Booster Rollout for Nursing Homes Is Sluggish

A Connecticut nursing home had planned to roll out Covid booster shots to residents at the beginning of this month.

But before it could start the program, the coronavirus swept through the home, the Geer Nursing and Rehabilitation Center in North Canaan, infecting 89 people, including 67 residents. Nearly all were fully vaccinated.

Eight of the residents died from Covid, according to the home, which described all as having “serious underlying health issues.”

The severity of the outbreak helped spur Connecticut officials to announce recently that the state would set up booster clinics at all of its nursing homes, to cover those facilities that had yet to administer additional doses.

Several states are experiencing new surges in Covid cases, especially in the Midwest and the Northeast. And fresh outbreaks have been reported this month at nursing homes in Vermont, Virginia and elsewhere despite a monthslong vaccination rate nationwide of about 86 percent among residents in skilled nursing facilities.

Booster programs have taken on more urgency given that nearly 4,000 new Covid cases are reported every week in nursing homes, according to federal data, and experts say many of the case clusters are occurring in homes that have yet to administer the extra doses.

“When we compare rates of Covid-19 disease between those who are vaccinated with two doses and those who received a booster dose, the rate of disease is markedly lower for those who received their booster, demonstrating our booster shots are working,” said Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, at a White House briefing this month.

And in some places, outbreaks among residents may still be occurring because vaccination rates among nursing home staff members continue to lag behind national averages.

Unlike last winter’s concerted federal push to vaccinate residents and staff in nursing homes, the booster rollout has been sluggish and piecemeal, health experts said. Public information is sparse: About 42 percent of Americans over 65 have received a booster shot, according to federal reports, but there is no data available yet on U.S. sites to track nursing home booster programs.

The staggering Covid death toll at nursing homes in 2020, steep declines in cases after the successful vaccine campaign and then the steady rise again in late summer and this fall should have made boosters for older Americans a top priority, some experts say.

“What’s been surprising is the lack of data and attention on nursing homes this time around,” said Dr. Ashish Jha, a physician and dean of the Brown University School of Public Health. The government should have authorized additional doses as early as July, he noted, especially since nursing home residents were among the first to receive the vaccines 10 or more months ago.

“The data was clear at that point,” Dr. Jha said. “We were seeing waning immunity, particularly in the elderly.”

In August, third doses of some vaccines were authorized for people with weakened immune systems. But by the time booster shots were approved for the Pfizer-BioNTech vaccine in late September, followed by approvals for the Moderna and Johnson & Johnson vaccines the next month, many nursing home residents had already lost some of their initial protection against infection, experts say. And they were more vulnerable to serious disease because of their age and declining health.

“Six months for them was a lot earlier than six months for the general population,” said David Grabowski, a health policy professor at Harvard who studies nursing homes. Residents of assisted living facilities are particularly at risk because there does not appear to be a coherent strategy, he said. New outbreaks complicate matters by putting booster programs on hold until the cases subside.

The effort to vaccinate residents last winter was delegated to two large drugstore chains, CVS Health and Walgreens. When the federal contracts ended earlier this year, nursing homes reverted to relying on the pharmacies typically used to help them vaccinate residents against the flu.

The Biden administration said it was having success in its efforts to ensure residents receive the additional doses. “We’re seeing really, really strong progress in states across the country,” said Sonya Bernstein, a senior White House adviser on Covid. She singled out programs in West Virginia, Ohio and North Carolina as robust.

Other areas have also managed to provide significant booster coverage. For example, Los Angeles County announced in mid-November that nearly all the residents in skilled nursing facilities had received booster shots.

Ms. Bernstein said the federal government was also working with facilities that can’t find a pharmacy. “Any long-term care facility that needs help is being matched with one of our partners,” Ms. Bernstein said.

Half of those 65 and older who became eligible for booster shots of the Pfizer vaccine in late September have received them, public health officials said in a recent announcement. That’s compared with the nearly three months it took to deliver half of the first doses to this group.

The Centers for Medicare and Medicaid Services, which reports vaccination rates nationwide and for individual facilities on its website, said it planned to post data on boosters within the next two weeks and on its website allowing consumers to compare individual nursing homes “in the coming months.”

“C.M.S. is working with nursing homes to increase Covid-19 booster uptake,” the agency said.

Pharmacies helping nursing homes with these efforts say they have not experienced any particular problems. “From our perspective, we have not heard of any delays or concerns,” said Chad Worz, the chief executive of the American Society of Consultant Pharmacists. “The vaccine is in ample supply.”

CVS Health, whose Omnicare unit provides services to nursing homes, said it could not provide any data on the number of booster shots it had delivered to nursing homes. “We’ve seen strong interest from our long-term care customers and continue to meet that demand through several distribution channels,” said T.J. Crawford, a spokesman.

But other pandemic-related problems continue to plague nursing homes, some of which still had large numbers of unvaccinated workers, although the average staff vaccination rate has now reached 74 percent. Looming close is the federal mandate to immunize staff, although numerous states are suing to block the rule.

Many facilities are also coping with severe and costly staffing shortages. Some say the decision by C.M.S. earlier this month to require nursing homes to allow unfettered visitation of residents is complicating their efforts. Some said they were caught off-guard by the announcement that visitation was now being allowed for all residents at all times, which could introduce new community infections into the homes.

In Minnesota, a state where cases are climbing rapidly, only a fifth of nursing home residents had received boosters by early November, according to a report by The Star Tribune. State health officials declined to comment.

To handle the increasing workload, Gov. Tim Walz recently deployed 400 members of the Minnesota National Guard to the state’s nursing homes, which are having difficulty finding enough workers to care for residents.

For its part, the nursing home industry’s trade group, the American Health Care Association, said the booster rollout was “going well.”

“With 15,000 nursing homes nationwide, these on-site clinics take a bit of time to plan and prepare,” the association said.

With approval for booster shots of all three vaccines granted in late October, the association said it would take “about another month to see a large portion of residents and staff boosted.”

Still, many view the current outbreaks as evidence of the need to move much more quickly. At ArchCare, which operates six nursing homes in the New York area, 93 percent of residents have received their boosters, said Scott LaRue, the chief executive, after starting to administer extra doses in mid-October.

“In my mind, it is too late to be getting plans together if you want to save lives,” Mr. LaRue said. “You need to vaccinate residents and vaccinate staff and you need to get boosters in them. It’s a life or death matter.”

Booster shots in nursing homes “couldn’t have arrived too soon,” said Brendan Williams, the chief executive of the New Hampshire Health Care Association, whose facilities are reporting increasing caseloads. “Everything that is happening right now is an advertisement for booster shots,” he said.

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