The extremely low vaccination rates suggest that the NYC area has no more to provide care for COVID-19

The updated COVID-19 booster vaccines don’t seem to be at the forefront of people’s minds — even as the autumn surge creeps toward the U.S. It’s hard even to find how many people are taking the shots.

As of Monday morning, neither the COVID-19 dashboards for New York City nor New Jersey were displaying the numbers of bivalent boosters, which are designed to fight newer coronavirus variants. That’s despite the bivalents becoming the go-to booster for anyone over the age of 12 nearly two months ago, on Sept. 2.

New York officials said the city had given out 476,221 bivalent doses as of last Wednesday, while 579,977 have been administered in New Jersey. However, the data on their websites isn’t clear, and when counting the number of doses listed from Sept. 2 onward, a much lower number of doses is represented — about 12,000 in each place.

Officials said this is because their dashboards are not updated.

“The booster data on our site does not include bivalent doses,” Patrick Gallahue, a New York City health department spokesperson, said via email. “Updates will be made to add the bivalent numbers, but that remains a work in progress.”

“The dashboard currently reflects the earlier booster and other additional doses for immunocompromised, etc.,” Nancy Kearney, New Jersey Department of Health Deputy Director of Communication, said. “The updated booster doses will be added shortly.”

This data is valuable because it can help convey how much general interest there is in the shots — and what areas might be at-risk as new variants emerge.

Its absence also speaks to a larger trend of people not really knowing if they should care about COVID-19 anymore, health experts said.

They said COVID-19 messaging has essentially evaporated as the midterm elections approach, even though the virus has killed 239,000 Americans so far this year. Half of eligible adults have said in surveys they don’t even know why they need to get the boosters.

“A lot of people seem to have kind of moved on,” said Lunna Lopes, a senior survey analyst at the health policy nonprofit KFF which conducts monthly national surveys on the vaccines.

“There’s a lot going on right now in terms of the election, the war in Ukraine and the economy. COVID just isn’t as big a presence in people’s lives.”

But that could soon change as COVID-19 deaths increase overseas, driven in part by newly emergent variants. The same strains are starting to gain a foothold in the U.S. Experts said an upcoming case surge here feels inevitable, and hospitalizations are already rising in parts of New York.

How bad the surge gets will depend on people’s immunity, either acquired through very recent infections or vaccination. Most Americans – 65% in a recent Ispos poll — do not want mandates anymore, and recent research shows that such requirements may not be necessary to motivate booster vaccine rates.

While half a million bivalent boosters over the rollout’s first 47 days might sound like a lot, this progress is tiny relative to the original booster rollout a year ago. Over the same timeframe, after the CDC opened up eligibility to all adults in mid-November 2021, nearly 1.5 million people took booster doses in New York City. In New Jersey, it was 1.2 million.

Another way to think of it: Only 7% to 8% of the eligible population has received bivalent boosters in New York City and New Jersey since early September.

“I’m not shocked, given frankly, how quiet the rollout was. It didn’t have the splash of previous rollouts” said Dr. Katherine Milkman, a professor and behavioral scientist at the University of Pennsylvania’s Wharton School. She studies how psychology can be used to motivate good social behaviors, like taking vaccines.

She and other researchers said the low uptake of the bivalent boosters stems from a lack of clear explanations on why the shots are still important — as well as people feeling less urgency around COVID-19.

New York City Health Commissioner Dr. Ashwin Vasan, for example, has spoken out on news programs and press conferences about how the bivalent boosters can provide a few months of protection against getting infected. The updated shots target two offshoots of the omicron variant that dominated this summer, known as BA.4 and BA.5, as well as the original strain of the virus. This burst of immunity, in turn, can slow the spread of the virus and the chances of severely harming at-risk groups, such as those older than 50 or people with pre-existing conditions, as Gothamist previously reported.

“We have pop-up vaccination sites, mobile units serving vulnerable New Yorkers, at-home vaccination for eligible New Yorkers and the Health Department is deploying its community-based networks to get our city boosters,” Gallahue added. “We are also actively running advertising campaigns.”

But parallel messages aren’t coming from federal leaders — and it shows.

A KFF survey conducted in mid-September — about two weeks after the federal government released its recommendation — found two out of five fully vaccinated adults didn’t know if they needed to take the bivalent vaccines.

KFF reported that the size of this knowledge gap held steady across age groups, but it was slightly more prominent in rural areas and among people of color. Overall, half of all adults knew little to nothing about the updated boosters.

Over the course of the pandemic, Europe, especially the United Kingdom, has offered an early warning on COVID-19 surges for the United States.

“We’ve seen over and over again what happens in Europe tends to happen in the United States — maybe four to six weeks later,” said Dr. Bruce Y. Lee, a public health policy expert at CUNY and executive director of the research group PHICOR.

In England, reported cases began rising about two months ago — going from a lowpoint daily average of 3,400 infections in late August to 8,900 by the start of October.

