A nurse readies a shirtless man's arm for a Covid-19 vaccine.
San Francisco resident receives a dose of the vaccine at a community clinic in the Mission. Photo by Clara-Sophia Daly. Photo June, 2021.

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.” 


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REPORTER. Annika Hom is our inequality reporter through our partnership with Report for America. Annika was born and raised in the Bay Area. She previously interned at SF Weekly and the Boston Globe where she focused on local news and immigration. She is a proud Chinese and Filipina American. She has a twin brother that (contrary to soap opera tropes) is not evil.

Follow her on Twitter at @AnnikaHom.

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  1. 38%? That’s double the rate of the country as a whole, so I’d say you’re getting the results you want. Personally, I don’t see any need to get something that doesn’t stop you from getting or transmitting covid. And if you’re one of the unlucky few that gets an adverse reaction, well, you’re on your own. Not worth the risk.

  2. I’ve gotten all the COVID vaccines and boosters I’m eligible for, but haven’t been clear on whether the last one I got was the bivalent or not. I think it would be helpful in the messaging to include at date — ie “If you haven’t gotten a COVID shot since x/y/202z, you should come in for the bivalent shot!” I think there are receptive people out there who would get it if they realized they needed it.

  3. When government officials, especially public health officials, and a herd of celebrity “experts” and leading media outlets tell us in a thousand ways, explicit and implicit, that “pandemic is over”, there is no data to contradict that (because there’s no real data), why should people run out to get yet another shot? BTW, I would check your assertions that the bivalent vaccine protects against infection. It may, for two months, but no covid vaccine available in the U.S. is a non-sterilizing vaccine, which means they are not designed to protect against infection, reinfection etc. They do a good job protecting against severe illness, hospitalization and death (we think — there was never any useful data on hospitalization and now it’s far worse). The message megaphoned in early 2021 that the vaccine protected against infection is probably the worst piece of misinformation of the crisis, as did more to undercut trust in the vaccine and public health officials generally than any of the anti-vax bs could have ever hoped to do. The FDA, which appears to be a PR arm of Pfizer and Friends, continues to degrade any kind of trust. If they were serious, they would call for a truly sterilizing nasal vaccine, instead of rejiggering the same old vaccines which will do little if anything to keep infections down. We learned our public health infrastructure has been decimated by decades of defunding. What have city/state/federal officials done, what programs have been forwarded to begin to change that dynamic? And what have we ever heard from the hospitals and the nursing homes about the changes they have instituted or are instituting to prevent further pandemics? Nothing? Not a word? Do they still get their N95s from China? How many ICU beds are staffed? How have hospitals (private and public) improved pay and working conditions to bring back workers lost in the pandemic and to increase what we saw to be woefully inadequate staffing. When profit means more to hospitals than the health of their patients, something has gone dreadfully wrong and it’s going to take a lot more than “messaging” to change it.

  4. Not everyone needs a flu shot. The problem is there’s lack of credible information, even from doctors. It’s no surprise that we stopped trusting what used to be the official sources of information. There’s so much corruption in the government, medical industry and we know this. Medicines are overpriced, then withheld or over prescribed arbitrarily based on fear or monetary gains. Big pharmacies aren’t held accountable.
    So we’re pretty much left to figure it out, or guess for ourselves.
    Covid pandemic was a great way to observe how functional we are on this planet. For the most part, we’re not.

    1. Sure there’s some bumbling around among health officials. Don’t let the state of the health care system distract from the bottom line: mRNA Covid vaccines are safe and effective, still free of charge, get it.

    2. You may not think you need a flu shot. But if you catch the flu and then give it someone else who may not be medically healthy or even unable to get a vaccine for flu, you could kill them despite having no desire to do so. Those who refuse vaccines because they assume they are healthy are selfish IMO.

      1. only a person who treats other humans as human shields to be used is selfish if your medically fragile take steps to protect yourself

    3. I’ve personally watched a healthy man who was very rarely ill with any type of respiratory infection (cold, flu) die in ICU from influenza (the flu) that quickly turned into a ravaging, irreversible case of pneumonia. Two thirds of his lung tissue turned into goo.

      He was most vociferously adamant about not taking any type of vaccine. Especially flu vaccine. Duh.

      You may go thru each wave of flu and cold seasons for years without getting sick or recovering quickly if you do. But then … your body encounters something its never even seen before and blamo … you risk dying a stupid, agonizing death.