Fall 2024 Covid-19 vaccine uptake is somewhat higher than 2023 so far. That's good, right?

Covid-19 vaccines are now part of fall campaigns to prepare for respiratory virus season. How’s uptake? Not great overall. As of November 4th, 17% of US adults in the CDC’s National Immunization Survey say they are “up to date” on their Covid-19 vaccine.

Demographic details.

The rates vary by demographic. Here’s a graph comparing Covid-19 vaccine rates this season (orange bars) to last (blue bars) followed by a brief summary pointing out some key findings.

Data: CDC. Graphic by Benjy Renton for Inside Medicine.

Here are some things in these data I noticed:

• Age: Rates are highest in people ages 65 and up (38%), compared to 23% at this time last year.

• Sex: Females are more likely (19%) to be up to date than males (16%).

• Race/ethnicity: Non-Hispanic White people have the highest rates among race/ethnicity demographics (21%).

• Income: Rates are higher among those above the poverty level (21%) compared to those below it (17%).

• Insurance: This is where the greatest disparity exists. Among those with health insurance, 19% are up to date, compared to 5% without insurance.

Rates are a bit higher. It’s not clear why.

You may have noticed that Covid-19 vaccination rates for the fall of 2024 (orange bars) are higher than last year (blue bars) at this time. Why is this? It looks like it is in part because the CDC pushed the vaccine rollout up by several weeks this fall, so people have had more time to get their fall shots.

But that does not seem to be the whole picture, because on a deeper dive into the data, I noticed that weekly vaccine rates among seniors in particular have been higher in recent weeks, compared to the same weeks last year. For example, by week 9 of the rollout last year, 23% of people ages 65 and up had been vaccinated. It has already reached 38% by week 9 of this year’s rollout. I’m not sure why this is. Some suggest this says more about confusing rollout messaging last year than anything about this year’s rollout or interest. Indeed, deeper in the data, the percent of people aged 65 and up who said they were vaccinated or planned to receive one was 73.9% at this time last year, compared to 75.4% now. So, interest/intent alone doesn’t explain the 15-point gap in the 65+ age group either.

We didn’t graph this, but in the 75 and older age group, around 45% have received a Covid-19 vaccine during the 9-week rollout period this fall, compared to 22.6% at this exact time last year (and 28% at a comparable time in the rollout by later November).

Usually I come with answers. Not today. Anyone have any ideas about what is going on here? I’m interested in your views and insights, so please leave a comment below!

Increased uptake is good, right?

Regardless of why, on the surface, increased Covid-19 vaccine uptake would seem to be a good thing—especially in seniors and high-risk individuals. But I’m not entirely sure of that—and this is where nuance comes in. As I wrote in the New York Times regarding flu shots, the outcome we most care about is not the percent of the population vaccinated but, rather, the number of illnesses (especially severe ones) averted by vaccines. That means that when people get their shots can have a large effect on population outcomes. Remember, these annual vaccines wane in effectiveness over 4-16 weeks, to the point where very few (if any) infections are prevented four or more months after vaccination.

Imagine it’s January 10th, a typical peak for Covid. Which would you rather have: A population in which 100% of seniors got vaccinated back in July and August? Or one in which 50% were vaccinated in November and December? Given what we know about waning, we’d much rather have the second scenario in which a lower percent of the population has been vaccinated, but they’d received their doses more recently.

Given how low wastewater levels of Covid have been this fall, I’m worried that the 37.6% of seniors who have already received a Covid-19 vaccine this fall won’t have as much protection as the 33% of the senior population had back in early January of 2024.

That’s why back in September when high-risk people (not counting immunocompromised folks who can get doses as often as every 2 months if needed) asked me if they should get a Covid shot right away, I often told them to wait until at least mid-to-late October, if not November or December, because we expected a quiet fall followed by a winter surge (with the caveat being that if there were a sudden outbreak due, say, to a new variant, that it would be wise to get vaccinated then).

But as I’ll discuss below, now may be the time to get your Covid and influenza shots, if you’ve been waiting until later in the season to maximize their benefits.

State of the states.

As you can see, as of early November, vaccination rates among adults around the nation vary widely, from 5% in Idaho and Louisiana to 45% in Arizona. Why Arizona is so out in front on this, I am not certain. Again, if anyone has insights on this, please let me know in the Comments section.

Visualization: Benjy Renton for Inside Medicine .

To be honest, I’m less worried about the low rate of vaccination in the population overall (19%) than I am about the insufficiently high rate in seniors. Last season, 41% of people aged 75 and older ever got vaccinated. This year it’s already at 45% in this group. That’s better, but in this age group it really ought to be far higher.

What worries me is that the next administration may not help these rates. The key, in my view, is uptake in high-risk people. I continue to believe that high-risk people need Covid vaccines twice per year for the foreseeable future (which the CDC has advised for 2024-2025 at least).

Make a plan, follow through.

It’ll be interesting to see where rates go between now and January. Given modeling and the latest data (which I’ll discuss next week), we are expecting Covid levels to rise in the coming weeks as we approach late fall and winter.

If you’ve been waiting to get your Covid or flu shots until later in the season, now’s a good time to make plans to follow up on those intentions. This happens every year. In fact, last November, of adults ages 18 and over who said they would definitely get a vaccine (but who had not yet), 41% never did! And even in the 75+ age group, 23% of people who said they were definitely getting a vaccine (but who had not yet), never did either. You certainly don’t want to be a person who intended to get a shot but never got around to it.

So, here’s a link to where you can find vaccines in your ZIP code. Long may it last!

Thanks to Benjy Renton for wrangling this data and the great graphics!