In May this year, the Chief Medical Officer and the Minister for Aged Care raised the alarm that fewer than half of all aged care residents had received a COVID-19 booster within the previous six months. 

Their statements were made in the context of rising numbers of COVID cases in residential aged care. 

More recently, government sources have named and shamed the facilities that have particularly low COVID booster rates among their residents. 

While this urgent problem is the responsibility of aged care providers, it should be a reminder to all of us to stay up to date on our COVID boosters. 

This is especially the case because older age increases our risk of experiencing serious illness from COVID-19, and needing hospitalisation. 

As a reminder, the Department of Health advises: 

• All people aged 70 or older are at a high risk. 
• People aged 50 or older are at high risk if they have at least two risk factors, such as neurological diseases, chronic lung disease (including moderate or severe asthma), heart disease, obesity, diabetes, or kidney disease. If you are Aboriginal or Torres Strait Islander and aged 30 or older, one of these risk factors is sufficient to put you at high risk. 
• Living in a rural or remote area with limited healthcare access, being immunocompromised, or having a complex and significant disability all contribute to high risk too. 

In February 2024, the 12th National Seniors Social Survey (NSSS-12) asked more than 4,500 older Australians if they continue to get COVID booster shots when they become available. 

A clear majority 78% said they did.  

However, there was a striking age pattern, with the proportion increasing from 67% of people aged 50-64 through to 88% of people aged 85 or older. 

Just over 950 people said they did not continue to get the booster shots, and almost all answered a follow up question asking why not. 

The question offered set reasons for not keeping up with booster shots and people could select as many as they liked or provide another reason. Around 20% of respondents selected the “other” option to write a comment, but most of their comments fit one of the set answer options. 

• Worry about side effects of the booster was a concern for more than a third of non-boosters. An additional fifth of non-boosters said they had previously had a reaction to a COVID shot. In comments, some people described their concerns, which ranged from developing heart issues after a jab, to witnessing other people experiencing bad side effects, through to the notion that vaccines are poisons to the immune system. A few people wrote that their spouse or another person they know died or almost died after receiving a COVID vaccine or booster. 

• More than a quarter of non-boosters selected the option that they didn’t think COVID boosters were necessary anymore. Comments on this topic ranged from the feeling that three or four jabs is enough through to the idea that COVID is no longer serious as an illness. 

Around the same proportion selected “I don’t agree with it” as their reason for not continuing with boosters. Comments related to this sentiment included anger at government mandates, suspicions about vaccine ingredients or their development process, and the view that vaccines and boosters are not effective because a vaccinated person can still get COVID. 

These concerns are understandable, and we explore them in the following sections. 

However, the evidence suggests getting regular COVID boosters is still a safer option than going without them.

Side effects from COVID boosters are not unusual and often unpleasant. The most recent COVID-19 vaccine safety report from the Therapeutic Goods Association (TGA) indicates that two out of every 1,000 vaccine or booster shots resulted in what population health experts call “adverse events”, most of which were soreness at the injection site, headache, muscle pain, fever, and chills. 

Inflammation of the heart (myocarditis) or heart membrane (pericarditis) are also known side effects and should be treated seriously if they occur. However, they are much less common than other adverse events, affecting 1-4 per 100,000 people, depending on the vaccine brand. The Comirnaty (Pfizer) vaccine is associated with the lowest incidence of these compared to other vaccine brands (1-2 per 100,000 people). 

If we consider there have been more than 71 million COVID vaccine doses delivered in Australia to date, the incidence of these issues equates to fewer than 3,000 cases of myocarditis or pericarditis caused by a COVID vaccine since their inception. Only one of these was fatal (discussed in the next section). 

This is certainly not insignificant, and you should consult your healthcare provider if you are concerned.  

But remember that COVID itself also causes cardiovascular problems including heart attacks, arrhythmias, and strokes, which often require hospital treatment and have caused countless COVID deaths. It’s a mistake to think the vaccines are the only culprit. 

Indeed, the vaccines can provide some cardiovascular protection. Studies of hundreds of thousands of people have showed that COVID vaccination reduces the risk of these cardiovascular complications, including heart problems caused by COVID itself. 

In terms of deaths, the TGA acknowledges that 14 people in Australia have died because of a COVID vaccination since the first vaccine became available. 

Thirteen of these were associated with the AstraZeneca vaccine, which became notorious in 2021 for causing blood clots in some vaccinated people. It is no longer available in Australia and was withdrawn globally in 2024. 

The fourteenth person to die in Australia from a COVID vaccination was a woman in her 20s who received a Spikevax (Moderna) booster in 2022. An investigation into her death found she died from myocarditis likely related to the vaccine. 

While every one of these deaths was a tragedy, the likelihood of a COVID vaccine causing death is extremely low. 

Excluding the 13 AstraZeneca deaths and almost 14 million AstraZeneca doses, it is one tragic death out of more than 57 million doses of COVID-19 vaccine administered in Australia. 

However, at the population level, it compares to more than 17,000 Australians whose deaths were directly caused by the COVID-19 virus between March 2020 and January 2024, and another 4,000 or more whose deaths had COVID-19 as a contributing factor. 

In this sense, COVID is much more dangerous than the vaccine or booster. 

Deaths from COVID-19 continue, with the latest figures showing 694 people died due to the disease in January-February 2024. For that reason, we must continue to be vigilant. 

Aside from potential side effects, another reason NSSS-12 respondents gave for not keeping up with COVID boosters was the feeling they were no longer necessary. 

Again, it is understandable that people would feel this way because the illness seems less severe these days for most people who get it. 

This is no coincidence because the severity of the COVID illness is vastly reduced by vaccines. 

A study of people aged 50+ in NSW at the height of the pandemic showed that “unvaccinated individuals had a 7.7-fold greater mortality rate than those who were fully vaccinated… which rose to 11.2-fold in those who had received a booster dose”. 

In other words, unvaccinated people were many times more likely to die from COVID than those who kept up with the booster program. 

Studies from around the world have consistently shown that vaccination provides excellent protection against hospitalisation or death from COVID-19. People who routinely have the recommended boosters are much less likely to experience severe illness if they contract COVID, and less likely to die from it. 

Hence, the generally high rates of COVID vaccination in Australia are a big part of the reason why most people who get COVID now experience it as a bad flu. 

However, the protection provided by vaccines drops off with time, hence the need for regular boosters to keep up the protection. 

This is no different from getting a tetanus booster if you step on a rusty nail and it’s been over 10 years since your last one. COVID boosters are just needed more often than tetanus boosters. 

Another argument made by some non-boosters in the NSSS-12 survey was the notion that COVID vaccines are ineffective because a vaccinated person can still get COVID. Such cases are called “breakthrough infections” because they break through the vaccine barrier. 

This is once more an understandable view. But it is based on a narrow view of how vaccines work. 

We have vaccines for many different diseases these days and they each work slightly differently. Some can protect against infection altogether. Others lower the risk of infection, or they mitigate the disease’s severity. 

The ability of a vaccine to eliminate a disease also varies with the cause of disease, and COVID is a fast-evolving virus. 

The fact that breakthrough COVID infections are possible does not mean the vaccines are ineffective. They are effective at reducing our likelihood of severe disease and death.