From Pandemic to Endemic: The Role of COVID-19 Vaccine Boosters and the Need for a Recurring Vaccination Schedule

An ECRI Position Statement

COVID-19 vaccine boosters have failed to mobilize the public

Though largely anticipated as necessary, COVID-19 vaccine booster doses have received much less public interest than the primary vaccine series. Six months after booster dose authorization in the United States, uptake has stalled at just over 30% of eligible recipients. Public policy regarding vaccination booster dose requirements in hospitals, schools, and businesses remains inconsistent across the country, even as other public health measures are brought to an end, and healthcare systems are limiting their engagement on this front. Mental fatigue and a desire to return to normal are clear drivers of this “COVID apathy,” but uncertainty about the pandemic outlook and the future role of vaccines plays a magnifying role. While the majority views vaccines as safe and effective, many are unconvinced of the necessity of boosters, especially amidst declining disease rates. Paradoxically, the vaccination campaign’s success may be setting the stage for COVID-19’s resurgence.

Maintaining public engagement in the COVID-19 response requires clearly stated goals and strategy. ECRI applauds the National COVID-19 Preparedness Plan released in March 2022 by the U.S. Federal Government, which lays out a comprehensive strategy for transitioning from a SARS-CoV-2 pandemic to an endemic-like state. However, ECRI notes that current COVID-19 response plans do not provide sufficiently clear guidance on vaccine booster timing and distribution. Considering COVID-19’s likely transition from pandemic to endemic and its propensity for producing new variants, ECRI encourages public health agencies to consider adopting a more structured, recurrent (e.g., semiannually, annually, biannually) vaccine booster schedule for SARS-CoV-2 as part of a sustainable approach for long-term COVID-19 management.

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