New Covid Shots Were Approved. But Who Will Get Them?

The Food and Drug Administration on Thursday approved the latest slate of annual Covid vaccines, clearing the way for Americans 6 months and older to receive updated shots in the midst of a prolonged summer surge of the virus.

Pfizer and Moderna, the vaccine makers, are expected to begin shipping vaccines to pharmacies and doctors’ offices within days. The shots are tailored to a version of the virus that took off this spring before giving way to closely related variants, all of which appear to spread faster.

For the frailest Americans, who have been dying of Covid in growing numbers this summer, the shots could offer a reprieve from a virus that disproportionately endangers those whose vaccinations are out of date.

But the approval is occurring months after wily new variants began driving up infections, a matter of consternation for some scientists who have urged faster turnarounds for updated shots.

In recent weeks, people have been hospitalized with Covid at a rate nearly twice as high as during the same time last summer. By late July, Covid was killing roughly 600 Americans each week, a substantial drop from this winter but double the number from this spring.

The availability of boosters has not translated into actual vaccinations. By spring, only one in five adults had received last year’s updated Covid vaccine. Even older Americans, who are at far greater risk of being severely sickened, largely spurned the shots, with only 40 percent of people 75 and older taking last year’s vaccine.

The prospects for this year’s rollout remain dim. Older people were still dubious about the need for additional doses, doctors said. The Biden administration has been scrambling to find money to vaccinate uninsured Americans. And public health departments remained short on funding for the proactive vaccination campaigns that drove uptake earlier in the pandemic, officials said.

“Health departments got extra money during the pandemic to send teams to people who were so disabled they had to stay at home,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “That money’s gone.”

Public health experts have been especially worried by modest booster uptake in nursing homes. Problems were evident a year ago, when many nursing homes waited months after approval to begin inoculations. Today, less than one-third of nursing home residents are considered up-to-date on Covid vaccinations, according to the Centers for Disease Control and Prevention.

Long-term care experts have pointed to a number of problems complicating vaccinations in nursing homes, including inadequate staff levels and federal recommendations that older people receive two Covid shots a year — a frequency at odds with the usual annual flu shot schedule.

But despite the increasingly disproportionate risks facing older Americans, not all nursing homes put on major vaccination drives, even when local health departments offer to help. In many cases, that left relatives in charge of finding vaccines for residents.

“It’s not just whether they care,” Dr. Ben Weston, the chief health policy adviser for Milwaukee County, said of nursing homes. “It’s what their resources are.”

Jodi Eyigor, the director of nursing home quality and policy at LeadingAge, an association of nonprofit nursing homes, appealed to White House officials last month for a more organized distribution campaign. Nursing homes, Ms. Eyigor wrote, were dealing with fatigue over repeated Covid vaccinations and distrust in federal guidance.

“Residents, families and staff become confused about how many vaccinations are required to stay up to date, and many are reluctant to continually inject vaccine product into their bodies, particularly more than once per year,” she wrote.

While most Americans have acquired immunity against the virus from repeated infections or vaccinations, or both, older and immunocompromised Americans struggle to mount immune responses, leaving them exposed.

Last year’s Covid vaccines offered moderate protection against getting infected, but those defenses waned over time, studies have suggested. The shots provide a stronger guard against severe disease. Across all ages, a vast majority of Americans who were hospitalized for Covid did not receive the shots offered last fall, according to data presented in June to a C.D.C. advisory committee.

Adding to the vaccine delivery difficulties, a Biden administration program meant to guarantee shots to uninsured Americans or people whose health plans might not cover the inoculations expires this month.

Earlier Covid vaccines were purchased in bulk by the federal government and administered for free. But the vaccines last year shifted to the commercial market, leaving the uninsured without a clear option. Federal officials have estimated that about one million people interested in getting shots may not have insurance that covers them.

Dr. Demetre Daskalakis, director of the C.D.C.’s National Center for Immunization and Respiratory Diseases, said the agency had found $62 million in unused vaccine contract funding that would be funneled to state health departments next month for purchasing the shots, or enough for up to roughly a million doses.

But money for programs to bring shots to community centers, nursing homes and even people’s front doors has dried up, experts have said.

“We don’t have the community push or diffusion of vaccines the way we once did,” said Dr. Zeke McKinney, a physician in Minneapolis, who had organized vaccinations at a local barbershop until funding disappeared. “It’s mostly up to everyone on their own to figure it out.”

In Bismarck, N.D., public health officials have persisted in offering drive-through mass vaccination events, a hit with people who work odd hours or do not want to visit a pharmacy and with assisted-living facilities that bring residents in buses.

But even those events have gotten trickier in recent years, said Renae Moch, the public health director there, taxing an already busy staff.

The city, which once received vaccines for free from the federal government, now buys them from manufacturers. As a result, its small team of health officials have to record people’s insurance information and then ask insurers to reimburse the city for the shots.