Only a fraction of aged care residents are getting COVID boosters, despite high influenza vaccination rates – why the mismatch?

As Australia enters its fourth COVID-19 winter, low COVID booster vaccination rates in residential aged care place some of the country’s most vulnerable people at high risk.

Only 29% of eligible residents have received the COVID-19 2023 booster, despite the fact that aged care facilities remain a major source of outbreaks, and an alarming number of deaths continue to occur.

As of 11 May, the Department of Health and Aged Care reported 386 active outbreaks in aged care, including 171 new outbreaks since the previous week, resulting in 2,654 active cases among staff and residents. There were also 115 new resident deaths attributed to COVID over the previous 14 days.

In contrast to the low percentage of aged care residents who are up-to-date with ATAGI recommendations for COVID boosters, Griffith University public health physician Professor Paul Van Buynder says that AIHW data over the last thirty years has consistently shown that 75-80% of people over the age of 65 get vaccinated against influenza—with residents of aged care facilities included.

“We’re having 20 people die of COVID every day. Many of these are in aged care and they’re not boosted, so this will continue to happen…And its people’s grandparents and loved ones who are dying in aged care from COVID because we haven’t got them protected,” he says.

So what’s the deal?

Professor Van Buynder says several factors are likely to contribute to low booster rates in residential aged care facilities. He believes aged care providers need to be more proactive in establishing booster programmes, pointing to the success of flu vaccine programs.

He says there has been a shift away from GPs administering COVID vaccines more broadly, which can leave a gap in services for aged care residents. Pharmacists are playing an increasing role in delivering boosters in the community, but most don’t go into residential aged care, he says.

While GPs have been at the forefront of Australia’s COVID response since the start of the pandemic, Healthed survey data this month suggests that only about one third of the nearly 1,800 GPs who responded had patients in aged care facilities, with around 13 percent routinely providing COVID boosters at aged care facilities.

To put that in perspective, two thirds of survey respondents are routinely providing COVID boosters in their main practice–and GPs with patients in aged care facilities are more likely to provide COVID boosters in their main practice (73%) than in aged care (50%).

Challenges abound

Surveyed GPs cited a range of barriers to providing COVID boosters in aged care facilities.

Over half of respondents(59%) said time constraints were a barrier to providing COVID boosters in aged care facilities, while more than one third said the remuneration was insufficient for the time required. Around one quarter also said there was inadequate nursing support. And one fifth cited vaccine hesitancy as a barrier.

Some GPs identified issues within aged care facilities, such as facilities organising their own vaccination programs and difficulties gaining access to necessary resources such as rooms, computers to check patient history and nursing assistance, among other things.

GPs also cited difficulties with the vaccine itself, including concern about transportation and storage and wastage.

Dr Kasia Bolsewicz, a social science researcher at the National Centre for Immunisation Research and Surveillance and the Hunter New England Local Health District, who conducted studies at HNE residential aged care facilities during the pandemic also points to multiple barriers. She says the shift away from mandating public health measures such as masks, isolation and vaccinations has put the onus on residential aged care facilities to make those choices on an individual basis.

When it comes to the specific barriers for providing COVID boosters in aged care, Dr Bolsewicz says staff shortages and difficulty finding GPs to administer on site vaccinations have both played a role throughout the pandemic. She says mixed messaging around the risks of COVID and benefits of vaccination has also led to waning perceptions of risk among the general public, which may lead to low uptake of boosters among visitors and their elderly family members. Additionally, aged care residents who live with dementia and cognitive impairment may not understand what COVID is and why vaccination and additional boosters are needed.

Meanwhile, although the budget allocated $591.3 million over two years to support aged care providers response to COVID, there is no mention of any specific resources or policies aimed at increasing vaccination rates in residential aged care facilities.

GPs are in a powerful position to make a difference

Survey results indicate that time pressure is the greatest barrier to GPs providing booster vaccines in aged care, and Professor Van Buynder says this has likely been exacerbated by the relative complexity of the COVID vaccine compared to single dose flu shots. He’s hopeful that the recent approval of the Moderna bivalent BA.4/5 vaccine, which comes as a single dose syringe, will make administering the bootster more efficient and help reduce time barriers for GPs.

He also recognises that some primary care providers have stopped offering COVID vaccines as part of their services due to financial pressures, and consequently may no longer have access to the COVID vaccines.

Still, he emphasises that GPs can play a key role in protecting aged care residents from COVID-19.

“GPs are going to be giving influenza vaccine to a lot of people in aged care, so there are opportunities for them to combine it with boosting,” Professor Van Buynder says.

“We’re having 20 people die of COVID every day. Many of these are in aged care and they’re not boosted, so this will continue to happen…And its people’s grandparents and loved ones who are dying in aged care from COVID because we haven’t got them protected,” he says.

Credits

Survey conception and design – Dr Ramesh Manocha, Yasmin Clarke, Lynnette Hoffman

Survey analysis and visualisation – Yasmin Clarke

Writing and reporting – Emma Tinning

Editing – Lynnette Hoffman