COVID-19 vaccine disparities return as JN.1 variant surges - The Boston Globe

The post-Thanksgiving COVID-19 wave is threatening to become an annual rite of passage, as predictable as Black Friday crowds and holiday weight gain. But public health officials say this year’s seasonal surge has a new, potentially deadly wrinkle: the lowest vaccination rates since the start of the pandemic.

Though the latest version of booster shots confers broad protection against a new, highly contagious variant that is expected to gain dominance in the coming weeks, just 17 percent of Massachusetts residents have received it, according to the latest numbers from the Department of Public Health.

That’s down from the nearly 50 percent uptake for the first booster shot in 2021 and 25 percent for the bivalent booster at this time last year, according to the Centers for Disease Control and Prevention. Across the country, vaccination rates are so low for influenza, RSV, and COVID-19 that last week the CDC issued a health advisory warning the situation could lead to more severe illnesses and overburdened hospitals in the weeks ahead. In Massachusetts, the amount of the virus found in waste water levels has roughly doubled since Thanksgiving and hospital admissions are up in several counties. The amount of COVID-19 in wastewater across the city of Boston has risen by 23 percent over the last two weeks.

As vaccination rates have declined, racial health disparities have reasserted themselves. About 18.2 percent of white Massachusetts residents and 13.6 percent of Asian residents are up to date on their vaccinations, compared to 7.3 percent of Black residents, 6.8 percent of Hispanic residents, and 2.9 percent of American Indian or Alaskan native residents.

“I’m very concerned about the low number across the whole state, and I’m even more concerned about the fact that we see this gap,” said Alan Geller, a researcher and senior lecturer on social and behavioral science at the Harvard T.H. Chan School of Public Health. “We have to really look very, very seriously as to why the rates are so low. Clearly something’s not working.”

Vaccination rates in the state’s 50 largest communities have an “almost perfect” correlation to income levels, said Jonathan Levy, chair of environmental health at Boston University’s School of Public Health. The highest updated rates are in wealthier communities: Arlington, at 35 percent, followed by Lexington, Newton, and Needham. The lowest rates were in Lawrence, with just 3 percent, and Brockton, Fall River, and New Bedford each at 6 percent, according to recent state figures. About 15.7 percent of Bostonians have received the updated COVID-19 vaccine.

Those disparities extend to seniors, who are most at risk of severe illness and death. Fewer than 20 percent of those over 80 in Lawrence, Fall River, and New Bedford are up to date on their shots. Conversely, vaccination rates for seniors in Arlington and Needham are between 40 and 60 percent and higher still in Lexington and Newton.

“I would note that the pattern is almost identical with flu shot rates as with COVID vaccine rates,” said Levy. “So this story goes beyond COVID and speaks to issues of access and broader health disparities.”

The disparities in flu vaccination rates predate the pandemic. In the period before the lockdown, communities that would go on to have the highest rates of COVID-19 also had significantly lower flu vaccination rates.

Some experts say state officials need to step up their efforts to close the gaps.

In February 2021, former governor Charlie Baker’s administration announced a “vaccination equity initiative” focusing on 20 cities and towns with much higher rates of COVID infections and high poverty and unemployment rates. Many were communities of color.

The state subsequently spent millions of dollars on funding efforts to recruit trusted “vaccine ambassadors” in every community, mobile vaccination units, mass advertising campaigns on TV and social media, and a push by primary care doctors to overcome vaccine skepticism.

It was remarkably successful. By late 2022, 78 percent of white people, 75 percent of Black residents, and 67 percent of Hispanic residents in Massachusetts were fully vaccinated.

Without an “immediate return to what works, the state is guaranteed a pretty miserable winter,” Geller said.

Public health officials deny they have eased up.

“We have definitely not taken our foot off the gas and, in fact, we are accelerating the work that we’re doing to try to address vaccine hesitancy, which persists, and the inequities and disparities that we see in vaccination rates and in risk for disease,” said DPH commissioner Dr. Robert Goldstein. “We are pushing as hard as we can to get as many people vaccinated.”

Though funding sources have changed — there is less for COVID-specific advertising — Massachusetts is still spending a “tremendous amount of money to support our vaccine efforts,” he said.

COVID-specific funding is $24.3 million, and just since October, the state has deployed more than 190 mobile clinics around the state, held four vaccination events in rural areas, partnered with the Mashpee Wampanoag Tribe and Malden Islamic Center on events, and offered shots at legal clinics and shelters. The agency continues to run TV spots about the importance of getting vaccinated against respiratory diseases.At the height of the pandemic, as the vaccine first became available, COVID-19 funding was $81.8 million.

Goldstein noted that a number of factors are likely at play, including the lifting of the public health emergency, ending of vaccine requirements by many employers; and disinformation about vaccines.

“It’s just a very different environment,” Goldstein said. “We’re in a very different place.”

Geller notes vaccination rates declined dramatically nationwide between the first shots and the first boosters, coinciding with loosening of public health measures. Many Americans tested positive for the virus in the intervening period, which led some public health experts to speculate many either concluded the vaccine didn’t work, or they didn’t need updated shots because they had already been sick. During that period, misinformation and vaccine conspiracy theories also reached “full bloom” Geller said, while public health officials began to scale back mass vaccination events and advertising.

Dr. Sabrina Assoumou, an infectious disease specialist at Boston Medical Center, finds herself reminding patients that immunity wanes over time, and that the boosters protect against new variants.

“We’ve all gone through a pretty long, intense period during the pandemic, so people are just frankly tired,” she said. “If you talk to most people who either have had COVID or know someone whose had it, most of the people are not necessarily getting critically ill and needing to be hospitalized. So there’s no longer that urgency to get vaccinated today.

The Sportsmen’s Tennis & Enrichment Center, a 60-year-old community sports club in Dorchester, said interest in weekly vaccination clinics held with nearby Brookside Community Health Center has waned. Now the center focuses on afterschool programs.

“It just feels like there’s more urgency right now addressing the fallout of the pandemic instead of a potential resurgence,” said Mandy Bass, director of the Brigham and Women’s Hospital Center for Community Wellness at the Sportsmen’s Center.

In Boston, efforts to raise booster rates and close racial gaps continue, said Dr. Bisola Ojikutu, executive director of the Boston Public Health Commission. The city has two standing sites offering free booster and flu shots and plans to hold “be safe for the holidays” vaccination events. It’s also considering reviving a popular gift card giveaway to incentivize vaccinations.

Vaccination rates have bottomed out just as some experts predict a COVID surge over the holidays. The JN.1 variant, which has triggered steep increases in waste water levels across Europe and is now becoming dominant in the United States, has developed mutations that make it more transmissible or better able to evade defenses, said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center. Since more people will be infected, COVID-19 related deaths will inevitably rise. Yet the new boosters are a good match for the variant, making it especially important that those most at risk get the shot.

Goldstein pledged to continue bringing vaccinations for multiple respiratory viruses to all communities.

“We’re trying our best, and we’re out there in as many ways as we possibly can, but we’re up against really historic vaccine hesitancy and a growing concern and mistrust in public health and public health measures,” he said. “That makes it really hard to get vaccines into arms.”

Adam Piore can be reached at adam.piore@globe.com.