Document text
Implementation Considerations for Additional
COVID -19 Vaccine Doses
Georgina Peacock, MD, MPH
Immunization Services Division
Centers for Disease Control and Prevention
October 23, 2024National Center for Immunization and Respiratory Diseases
COVID -19 Vaccination Coverage and Intent for 2 Doses,
National Immunization Survey -Adult COVID Module
2023 -2024 Data
2-Dose Coverage and Intent Among Adults 65 Years
and Older
COVID -19Vaccination Coverage (≥1 Dose and ≥2 Doses) A mong Adults 65Years
and Older, 2023 -2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
COVID -19Vaccination Coverage A mong Adults 65Years and O lder, ≥2 Doses of
the 2023 -2024 Vaccine by End of June 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
21.813.516.29.011.18.112.76.78.311.17.49.09.210.69.18.78.9
0.0 10.0 20.0 30.0 40.0 50.0 60.0AI/ANOther/multiple, non-…NH/OPIHispanicBlack, non-HispanicWhite, non-HispanicAsianRuralSuburbanUrban65-6970-7475-7980+MaleFemaleOverall 65+
W eighted % (95% C I )9.48.48.510.510.78.818.011.17.87.76.88.97.39.38.08.4
0.010.0 20.0 30.0 40.0 50.0 60.0Income unknownAbove poverty, >=$75KAbove poverty, <$75KBelow povertyUninsuredInsuredHHS Region 10HHS Region 9HHS Region 8HHS Region 7HHS Region 6HHS Region 5HHS Region 4HHS Region 3HHS Region 2HHS Region 1
W eighted % (95% C I )*
**
AI/AN: American Indian or Alaska Native; NH/OPI: Native Hawaiian or Other Pacific Islander.
*Statistically significant at p<0.05 (referent categories: Age 65 -69, Rural, White non- Hispanic, HHS Region 1).*
7.213.68.79.713.97.710.38.69.38.7
0.0 10.0 20.0 30.0 40.0 50.0 60.0No provider recommendationHealth care provider recommended…Does not have any disabilityHas a disabilityImmunocompromisedNo health conditionHas health conditionHigh SVIModerate SVILow SVI
W eighted % (95% C I )COVID -19Vaccination Coverage A mong Adults 65Years and O lder, ≥2 Doses of
the 2023 -2024 Vaccine by End of June 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
*
*
*Statistically significant at p<0.05 (referent categories: No health condition, No provider
recommendation).
36.8
0.0 10.0 20.0 30.0 40.0 50.0 60.0Overall 65+
Weighted % (95% CI)
20.0 44.3 30.9 4.7
0.0 50.0 100.0
W eighted %COVID -19Vaccination Coverage and Intent for Second Dose A mong Adults 65
Years and Older, April -June 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
Percent of adults 65+ who received
≥1 dose of 2023 -24 Covid vaccine
Among adults 65+ who received
≥1 dose of 2023- 24 Covid vaccine:
Receipt /intent to receive 2nd dose
Probably or definitely will not get another dose
Probably will get another dose or unsureDefinitely will get another doseVaccinated with ≥2 doses of 2023- 24 Covid vaccine
27.432.740.327.928.017.819.817.319.122.817.819.319.225.8
41.034.627.235.238.046.638.545.444.743.245.843.745.441.2
30.026.327.031.029.531.237.832.831.030.030.433.330.928.3
1.56.45.55.94.44.53.94.55.24.16.03.74.64.7
0.0 20.0 40.0 60.0 80.0 100.0AI/ANNH/OPIBlack, non-HispanicAsianRuralUrban65-6975-79
W eighted %COVID -19Vaccination Coverage and Intent for Second Dose A mong Adults 65
Years and Older, April -June 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
Among adults 65+ who received ≥1 dose of 2023- 24 Covid vaccine:
Receipt and intent to receive 2nd dose
AI/AN: American Indian or Alaska Native; NH/OPI: Native Hawaiian or Other Pacific
Islander .