Right on cue, hospitalizations have risen in England to 1,200 per day — already about halfway to the peak omicron rates seen in January. The death rate — 117 daily average — is double what it was in early September. The European Centre for Disease Prevention and Control has reported similar patterns across the continent, namely in France and Germany.

While England’s cases are happening across adult age groups, recent deaths are mostly occurring among people older than 50, likely because their immunity erodes faster.

Lee said the concern is that Europe is also seeing these trends manifest earlier in the year than expected.

“If you’ve looked at the past two years, November 2020 and November 2021, that’s when you saw a COVID-19 surge. That’s when things, cases, start picking up,” Lee said.

The answer depends somewhat on when you caught COVID-19 this year, given the makeup of the variants causing problems right now.

Every coronavirus circulating right now is essentially just a shade of the omicron variant that emerged last November. Recall that the winter wave started with a surge of BA.1 and BA.2 subvariants. This duo was dominant in New York through the end of June — meaning if you caught COVID-19 prior to the summer, it was most definitely because of BA.1 or BA.2

That matters because the virus continues to evolve, increasing people’s risk the further in time they get from the early stages of omicron. The coronavirus is drifting away from our immune defenses.

By the late spring, BA.4 and BA.5 had claimed the subvariant crown. In New York and nationwide, BA.4 and BA.5 hung out all summer long — causing about 20,000 cases and 90 deaths on average each week since late June. That’s about 1,600 COVID fatalities since the summer started.

Statewide, particularly in colder northern regions, this pair is already causing upticks in COVID-19 hospitalizations this fall. And health officials are now worried about a more immune-evasive descendant of BA.5 — known as BQ.1. It’s gaining ground in Europe and the U.S. Another immunity evader — XBB — has sprung up in Asia. It’s a spinoff of BA.2.

(If you think these naming conventions are getting ridiculous, health experts agree with you.)

Outgoing White House COVID-19 adviser Dr. Anthony Fauci and other health experts predict the bivalent boosters can offer some protection against BQ.1 and XBB.

“We would hope more and more people do come in and get their updated bivalent B.5 boosts because that could protect them,” Fauci told the Brian Lehrer Show on Friday.

This year, COVID-19 has killed approximately 7,000 people in New York City. For comparison, the NYPD has recorded about 300 murders this year and 1,500 shooting victims.

That’s a fair point. When COVID-19 vaccines dropped in December 2020, mass vaccination sites and other rollout measures — such as nursing home drives — propelled coverage rates to about 50% percent by May 2021. New York and New Jersey responded by lifting the “coronavirus pause” restrictions like capacity limits on indoor activities and social distancing.

But then the delta variant arrived, causing a summer surge of new hospitalizations and deaths. Rather than restore measures like universal masking, many jurisdictions opted for incentivizing vaccine uptake.

New York City, for example, launched the Key to NYC vaccine requirement for indoor venues, a $100 incentive program, along with workplace mandates from July to November 2021. A study published this September, led by former city health commissioner Dr. Dave Chokshi, looked at whether these efforts had any impact on vaccination rates. It found that New York City recorded about 400,000 more shot takers compared to similar urban areas without these measures.

The Key to NYC requirements, the $100 incentives and workplace mandates certainly put pressure on people to get vaccinated — though it’s hard to say if one’s impact outranked the other given they all started within weeks of each other.

Former Mayor Bill de Blasio announced the $100 payout for doses in late-July 2021. By the start of October, 250,000 people had tried the program, according to the New York Post. De Blasio ultimately expanded from first shots to boosters and tried the programs with kids, too. Mayor Eric Adams continued the incentive earlier this year. The Adams administration told Gothamist last week that the program had given out approximately $90 million and 900,000 doses to date.

But studies report less success with vaccine payments elsewhere in the country. A randomized controlled trial by the University of Southern California saw no benefit overall with cash payments for the shots.

“Even in some subpopulations that were pretty vaccine-hesitant, they saw a reduction in the likelihood that they would go and get a vaccine,” said Milkman from UPenn. She said that’s likely because some people distrust the idea of a government paying them for immunizations.

A year ago, when New York City established a vaccine mandate for municipal workers, some agencies had coverage rates as low as 51%. Now, there isn’t a department below 90%. The mandates also caused a fair amount of public animosity and protest, even though less than 1% of the city’s workforce lost their jobs.

In the post-mandate era, one of the most powerful motivators could be a simple text message. Recent trials found that text reminders like “your vaccine is waiting for you at your local pharmacy” work well, motivating thousands of people to get immunized against COVID-19 — and the flu, too.

“We think part of the reason telling people that a vaccine is reserved for you or waiting for you works, is that it plays on the endowment effect,” Milkman said. “Now this feels like it’s mine. This is my vaccine.”

Outside of that, the next best motivator might be COVID-19 cases themselves. Data shows case surges and community transmission tend to be followed by increased demand for vaccines. Reminder: The shots take about two weeks to kick in.

“This will be the first winter in two years where people really aren’t taking precautions,” Lee said. “Hopefully, things won’t get too hairy, but we’ll have to see.”