The state Department of Health is recommending that residents get their updated COVID-19 and flu vaccination shots ahead of the upcoming holiday season.

“We often see surges of COVID-19 and influenza during the holiday season due to increased travel and social gatherings,” said State Epidemiologist Dr. Sarah Kemble in a statement. “DOH recommends everyone 6 months and older get the updated COVID-19 and flu vaccines to protect themselves as well as others, especially our kupuna and those who are immunocompromised.”

Uptake of the newest COVID-19 vaccine, which was recommended by the Centers for Disease Control and Prevention on Sept. 12, has been low across the U.S.

At last check, only 7% of adults and 2% of children in the U.S. had received the COVID-19 vaccine targeting the most recent variants.

In Hawaii, an estimated 98,738 doses of the updated vaccine have been administered, according to DOH data from voluntary reports up to Wednesday, which is nearly 7% of the state’s population.

There appears to be little sense of urgency six months after the U.S. declared an end to the COVID-19 pandemic emergency.

In January, a study by the University of Hawaii Economic Research Organization found COVID-19 fatigue had already set in, and that more than a third surveyed perceived the pandemic as over for their personal life.

Thus, there has been no rush by most residents to get the COVID-19 vaccinations, even among those who are receptive to it.

Kaiser Permanente Hawaii confirmed a 6% drop in vaccination rates this year compared with last year. The COVID-19 vaccines are available to all members ages 6 months up at Kaiser clinics, with no appointment necessary.

Dr. Scott Miscovich of Premier Medical Group is offering the updated COVID-19 vaccines at his clinics for children and adults.

He is recommending them to all of his patients, but will make them available for non-patients as well.

The interest among his patients ages 65 and older who have been previously vaccinated is high, but low among his younger patients.

“The interest in people below 50, I would say, is fairly nonexistent,” he said. “Some maybe have the two-shot series at the very beginning and say, ‘You know, I had COVID twice plus I got vaccinated already’ and they just don’t want to. They think they’re protected.”

There are other patients who say they are not worried because they do not feel COVID-19 is a health threat to them.

Miscovich said he then explains why this updated vaccine is different than the ones rolled out in 2020.

He also reminds patients that conditions such as diabetes or being overweight place them at greater risk from illness with COVID-19, saying many do not realize this.

The newly updated 2023-24 COVID-19 vaccines target the XBB lineages of the omicron variant, which DOH in September said accounted for the majority of COVID-19 cases in Hawaii.

CDC recommends everyone ages 6 months and older get the updated vaccines for protection against severe illness, hospitalization and death.

Federal health officials have also moved away from the term “booster” and are calling the COVID-19 shots “vaccines” in an effort to help people to understand it is updated, just as the flu shot is updated yearly.

Those who were last vaccinated a year ago have minimal protection, according to Miscovich, because immunity wanes, and does so even quicker for those who are older or immunocompromised.

The bumpy rollout of the new vaccines via the commercial market nationwide did not help, either.

In September, some residents seeking the vaccines at CVS Pharmacy’s Longs Drugs were told they were not covered by the Hawaii Medical Service Association, one of the state’s largest insurers, and that they would have to pay up to $200 out of pocket.

HMSA said there was a lag in coverage due to technical issues, which have since been resolved. But then residents dealt with appointments canceled last-minute at pharmacies due to supply issues. Some parents are also finding it difficult to get their younger children vaccinated for COVID-19.

The weekly infection and hospitalization rates in Hawaii, meanwhile, have declined from summer rates.

On Wednesday, DOH reported an average of 69 new COVID-19 cases per day, and average positivity rate of 7.3%, down from 8.0% reported the previous week.

Hospitals reported an average of 50 COVID-19 patients per day, with little change over five weeks.

But COVID-19-related deaths continue to climb, and with 10 more were reported Wednesday, Hawaii’s COVID-19 death toll is now at 2,075. Most deaths have occurred among residents ages 65 and older.

Tracking COVID-19 metrics has also become challenging as more residents switch to home tests instead of PCR tests, which are not reported to the state.

With a lower volume of clinical specimens to sequence, the DOH State Laboratory says it is publishing COVID-19 variant reports once every four weeks instead of biweekly to provide more meaningful data.

Wastewater monitoring has also been stalled due to CDC’s contract dispute with Biobot Analytics, which was tracking and sampling Hawaii’s wastewater for the virus up to September.

CDC chose to switch to Verily, owned by Alphabet Inc. Biobot protested the award, and testing Hawaii’s wastewater will be delayed until it has been adjudicated, DOH said.

As long as the coronavirus keeps circulating, it will continue to evolve, with omicron variant HV.1 now dominant in the U.S. This is why getting the updated vaccine is important, Miscovich said.

He expects an uptick in cases over the holidays — to occur on a yearly, seasonal basis — due to an increase in gatherings, particularly with fewer people masking. COVID-19 has not gone away, he said.

“If you’re going to be with your kupuna, you have to be sensitive, to think that they are at risk and you should be careful,” he said. “Please get vaccinated. Consider this a virus that is now with us forever. People over 65 are at risk.”