Explained COVID death rates, dismal booster stats, and new vaccines

Tanya Lewis: Hello and welcome to COVID, Quickly, a Scientific American Podcast Series.

Josh Fischman: This is your quick update on the COVID pandemic. We bring you up to date with the latest science behind the most pressing questions about the virus and the disease. We demystify research and help you understand what it really means.

Lewis: I’m Tanya Lewis.

fishman: I’m Josh Fischman.

Lewis: And were Scientific American‘s Senior Health Editors. Today we explain how to interpret COVID deaths in vaccinated and unvaccinated people.

fishman: And we will discuss why so few people get booster shots.

Lewis: Plus, the latest news on new vaccines.

fishman: In the past few months, a fair number of people who have died from COVID have been vaccinated. However, studies have shown that vaccination protects people, especially against serious diseases. That seems like a big contradiction. Are the studies wrong?

Lewis: It’s a common misconception that vaccines shouldn’t work because vaccinated people can get COVID and occasionally die from it. But you have to understand the context.

Our graphics editor, Amanda Montañez, and I published a story about it. We used CDC data from a subset of US jurisdictions that tracked immunization and booster status and COVID-related deaths for people 12 and older. In March, there were 143 deaths among people vaccinated with only the primary series—that is, two shots of Pfizer or Moderna, or one shot of J&J. And there were 383 unvaccinated deaths.

fishman: That still seems like a lot of vaccinated deaths. What am I missing here??

Lewis: These figures do not take into account the incidence rate – in other words, the number of deaths divided by the total number of people vaccinated or unvaccinated. If you do, you’ll find that vaccinated people are much less likely to die from COVID than unvaccinated people. In fact, the unvaccinated had a mortality rate 8 times higher than those vaccinated with only the primary series and a mortality rate 17 times higher than those who were vaccinated and received at least one booster shot.

fishman: That seems more in line with what we’ve been told about the effectiveness of the vaccines. But isn’t it that they are less effective in older people?

Lewis: Yes. We know that older Americans are generally more likely to become seriously ill or die from COVID. And while the vaccines are very protective, their effectiveness diminishes over time. That’s why it’s so important to get booster shots.

Over time, you’re likely to see more COVID deaths among vaccinated people simply because a greater number of unvaccinated people will die from the virus and there are more vaccinated people in general. But if you are vaccinated, your risk of dying from COVID is still MUCH lower.

Lewis: Refresher shots are even more important now that new Omicron variants like the BA.4 and BA.5 are rolling across the country. However, not many people get the extra shots. Josh, what do the booster numbers tell us?

fishman: The numbers don’t look very good, to be honest. And that’s especially true for people aged 65 and over, who were most susceptible to the disease. This group was very eager when it came to the original round of vaccinations over a year ago. 91 percent of them were vaccinated.

But things changed with boosters. At the first booster shot, only 68 percent of the senior group got one. And second boosters only reached 30 percent of these people.

Lewis: This is worrying given that it is such a high-risk group. About three quarters of deaths in the US have occurred in seniors, right?

fishman: Yes, and it’s frustrating because boosters really reduce your risk. Antibodies to the virus drop to lower levels four months after the first vaccinations, and protection wears off with them. But a booster turns things around. A study of the Pfizer and Moderna vaccines in older people showed that a booster shot reduced the risk of hospitalization by more than 60 percent. The booster shot reduced the chance of death by 75 to 79 percent.

Lewis: So this begs the question: Why aren’t older people getting these protective extra shots?

fishman: There seem to be a number of reasons. One of the big ones is that officials aren’t making boosters readily available, unlike what they did with the original vaccines.

Remember that the government sent the first vaccines to nursing homes. Large vaccination clinics have sprung up everywhere in sports stadiums, schools and other places, supported by FEMA and other federal agencies. Many of these clinics were located near public transport for easier access. And there was a huge public messaging blitz.

This did not happen with boosters on either the third or fourth shot. Eric Topol, director of the Scripps Research Translational Institute, told me the CDC really didn’t fund boosters for months. The agency simply said people had a chance to get them. Topol says the CDC needs to be emphatic and show people off should Get shots because they are an essential protection. He is very critical of this oversight and says the messaging was badly botched.

Lewis: That doesn’t sound good. Were there other problems?

fishman: There was. Nursing homes use the same services they use to deliver flu shots, and these are more spotty. There are no big clinics, no big advertising campaigns. People have to register for booster shots at pharmacies and registering online can be very confusing. So awareness is lower and access more difficult.

Lewis: Are there ways to overcome these obstacles?

fishman: There are places that have done well with boosters and they show what works. Minnesota, for example, has the highest percentage of first-time boosters in the country at 83 percent. Dakota County in the state has done exceptionally well, reports Kaiser Health News. It hired an agency that put boosters in nursing homes. The county also operated lunchtime and evening clinics. It used money provided by Congress to buy a mobile vaccine truck that traveled to different parts of the city. Health workers walked through these neighborhoods, answering questions about the importance of boosters and raising awareness.

The county also used federal pandemic funds to give people $50 vouchers for the shots, which helped defray the costs of those who had to pay to travel to a clinic.

Now is the time for such efforts at the national level, says Topol. Boosters need a big nudge, and he told me what the message should say loud and clear: “This shot could save your life.”

Lewis: There is also more vaccination news. The Food and Drug Administration’s Vaccine Advisory Committee voted almost unanimously last week to approve another COVID vaccine made by Novavax.

fishman: The new vaccine, which uses a more conventional preparation based on proteins of the virus rather than genetic material, complements Moderna and Pfizer’s mRNA vaccines and Johnson & Johnson’s adenovirus vaccine. The FDA is now closely examining the reliability of the Novavax manufacturing process. If the agency is satisfied and follows the committee’s recommendation, the recording could be available in the US in the coming weeks.

Lewis: Additionally, Moderna announced that there will be a booster dose targeting both the Omicron variant and the original version. This booster generated a better antibody response than the original version alone. However, they have not tested how well it actually protects against diseases.

fishman: The company said it will be sharing this data with the FDA and hopes the Omicron booster will be ready in early fall when it is approved. The agency also plans to hold a meeting at the end of June to decide which variants to include in upcoming boosters. Their hope is to keep up with this ever-evolving virus.

Lewis: Now you are in the loop. Thank you for joining us. Our show is edited by Jeff DelViscio and Tulika Bose.

fishman: Come back in two weeks for the next episode of COVID, quick! And visit SciAm.com for updated and in-depth COVID news.

[The above text is a transcript of this podcast.]

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