Tennesseans lag the nation in getting COVID-19 booster shots. Here's why that's a problem

Less than half of Tennessee – and the country as a whole – have received even one COVID-19 booster shot, despite federal recommendations and again-increasing infections and hospitalizations related to the novel coronavirus, government figures show.

The numbers are even worse for second booster shots, which are recommended for people 50 and older and those with weakened immune systems.

As of the holiday weekend, only 24% of Tennesseans of the recommended age have gotten both extra shots, according to the Centers for Disease Control and Prevention. The national numbers aren’t much better: 27% had done so as of last week, the CDC reported.

Part of it may be a result of the fact that the latest COVID-19 variants haven’t caused the spike in serious illnesses seen last winter and summer.

"The caveat to this though — and it’s an important one —is that there is quite a bit of concern for infections in people who are severely immunocompromised," said Leslie Waller, an epidemiologist with the Nashville Metro Health Department. " Because we know that they run a higher chance of experiencing these severe outcomes than other people, even if they’re vaccinated."

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Anthony Fauci, the Biden administration’s lead COVID-19 advisor, has said a second booster is often needed because the protection offered by the first booster shot wanes over time.

So, what is the consensus advice on getting vaccine boosters?

First booster

The CDC recommends that everyone who is at least 5 years old and medically able to get a first booster shot should do so.

Children and teens who are generally healthy should wait five months after completing their series of initial vaccinations before doing so. Children with compromised immune systems should do so after three months, according to the CDC.

Adults who are generally healthy should wait five months after completing their initial vaccinations with either the Pfizer or Moderna-brand shots. Those who received the one-shot Johnson & Johnson/Janssen vaccine should get boosted two months after the initial shot.

"Everyone is recommended to get a first booster and has been for a while," Waller said. "When this recommendation was made last year there were some indications in national data that were discussed that mentioned some waning immunity."

Second boosters

Public health agencies recommend that all adults 50 and older, as well as those who are immuno-compromised, get a second booster shot at least four months after getting an initial booster.

The CDC in May also strengthened its recommendations on boosters, recommending that children who are 12 and older who have compromised immune systems also get a second shot.

Health officials have not pushed for this as much as they have for initial vaccinations and initial boosters. Even Fauci, in an interview with The Tennessean in April, suggested that the need to get these second shots is not cut and dry.

"If you're talking to me about a man who's 52 who has diabetes and hypertension, I would recommend that person get a boost. If you have someone who's 50, 51, perfectly healthy, athletic, with no underlying conditions, I say it may not be necessary. It depends on your personal risk aversion."

It's unclear if additional booster shots will continue in the months and years to come, though Fauci has said it's likely we'll see public health advisories similar to annual flu shot recommendations.

Possibly the most important COVID shots

Despite the widespread availability of COVID vaccines for all Americans, millions still have not even received one shot to protect themselves from the novel coronavirus.

As of this holiday weekend, nearly 22% of Americans had not received a single dose. In Tennessee, it was more than 37%.

This worries physicians and epidemiologists because those who are completely unvaccinated are much more likely to get seriously ill or die from COVID-19. Yes, people still get sick and die after vaccination, but it's not common.

"Only about 11% of deaths locally are documented as breakthrough cases, which means the remaining 89% of COVID cases that died were unvaccinated," Waller said in an email. "When we’re talking about severe outcomes and concerning trends, the biggest concern, especially in times of widespread community transmission, is still for those who remain unvaccinated."

Evidence also suggests that people who are completely unvaccinated are more likely to suffer a range of long-term, and often physically and mentally debilitating, health problems, even if their initial COVID-19 illnesses were relatively mild — a condition commonly known as "long COVID," said James Jackson, a psychologist at Vanderbilt University and one of the country's leading experts on long COVID.

"Believe me you don't want to get long COVID, so please get vaccinated" Jackson said. "You might not die now if you get COVID. But, I think if many people knew how limiting and disruptive long COVID is for a lot of folks, I think they would factor that in in their decision to get vaccinated."

Frank Gluck is the health care reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.

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This article originally appeared on Nashville Tennessean: Less than half of Tennessee has received a COVID-19 booster shot