• Study IDs Reasons for Patients’ COVID-19 Booster Choices

    Questions About Availability, Eligibility, Protection Are Common

    Feb. 1, 2023, Michael Devitt — Nearly five months after the FDA and CDC approved bivalent formulations of the Pfizer-BioNTech and Moderna COVID-19 vaccines that offer additional protection against some omicron subvariants, just over 18% of adults eligible for a bivalent booster dose have received it.


    Researchers who surveyed 1,200 U.S. adults already vaccinated against COVID-19 have determined that no one reason fully explains why those numbers are so low. The results, reported Jan. 20 in the CDC’s Morbidity and Mortality Weekly Report, indicate a variety of reasons why people have not received the bivalent booster, suggesting that family physicians and other health care professionals should use multiple evidence-based strategies to educate people about benefits associated with the booster.

    “These findings underscore the importance of providing patients with up-to-date information on vaccine eligibility, effectiveness, safety and availability,” said Jonathan Temte, M.D., Ph.D., M.S., associate dean for public health and community engagement and a professor in the Department of Family Medicine and Community Health at the University of Wisconsin-Madison School of Medicine and Public Health.

    “These are all part of our day-to-day conversations with our patients,” Temte continued. “Moreover, it is important for family physicians to have vaccines readily available at their clinics, or know what other venues are available for their patients.”

    The researchers split participants into groups of people who had or had not received a bivalent booster. Each group saw a list of 10 suggested reasons for their decision and also could enter another reason.

    Story Highlights

    Those who had received a bivalent booster chose a median of five reasons, with the most common being

    • to protect themselves (90.7%),
    • to prevent severe disease (80.6%) and
    • to protect others (75.0%).

    Most people who had not received a bivalent booster chose a single reason for not receiving it. Among those who had not received a booster

    • 23.2% did not know they were eligible,
    • 19.8% did not know it was available and 
    • 18.9% thought they were already protected.

    Reasons for not receiving a booster varied slightly by age. The most common reason among those aged 18-59 was not knowing they were eligible, while the most common reason for older participants was thinking they still had strong protection against infection, followed by concern about side effects and uncertainty about effectiveness.

    Participants who had not received a bivalent booster later viewed information about eligibility and availability, and then were asked whether they planned to receive a booster. Almost 68% said yes.

    In a followup survey a month later, however, only about 28% of those respondents had received a bivalent booster. The most common reasons for those who had not were that they were too busy (35.6%) or had either forgotten or were concerned about side effects (both 22.7%).

    The researchers called for more outreach, such as recommendations from a clinician or other trusted messenger, to increase awareness about eligibility and availability.

    “To help increase bivalent booster dose coverage,” they wrote, “health care and public health professionals should use evidence-based strategies to convey information about booster vaccination recommendations and waning immunity, while also working to increase convenient access.”

    Advice From a Family Physician Expert

    Temte, who also serves as the AAFP’s liaison to the CDC’s Advisory Committee on Immunization Practices COVID-19 Vaccines Work Group, said he always recommends the National Vaccine Advisory Committee’s Standards for Adult Immunization Practice as an evidence-based approach to providing the best patient care. This includes

    1. assessing the immunization status of all patients at every clinical encounter, staying informed about the latest CDC recommendations, and ensuring that patients’ vaccine needs are routinely reviewed and that they get reminders about needed vaccines;
    2. strongly recommending needed vaccines by sharing reasons tailored to the patient, highlighting positive vaccination experiences, addressing questions and concerns, explaining the risks of not being vaccinated and remind patients that vaccines protect them and their loved ones against several common and potentially serious diseases;
    3. administering or referring for needed vaccines; and
    4. documenting all vaccines patients receive, including with the state immunization registry.

    For COVID-19, Temte added that FPs should make sure that vaccines are available in their clinics or know where patients can get them. He also recommended bookmarking the CDC’s COVID-19 Vaccination Clinical and Professional Resources.

    The AAFP also offers members resources to help boost immunization rates, including a video series on caring for vaccine-hesitant patients and CME activities on improving vaccine confidence and increasing immunization rates in African American communities

    Several Academy members have also shared best practices for increasing immunization rates using the AAFP’s Office Champions Quality Improvement model.

    In addition, the Academy’s Immunizations and Vaccines webpage contains several tools to help members discuss the importance of vaccinations and counter vaccine-related misinformation and disinformation, including a conversation guide on COVID-19 vaccines.