions expressed here are not those of ABC News.