Within weeks, updated COVID-19 vaccines could become available across the United States, offering protection against new variants of coronavirus that are making hundreds of thousands of Americans sick, and killing nearly 400 of them, every day.

A new University of Michigan poll shows that 61% of people over 50 who have already gotten at least one dose of COVID-19 vaccine are very likely to roll up their sleeves this fall to get an updated booster shot. 

That percentage might increase if health care providers specifically recommend the updated vaccine to their patients, the poll suggests.

The virus has had an especially lethal impact on people over 65, as well as on Black adults over 50 and people with low incomes. The poll finds that 68% of people in each of these groups who have had a COVID-19 vaccine in the past say they are very likely to get a COVID-19 booster this fall. By comparison, a much lower percentage—55%—of people aged 50 to 64 with a past COVID-19 vaccine said they’re very likely to get a fall booster.

In addition to those who say they’re very likely to get a fall booster, about 1 in 5 adults over age 50 (21%) who had gotten vaccinated against COVID-19 in the past say they are somewhat likely to get a booster this fall. But sizable percentages of some groups of previously vaccinated older adults said they won’t get a fall booster at all, including 23% of all adults aged 50 to 64, and 22% of white respondents over age 50.

Fall booster attitudes also vary depending on current vaccination status. While 24% of vaccinated-but-not-boosted older adults say they’re very likely to get a fall booster, the percentage was 56% among those who have gotten one booster and 88% among those who have gotten two boosters. Second boosters have been available to people over 50 since late March.

The poll was taken in late July for the National Poll on Healthy Aging, based at the U-M Institute for Healthcare Policy and Innovation. The poll is supported by AARP and Michigan Medicine.

Variant-specific boosters on the horizon

Before the poll was taken, vaccine makers Pfizer and Moderna had reported favorable results from tests of the updated COVID vaccines, but the U.S. government had not yet officially announced its strategy to buy millions of doses of the vaccines and make them available as soon as September if federal agencies approve and recommend them.

The new vaccine formulations aim to help the body recognize and fight off the Omicron BA.4 and BA.5 forms of the virus.

With more than 84% of Americans now living in areas where these variants have driven COVID-19 community levels to medium or high, and are causing repeated infections, the reformulated boosters can’t come soon enough, says Preeti Malani, the poll’s director and an infectious disease physician also trained in geriatrics at Michigan Medicine, U-M’s academic medical center.

“The vaccines we’ve had since late 2020 have saved countless lives and made COVID-19 much less serious for millions worldwide. We also know that those who got at least one booster dose have done better than others in the Omicron variant era,” she said. “But if we’re going to drive down deaths, hospitalizations, serious illness and long-term effects even further, we will need to get as many people vaccinated with these new formulations as possible.”

The importance of a provider’s recommendation

Malani calls on her fellow health care providers—physicians, nurses and nurse practitioners, pharmacists and physician’s assistants—to start communicating to their patients now about the importance of getting a dose of one of the updated boosters when they become available.  

That’s because the poll finds that 77% of older adults say their provider’s recommendation about COVID-19 vaccination is very or somewhat important to their decision to get vaccinated.

The percentage saying a provider’s recommendation was very important was highest for those over age 65 (56%) and those who are Black (79%), retired (56%) or have incomes under $30,000 (56%) compared with those of other racial and ethnic backgrounds, work statuses or income levels.

With the new vaccines still weeks away, the Centers for Disease Control and Prevention continues to recommend that people over 50, or over 12 and at high risk of severe COVID-19 because of health conditions, get their first or second booster dose of one of the existing vaccines if they haven’t yet. The new poll shows that only 19% of people aged 50-64, and 44% of people over 65, have gotten two booster doses.

The poll also shows that 17% of people over 50 have not yet received any doses of COVID-19 vaccine; Malani notes that a provider’s recommendation regarding the updated Pfizer and Moderna vaccines will be important for them, too. 

Past COVID-19 infections and testing

With officially reported cases surging in recent weeks, and many more cases going unreported because results of at-home tests aren’t tracked, the poll has some surprising findings about older adults’ experiences with the disease and testing.

• In all, 50% of those aged 50 to 64, and 69% of those over 65, said they had never had COVID-19 by late July 2022.
• In the 50-to-64 age group, 29% said they had had COVID-19 once, 9% said they had had it more than once, and 12% said they may have had it but weren’t sure.
• In the over-65 group, 24% said they had had it once, 2% had had it more than once and 5% said they may have had it.

At-home tests, which were scarce until early 2022 and have been made available for free through the federal government, health insurance companies and community locations, have been used by 44% of older adults. The percentage who had ever used an at-home test was highest among those aged 50 to 64, those with higher incomes and education levels, and those who are working.

Meanwhile, 57% of older adults had had PCR testing, which is what feeds official reports of COVID-19 rates, but has become less widely used in recent months given the ease of home testing. The same groups that were more likely to have used at-home tests were also more likely to have had a PCR test.

But 28% of those over age 65 and 22% of those aged 50 to 64 said they had never been tested for COVID-19. Those with high school educations or less and those with incomes under $30,000 were most likely to say this.

Of those who said they had had COVID-19 at least once, 21% said they had never gotten a test but had had symptoms. Meanwhile, 53% of this group said they had tested positive on a home test and 43% said they had a positive PCR test; respondents could indicate that they had tested positive on both kinds of tests.

Fall booster attitudes varied based on COVID-19 history. Two thirds (66%) of those who had not had COVID-19 by the time they took the survey, and had received a COVID-19 vaccine in the past, said they were very likely to get a fall booster, as did 56% of vaccinated people who had had COVID-19 once. Meanwhile, 39% of those who had had COVID-19 more than once, and had received at least one dose of COVID-19 vaccine, said they were not likely to get a booster this fall.

Flu vaccination

The poll also asked older adults if they plan to get vaccinated against influenza this fall; the optimal time for this year’s flu shots is likely to coincide with the availability of new COVID-19 boosters. Vaccine experts have advised in the past that the two vaccines can be given at the same time.

The difference between the two age groups was striking:

• 74% of people over 65 said they were very likely to get a flu shot, compared with 46% of people aged 50 to 64.
• Another 13% of the younger group and 6% of the older group said they were somewhat likely to get a flu shot.

Education level made a big difference in flu shot likelihood, with 70% of those who have college degrees or higher saying they are very likely to get a flu shot, compared with 53% of those whose formal education ended earlier.

Three quarters (75%) of those who said they were very likely to get a flu shot were also people who had gotten at least one dose of COVID-19 vaccine, and said they were very likely to get a fall COVID-19 booster.

In contrast, 20% of those who have never gotten a dose of COVID vaccine said they were likely to get a flu shot.

“We can’t forget that flu can pose a threat to older and more medically vulnerable adults, and the same precautions that work against COVID-19—vaccination, masks, good ventilation and keeping sick people away from others until their symptoms are over—work against flu,” Malani said. “Although we avoided a ‘twindemic’ of both viruses at once last winter, it’s not clear we’ll be so lucky again this winter. I encourage everyone to follow the CDC recommendations for their age and health status regarding vaccination and prevention.”

The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,024 adults over 50 from the Foresight 50+ Omnibus panel, which draws from the Foresight 50+ Panel by AARP and NORC at the University of Chicago, who answered a wide range of questions online and by phone in late July 2022. Questions were written, and data interpreted and compiled, by the IHPI team.