Following regulatory action by the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC) updated its recommendations regarding COVID-19 vaccination, providing more flexibility and additional options for protection among individuals at increased risk for severe disease.1 The CDC’s Advisory Committee on Immunization Practices (ACIP) discussed these changes at length, reinforcing their support for the revised recommendations and their implications.
Key Updates to the CDC’s COVID-19 Vaccine Recommendations
- It is recommended that adults aged 65 years and older and those at risk for severe disease receive an additional updated (bivalent) booster dose of the COVID-19 vaccine. This update encourages health care providers (HCPs) to administer additional vaccine doses to previously ineligible individuals, including those with immunocompromised conditions.
- Monovalent (original) mRNA COVID-19 vaccines are no longer recommended for use in the United States. The CDC advised receipt of an updated (bivalent) mRNA COVID-19 vaccine among individuals aged 6 years and older, regardless of prior completion of primary series vaccination.
- The CDC recommended against the use of additional booster doses of the bivalent COVID-19 vaccine for individuals older than 6.
- The recommendation for younger children to receive multiple vaccine doses remains unchanged, though the precise number of doses varies on the basis age, vaccine type, and type of vaccine previously received.
- For individuals who cannot or choose not to receive COVID-19 mRNA vaccination, alternative options include the (monovalent) NVX-CoV2373 vaccine.
The CDC and ACIP will continue to monitor COVID-19 disease levels and vaccine effectiveness in the coming months. They anticipate further discussion and potential updates to the current recommendations in the fall of 2023, as new data emerges and the situation continues to evolve.
Combating the Spread of Health Misinformation
As recommendations for COVID-19 vaccination continue to evolve, so too has the spread of health misinformation among the general public.
In a randomized controlled trial, researchers explored the effect of exposure to misinformation related to COVID-19 vaccines on vaccination intent and hesitancy.2 A total of 8001 participants were enrolled and surveyed via an online panel. Participants were randomly assigned to 2 different exposure groups. The first group comprised 3000 participants from the United Kingdom (UK) and 3001 from the United States who were exposed to misinformation associated with COVID-19 infection and vaccination. The second group comprised 1000 participants from each country were exposed to factual information on COVID-19 infection and vaccination (controls).
Two motives for vaccination receipt were considered to assess the causal impact of misinformation on vaccination intent. These included the desire to be vaccinated to protect oneself or to protect family, friends, and individuals at risk for severe disease. 3
Participants in the misinformation and control groups were nationally representative samples and similar on the basis of sex, age, and subnational region of residency. All participants indicated their intent to be vaccinated against COVID-19 infection prior to and after exposure to misinformation or factual information.
The researchers found that exposure to misinformation was associated with reductions in the percentage of US participants who expressed a ‘definite’ intention to be vaccinated to protect oneself (-6.4%) as well as to protect others (-6.5%). Similar results were noted among UK participants following exposure to misinformation (-6.2% and -5.7%, respectively). 3
Pre-exposure responses indicating a definite intention to be vaccinated were higher among both US and UK participants if it were toward protection of friends, family, and high-risk groups rather than protection of oneself.
Further analysis showed that more frequent use of social media was not significantly associated reduced vaccination intent following exposure to misinformation. In addition, exposure to images depicting a direct link between vaccination and adverse effects that included scientific imagery or links to scientific journals were associated with decreased vaccination intent.
For further insight into misinformation and methods to combat its spread, we spoke with Erica Johnson, MD. Dr Johnson is Chair of the American Board of Internal Medicine’s (ABIM) Infectious Disease Board and Assistant Professor of Medicine in the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, Maryland.
What steps can health care providers take in preserving the patient-provider relationship in the face of rampant misinformation about COVID-19 vaccines?
Dr Johnson: Patients generally have the most trust in the information provided by their own healthcare provider, and this was shown in research about beliefs related to the COVID-19 vaccine earlier during the pandemic. Continual investment into a strong relationship between a patient and a provider is important. When it comes to countering misinformation about COVID-19 vaccines, this means first asking non-judgmental questions about what people have heard or experienced about COVID-19 vaccines in the past to understand their concerns, and then providing information that addresses these concerns.
How might these steps differ for HCPs counseling patients who are vaccine-hesitant or remain steadfast in “anti-vax” beliefs so as to accept guidance in other areas of medical care?
Dr Johnson: Patients and providers won’t always see eye to eye on every issue. However, every patient deserves to have their concerns heard and understood by their providers, who can then serve as a reliable source of information. As long as providers work to preserve this relationship, they can continue to build trust in the relationship by responding to their patients’ other health needs, even if they hold steadfast views against vaccines. Continuing to build on this relationship provides the necessary foundation for improving patients’ overall trust in credible health information going forward.
What resources are available for HCPS to guide patients toward that might help in differentiating between correct and incorrect or misleading information about their health?
Dr Johnson: There is a resource from the National Institute on Aging (part of the National Institutes of Health) that serves as a helpful guide for navigating health information online and determining whether it is reliable.3
The guide includes some important questions to ask when evaluating any information on a website, including who sponsors the site and what is their intent, who wrote and reviewed the content, and when the content added and/or updated.
The ABIM Foundation is also working to counter misinformation in health care as a way to build trust in the health care system, and one of the ways they are accomplishing this is through a grant program that funds health care teams in implementing or expanding initiatives that do this. Some of the recent awardees have implemented programs that directly educate the public as a way to counter misinformation, such as Factchequeado, a project by Maldita.es, and Chequeado. These programs respond to misinformation claims trending on social media by pushing fact-checking and explanatory articles in Spanish. Another program is Cuidate/Take Care Annapolis, a door-to-door health education outreach program serving Hispanic and Black communities in Annapolis, Maryland and the surrounding area. The program offers culturally and linguistically appropriate education materials, addresses health questions, and connects families to basic resources like food and health care.
1. Centers for Disease Control and Prevention. CDC simplifies COVID-19 vaccine recommendations, allows older adults and immunocompromised adults to get second dose of the updated vaccine. April 19, 2023. Accessed May 18, 2023. https://www.cdc.gov/media/releases/2023/s0419-covid-vaccines.html
2. Loomba S, de Figueiredo A, Piatek SJ, de Graaf K, Larson HJ. Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nat Human Behav. 2021;5(3):337-348. doi:10.1038/s41562-021-01056-1
3. National Institutes of Health. How to find reliable health information online. Accessed May 18, 2023. Updated January 12, 2023. https://www.nia.nih.gov/health/how-find-reliable-health-information-online
This article originally appeared on Infectious Disease Advisor