Probably or definitely will not get another dose
Probably will get another dose or unsureDefinitely will get another doseVaccinated with ≥2 doses of 2023- 24 Covid vaccine
COVID -19Vaccination Coverage and Intent for Second Dose A mong Adults 65
Years and Older, April -June 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
Among adults 65+ who received ≥1 dose of 2023- 24 Covid vaccine:
Receipt and intent to receive 2nd dose
16.8 17.4 21.2 24.744.4 43.045.244.533.8 34.329.0 26.85.1 5.3 4.6 4.0
0.020.040.060.080.0100.0
Apr-24 May-24 Jun-24 Jul-24W eighted %
Survey month
Probably or definitely will not get another dose
Probably will get another dose or unsureDefinitely will get another doseVaccinated with ≥2 doses of 2023- 24 Covid vaccine
2-Dose Coverage Among Adults 18 Years and Older
Who Are Immunocompromised
COVID -19Vaccination Coverage (≥2 Doses) A mong Adults 65Years and O lder
and Adults 18 Years and Older Who Are Immunocompromised , 2024
National Immunization Survey -Adult COVID Module (NIS- ACM)
COVID -19Vaccination Coverage A mong Adults 18 Years and Older Who Are Immunocompromised , ≥2
Doses of the 2023 -2024 Vaccine by End of June 2024
National Immunization Survey -Adult COVID Module (NIS-ACM)
NA: estimate not reported because denominator is <30; AI/AN: American Indian or Alaska Native; NH/OPI: Native
Hawaiian or Other Pacific Islander.
*Statistically significant at p<0.05 (referent categories: Age 18 -49, Rural, White non- Hispanic, No Provider
Recommendation, Insured).
Intent to Receive 1, 2 or 3+ doses of 2024 -2025 COVID -
19 vaccine if recommended
Omnibus Surveys, August 2024
•Data are collected through the IPSOS KnowledgePanel and NORC AmeriSpeak
Omnibus Surveys, which use probability -based panels to survey a nationally
representative sample of U.S. adults ≥18 years of age on a set monthly
schedule.
•C DC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, and behaviors on each survey for 2 waves each month, for a combined
sample size of ~4,000 per month.
-These slides present combined results from August 2024 (N=4,224).
•Data were weighted to represent the non -institutionalized U .S. population and
m itigate possible non -response bias. All responses are self -reported.Omnibus Survey Methods
https://www.ipsos.com/sites/default/files/ipsosknowledgepanelmethodology.pdf
https://amerispeak.norc.org/content/dam/amerispeak/research/pdf/AmeriSpeak%20Technical%20Overview%202019%2002%2018.pdf
32.6 19.2 16.4 10.9 20.9
25.0
34.517.0
19.819.0
15.811.2
10.827.8
19.1
36.7
33.5
23.920.3
19.6
16.814.7
16.9
18.211.3
11.0
10.217.0
19.2
30.9
0 25 50 75 100Overall (N=1,263)
Age 65+ (N=1,012)Age 18 -64 with health
Condition (N=251)
Rural (N=265)Suburban (N=590)Urban (N=408)
Weighted %47.5 28.0 20.6
7.3 29.7 63.1
30.9
45.2
35.8
21.518.8
23.3
16.4
23.915.4
15.7
18.5
27.511.1
10.9
10.8
8.823.8
4.8
18.6
18.3
34.1
12.918.8
25.716.6
12.910.8
8.919.8
39.6
0 25 50 75 100Definitely/probably would not
get first dose (N=408)Definitely/probably would or unsure
if would get first dose (N=855)
Other, non- Hispanic (N=56)Hispanic (N=121)Black, non- Hispanic (N=109)White, non- Hispanic (N=977)
Uninsured (N=42)Insured (N=1,160)
Weighted %
*Health condition includes cancer (excluding basal cell carcinoma and squamous cell carcinoma), solid organ or blood stem cell transplant, HIV, and immunocompromised state. †NORC and Ipsos base urbanicity on different, but comparable
measures. NORC uses Census tract -based RUCA (Rural -Urban- Commuting Area) codes, whereas Ipsos uses Office of Management and Budg et's CBSA (Core Based Statistical Area) classification. §Insured group includes plans purchased through
employer, insurance companies, marketplaces, military insurance, Medicare, Medicaid, VA, IHS, and "other".
¶42 respondents excluded from analysis due to inconsistent answers.Intent to receive second 2024 -25 Covid -19 vaccination if recommended
among adults ≥18 years of age with health conditions or ≥65 years of age, by
demographics ,*†§Omnibus Surveys, August 8 -26, 2024 (N= 1,263)¶
•Based on data from the NIS -ACM, as of June 29, 2024, 8.9% of adults ≥65
years reported receipt of ≥2 doses of the 2023 -24 COVID -19 vaccine
-Among adults 65 years and older who received ≥1 dose of the 2023 -24 COVID -19
vaccine, 20.0% reported receiving a second dose
•Based on Omnibus surveys fielded between August 8 -26, 2024, 34.5% of
adults ≥65 years reported that they would definitely get two doses of the
2024 -25 COVID -19 vaccine if recommendedTopline Summary
Implementation considerations
•Should an additional dose* of 2024 –2025 COVID -19 vaccine be
recommended for adults ages ≥65 years?
