The holidays are just around the corner, but despite the urging of health officials, few U.S. residents, including those in Hawaii, have rushed out to get their updated COVID-19 vaccine.

The lackluster response, even among those who were receptive to the vaccines earlier in the pandemic, appears to be due to a lack of concern over getting COVID-19.

It’s just not as high of a priority anymore, according to the latest KFF survey, released Friday.

Roughly half of U.S. adults surveyed said they definitely or probably will not get the latest COVID-19 vaccine, which became available in September, with many saying they just aren’t that worried about catching the virus, according to the survey by KFF, a health policy research organization formerly known as The Kaiser Family Foundation.

This includes 3 in 10, or 31%, of previously vaccinated adults who now say they will not get the updated shot.

Additionally, half said they do not plan to take any precautions this holiday.

The 2023-2024 COVID-19 vaccines by Moderna and Pfizer, which target the XBB lineage of omicron variants in circulation, were federally approved Sept. 11.

The Centers for Disease Control and Prevention on Sept. 12 recommended a shot to all Americans ages 6 months and older to protect themselves and their loved ones ahead of the holidays, when there is generally an uptick in cases.

But uptake of the COVID-19 vaccine so far has been pretty dismal both in Hawaii and across the U.S., even among the most vulnerable.

An estimated 14% of adults and 5% of children in the U.S. have so far received the updated vaccine, according to CDC.

In Hawaii, a state that once led the way in COVID-19 vaccination rates, uptake of the new vaccines is even lower.

As of Wednesday, state Department of Health data showed only an estimated 107,720 people, or roughly 7.6% of Hawaii’s population, received the updated COVID- 19 vaccine.

Rates are also alarmingly low among the most vulnerable kupuna living in nursing homes.

Just under 31% of the state’s senior nursing home residents are up to date with COVID-19 vaccinations, according to CDC. The total percentage nationally is even lower, at 17%.

It’s a big drop from where Hawaii once was, in 2021, when the COVID-19 vaccination rate among nursing home residents was above 92%.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said the low uptake among nursing home residents is particularly concerning.

“They’re absolutely the most vulnerable for flu, for COVID or for RSV (respiratory syncytial virus),” he said.

He does not believe accessibility is the issue or that nursing homes have not made the vaccines available.

While federal funding is no longer available for vac­cination campaigns, the COVID-19 vaccines are covered by Medicare, Medicaid and commercial insurance, he said, and readily available from pharmacies and doctors’ offices.

Lack of worry

So why aren’t people getting the COVID-19 vaccine?

A small segment of the population has been resistant to the COVID-19 vaccines from the start, citing safety concerns and distrust of government.

Social media is rife with anti-vaccination viewpoints, which say the vaccines don’t work and never did or that they are a profit-making scheme for “Big Pharma,” the global pharmaceutical industry.

A person’s age and partisanship could play a role, as well.

Uptake is higher among adults ages 65 and older, at 34%, than ages 18 to 29, at 18%, according to the KFF survey. Uptake is also higher among Democrats, at 32%, than Republicans, at 11%.

But a top reason this time, according to KFF’s survey, is that fewer people overall are worried about COVID-19 anymore.

Of those previously vaccinated, 37% say they have not gotten it because they have been too busy, and 32% said they were waiting to get it later.

Raethel believes COVID-19 fatigue is part of it, along with the perception that the virus is no longer a threat.

The latest strains have not resulted in as much severe illness, he said, or been as deadly as the original delta and omicron variants.

“Because symptoms for current strains are not so severe,” he said, “people are not taking it that seriously. Unfortunately, people are still dying.”

DOH on Wednesday reported three more corona­virus-related deaths, bringing Hawaii’s COVID-19 death toll to 2,078.

But the proportion of deaths now is lower as well, according to Raethel. And Hawaii’s hospitalization numbers for COVID-19 have been flat since mid-October, at around 50 patients per day, down from about 100 during the summer.

Many of these are incidental cases, said Raethel, meaning they were initially admitted for health issues other than COVID-19.

While this is good news for the state, it also means that COVID-19 is out of the limelight and seldom reported anymore in the media.

“It really is this mindset of people saying, ‘Well, OK, I’m not hearing a lot about it anymore,’” he said. “There’s no sense of urgency about getting the vaccine.”

Reason to worry

Tim Brown, an infectious disease expert from the East-West Center in Manoa, said officials should be worried about the low vaccination rates, especially among nursing home residents who are of the ages most vulnerable to serious illness and death.

“We really need to step this up,” said Brown in an email. “Remember that almost all COVID deaths reported in Hawaii are among those 60 and above, with 80 and above making up the majority of that number.”

There have been nursing home outbreaks in the state, he noted, including the one that occurred in Hilo in May.

“Low vaccination rates are an invitation for that to keep happening over and over again,” he said.

Vaccine protections wane over time, he said, so they should be current to protect kupuna and staff in congregate settings such as nursing homes.

“Of course, we also need constant vigilance,” he said, “with ongoing vaccination campaigns, frequent testing, rapidly implemented masking policies among staff and residents if COVID is detected in one of these settings, and immediate access to Paxlovid and quality medical care. We should be using all the tools in our prevention and treatment arsenal to protect our kupuna.”

Brown said there may be in a lull now, but respiratory virus season is underway with influenza and RSV on the rise across the U.S. He expects COVID-19 cases to start rising again heading into the holiday season, just as it did in 2022.

Studies have shown a higher risk of developing other health issues following a COVID-19 infection and that repeat infections increase the risks of long COVID-19.

Audrey Suga-Nakagawa, AARP Hawaii advocacy director, said she would like to see higher vaccination rates among nursing home residents.

“It’s always a concern because we know the most vulnerable segment of our population is the kupuna,” said Suga-Nakagawa, “and that the most fatalities, the most extreme medical complications from COVID- 19, are among the older population.”

During the initial rollout of COVID-19 vaccines, federally funded efforts brought resources to nursing homes to make sure residents and staff there were vaccinated. Now, she said, it’s a different type of effort.

She is hopeful, however, that momentum will pick up in coming weeks.

She urges nursing home residents get their updated COVID-19 vaccines and that their family members do so, too, especially if they are visiting their loved ones.

“People still need to be very vigilant,” she said. “COVID is still here. We want them to get vaccinated this month or next month — the sooner the better. We want to make sure the residents, the staff and their families get vaccinated to protect themselves and their loved ones.”

UPTAKE OF LATEST COVID-19 VACCINE

>> Only 1 in 5, or 20%, of adults say they have gotten the updated COVID-19 vaccine.

>> Roughly half of U.S. adults say they won’t get the shot. This includes 3 in 10, or 31%, of previously vaccinated adults, who now say they will not get the updated shot.

>> Uptake is higher among adults ages 65 and older (34%) than ages 18-29 (18%).

>> Uptake is higher among Democrats (32%) than Republicans (11%).

>> About half, 52%, who were previously vaccinated have not gotten the shot yet because they’re not worried about getting COVID-19; 37% say they’ve been too busy; 32% are waiting to get it later.

>> Three-quarters, 74%, say they are “not too worried” or “not at all worried” about getting COVID-19 over the holidays.

Source: KFF COVID-19 Vaccine Monitor (Oct. 31-Nov. 7)