Only 38 percent of eligible residents in San Francisco have received a bivalent booster, according to city data. And, while that’s double the national average, it’s a figure that’s raising alarms among some Bay Area health experts.
“We clearly haven’t found a way to communicate to the public how important it is, and we have to keep trying,” said Diane Jones, the spokesperson for Unidos en Salud, a collaboration between the University of California, San Francisco, and the Latino Task Force, and a former nurse during the HIV/AIDS epidemic.
The bivalent vaccine uses two spike proteins, one from the original Covid-19 virus as well as the omicron variant, which medical experts found better protects residents from severe disease and death. In 2022, Covid-19 was on track to be the third leading cause of death in the United States, behind heart disease and cancer.
While more than 90 percent of eligible San Franciscans rolled up their sleeves and completed their primary series shots — one shot for the Johnson & Johnson vaccine, or two shots for Moderna or Pfizer — that has not happened for the bivalent vaccine.
Community health experts and clinics are working on increasing outreach and messaging about the bivalent booster. There is some urgency, as vaccines, testing, and treatment are still available for free in some low-barrier community pop-up sites, but once the federal emergency health order ends in May, funding for those resources will be gone.
Bivalent vaccines protect better against infection or reinfection, doctors said. Even if you are unlikely to land in the hospital or die, much is still to be learned about negative health outcomes associated with Covid-19.
“People still don’t know that covid is causing an increase of onset diabetes,” said Dr. Noha Aboelata, the founder of Roots Community Health Center in Oakland.
Often, the same populations that were affected the most by covid are at risk for chronic illnesses, like diabetes or heart disease, added UCSF’s Dr. Kim Rhoads, director of engagement at the university’s cancer center. These health risk factors were partly why Black Americans were at higher risk for Covid-19 death in 2020 and 2021.
And, avoiding infections decreases the chances of contracting long covid, or bouts of covid that last longer than 12 weeks. Its effects continue to be studied. “We don’t know the burden, exactly,” Aboelata said. “There’s still a lot we need to learn there.”
Some people who contract long covid have observable changes in the blood-brain barrier, which “can create clotting, neuropathy, symptoms that look like depression, exhaustion, multisystems in your body,” said Monique LeSarre, the executive director of Rafiki Coalition for Health and Wellness in the Bayview. And “people may not be taking it seriously because they may not be symptomatic, but there’s ongoing exposure.”
Yet many San Francisco residents are exhibiting a devil-may-care attitude toward the bivalent vaccines. Why? Doctors blame a failure of proper messaging on its importance, and also because of existing fears and misinformation. Some people are just tired of the constant push for yet another vaccine.
In the past few years, San Franciscans were asked to take their booster shot, a flu shot, a monkeypox shot, then a bivalent vaccine, Rhoads said. “People are worn out,” she said. “Too many shots. Too many shots.” And most adults, “unless you’re traveling, [are] not getting shots all the time. Now, you need five.”
Bivalent boosters became available for anyone over 12 last September. Infants as young as 6 months could get a shot since last December.
Another huge factor is the lack of information. People wonder if they should get the bivalent at all and, if so, when?
People might say, “Oh, ‘it’s just your lungs, or the flu kind of thing. But when you have this over and over, it can create long-term havoc in your body. This is not the message people are receiving,” so, “they are not treating it with seriousness,” Rhoads said.
The government is still figuring out information, too. During a federal Food and Drug Administration advisory panel in January, members were still determining whether a bivalent booster is needed once a year, like the flu shot, or if it’s needed twice a year to address regular winter and summer surges. This creates questions among the masses about when to boost up.
Plus, misinformation continues to circulate about the vaccine.
“I think there are a lot of groups at very high levels that are peddling various herbs and cures and seminars and lectures,” Aboelata said, adding that high profile anti-vaxxers and science deniers have gained followings. “I think this created enough doubt and confusion,” Aboelata continued. “So, a lot of people are like, ‘I don’t know what to think, so I’m going to play it safe and do nothing.’ Which is actually not playing it safe.”