•Should additional dose(s) of 2024 -2025 COVID -19 vaccine be
recommended for people ages ≥6 months who are moderately or severely
immunocompromised?Proposed policy questions
*Recommended interval: 6 months since last 2024 -2025 dose, minimal interval: 2 months since last 2024- 2025 dose
•Recommendations would not be
overly burdensome to implement.
-Additional dose recommendations
would be the same formula (2024 -
2025) of COVID -19 vaccine currently
available.
-Existing COVID -19 vaccine
administration infrastructure and product can be used.
-The recommendation could be easily
integrated into existing systems and
structures (e.g., standing orders,
CDSi ).Implementation considerations
“Should” vs “may” recommendations
Behavioral interventions for vaccination uptake: A systematic review and meta -analysis - PubM ed (nih.gov)“Should”
E asier to communicate
Strong call to action
F ramed as normativeR emoves cognitive decision work“May”
Difficult to communicate
Weaker call to action
Flexibility in decision makingAdds cognitive work
•Minimum interval vs. Recommended interval
•Recommended interval for vaccination
-“Recommended” interval is consistent with language used for other vaccines,
sowill be familiar to healthcare providers.
-A recommended interval of 6 months is consistent with previous recommendations for additional doses for ages 65+.
-Standardizing this interval across both 65+ and
immunocompromised populations will simplify schedule complexity.
•Minimum interval for vaccination
-A minimum interval of 2 months allows for flexibility of vaccine administration
when accounting for individual risk and circumstances.Intervals for vaccination
6.92.05.7
0.2 0.481.9
0.4 1.8 0.1 0.6
0102030405060708090100 Percent (95% CI)Reported place of updated COVID -19 vaccination, adults aged ≥18 years,
United States, National Immunization Survey -Adult COVID Module*
*Among persons who reported receiving an updated 2024 -2025 COVID -19 vaccination since August 22, 2024 (n=2,943). Data collected September 1 -28, 2024.Place of 2024- 2025 COVID -19 Vaccination
6.82.56.2
0.1 0.382.8
0.1 0.5 0.1 0.6
0102030405060708090100 Percent (95% CI)Reported place of updated COVID -19 vaccination, adults aged ≥65 years,
United States, National Immunization Survey -Adult COVID Module*
*Among persons who reported receiving an updated 2024 -2025 COVID -19 vaccination since August 22, 2024 (n=1,715). Data collected September 1 -28, 2024.Place of 2024- 2025 COVID -19 Vaccination
•“May” recommendations can be particularly challenging in these settings.
-Current recommendation for further additional doses are “informed by the
clinical judgment of a healthcare provider and personal preferences and
circumstances.”
•Some challenges reported from pharmacy organizations or pharmacists:
-Not all pharmacists feel this is within their scope of practice.
-There is some discomfort with the patient conversations to make a vaccination
decision.
•Some pharmacists feel they lack the time for these conversations.
-Not all pharmacists have a clear understanding of moderate or severely immunocompromising conditions.
-There are concerns about vaccinating the right patients for adequate
reimbursement, which can lead to hesitation giving additional doses.Additional doses in pharmacy settings
•Reports of people being denied vaccination tend to increase when there
are changes to the guidance. More reports of denied vaccination occur
with additional doses.
-For example, in February 2024 after recommendations for 65+ additional doses,
reports of people who are immunocompromised being denied additional doses
increased.
•CDC will work to assure recommendations are widely communicated to
reduce confusion and avoid missed opportunities for vaccination.
-Dedicated fall/winter workstream on healthcare provider engagement
-Education and communications on recommendations and the importance of self -
attestation to reduce barriers to vaccination
-Wide array of partnershipsDenial of vaccination with frequent guidance changes
•Social Determinants of Health drive differences in vaccine access creating
disparities in uptake.
•Additional dose recommendations may further increase these disparities.
For e xample:
-Insurance: decreased access with the end of the Bridge Access Program
-Disability: increased prevalence with age creating potential challenges getting to
vaccination sites
-Setting: decreased access in setting with existing challenges (e.g., long- term care)
•In the absence of an ACIP recommendation, decreased access if required to
pay out -of-pocket.Vaccine equity considerations
For more information, contact CDC
1-800- CDC -INFO (232- 4636)
TTY: 1 -888- 232- 6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.