FDA Approved Modern Covid Vaccines. But Who Will Get Them?

The Food and Drug Administration approved the latest round of annual Covid vaccines on Thursday, clearing the way for Americans ages 6 months and older to receive the updated doses amid a prolonged summer surge in the virus.

Pfizer and Moderna, the vaccine makers, are expected to begin shipping their shots to pharmacies and doctors’ offices within days. The vaccines are tailored to the version of the virus that emerged in the spring, before it gave way to closely related variants, all of which appear to spread more quickly.

For the most vulnerable Americans, whose COVID-19 death toll has surged this summer, the vaccines could prove to be a respite from a virus that disproportionately threatens people whose vaccinations are out of date.

But the approval came months after sneaky fresh variants began to cause a surge in infections, raising concerns among some scientists who called for fresh vaccines to be developed more quickly.

In recent weeks, the number of people hospitalized with Covid has been nearly twice as high as during the same period last summer. By delayed July, Covid was killing about 600 Americans a week, down significantly from this winter but twice as many as this spring.

The availability of booster shots hasn’t translated into actual vaccinations. By spring, only one in five adults had received last year’s updated Covid vaccine. Even older Americans, who are at much higher risk of severe illness, have largely rejected the shots, with only 40 percent of people 75 and older getting last year’s vaccine.

The outlook for this year’s rollout remains dim. Doctors said older people still have concerns about the need for additional doses. The Biden administration has struggled to find money to vaccinate uninsured Americans. And public health departments still haven’t had the funds for the proactive vaccination campaigns that fueled a surge in vaccinations early in the pandemic, officials said.

“During the pandemic, health departments got extra money to send teams to people who were so disabled they had to stay home,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “That money went away.”

Public health experts are particularly concerned about the meager uptake of booster shots in nursing homes. Problems were evident a year ago, when many nursing homes waited months after approval to begin vaccinating. Now, fewer than a third of nursing home residents are believed to have been vaccinated against Covid, according to data from the Centers for Disease Control and Prevention.

Long-term care experts have cited a number of challenges to vaccination efforts in nursing homes, including insufficient staffing and federal recommendations that older adults receive two doses of the COVID-19 vaccine per year — a frequency that conflicts with the usual annual flu shot schedule.

But despite the increasingly disproportionate risks older Americans face, not all nursing homes are organizing gigantic vaccination drives, even as local health departments offer assistance. In many cases, relatives have had to shoulder the responsibility of finding vaccines for residents.

“It’s not just whether they care,” Dr. Ben Weston, Milwaukee County’s top health policy adviser, said of nursing homes. “It’s what resources they have.”

Jodi Eyigor, director of nursing home quality and policy at LeadingAge, a nonprofit association of nursing homes, he turned to White House officials last month for a more organized distribution campaign. Nursing homes, Ms. Eyigor wrote, have been struggling with Covid vaccine fatigue and distrust of federal guidelines.

“Residents, families and staff are unsure how many vaccinations they need to stay up-to-date, and many are reluctant to get vaccinated, especially more than once a year,” she wrote.

While most Americans have acquired immunity to the virus through repeated infections or vaccinations, or both, older and weak Americans have difficulty mounting an immune response, leaving them vulnerable to infection.

Last year’s Covid vaccines offered modest protection against infection, but those defenses waned over time, research suggests. The vaccines offer stronger protection against severe disease. Across all age groups, the enormous majority of Americans hospitalized with Covid did not receive the shots offered last fall, according to data presented to a CDC advisory committee in June.

Compounding the difficulties in vaccine delivery is the fact that a Biden administration program that was supposed to guarantee shots for uninsured Americans or people whose health insurance might not cover the shots is set to expire this month.

Previous Covid vaccines were bought in bulk by the federal government and given free of charge. But last year, the vaccines went on the commercial market, leaving the uninsured without a clear option. Federal officials have estimated that about a million people interested in getting vaccinated may not have insurance that covers them.

Dr. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, said the agency found $62 million in unused funds from vaccine contracts. That amount will be distributed to state health departments next month to buy vaccines, enough for about 1 million doses.

But experts say there has been a lack of money for programs that deliver vaccines to community centers, nursing homes and even private homes.

“We don’t have the public pressure or the distribution of vaccines like we used to,” said Dr. Zeke McKinney, a Minneapolis physician who organized vaccinations at a local barbershop until funding ran out. “It’s very much up to each of us to figure this out.”

In Bismarck, North Dakota, public health officials are continuing to offer mass vaccinations via drive-through, which has been a hit with people who work odd hours or don’t want to visit a pharmacy, as well as assisted living facilities that are busing their patients.

But even those events have become more arduous in recent years, said Renae Moch, public health director, putting a strain on already busy staff.

The city, which once received vaccines for free from the federal government, is now buying them from manufacturers. As a result, its tiny team of health officials must record people’s insurance information and then ask insurers to reimburse the city for the vaccines.