Long-term care advocates, worried about vulnerable residents, say plans for COVID-19 booster shots must start now

Five months after the first COVID-19 vaccine doses made their way to the nation's nursing homes, long-term care advocates are sounding the alarm about the need for a plan for a potential booster shot, out of concern that elderly long-term care residents will be the first to see the effects of the coronavirus vaccine wear off.

Although vaccine companies have already begun clinical trials for booster shots, there is still not enough research to know if or when people will need them, experts tell ABC News.

"We don't have quite all the pieces yet," said Dr. Thaddeus Stappenbeck, chair of the Department of Inflammation and Immunity at Cleveland Clinic. "We don't know how long immunity lasts in any individual, because we just haven't had enough experience with this virus."

The challenge, Stappenbeck said, is that the part of the immune system that controls the production of antibodies declines as people get older. As a result, said Stappenbeck, vaccine companies and health officials need to get ahead of the curve before immunity wanes among the older people in nursing facilities who were among the first during the pandemic to be vaccinated.

The CEOs of vaccine manufacturers Pfizer and Moderna said last week that those who were among the first in the U.S. to receive a coronavirus vaccine could need a booster shot by this fall.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said it is unclear when a COVID-19 booster shot will be needed -- but he suspects it will be.

"I don't anticipate that the durability of the vaccine protection is going to be infinite -- it's just not," Fauci said during a Senate Appropriations Subcommittee hearing on Wednesday. "So I imagine we will need, at some time, a booster. What we're figuring out right now is what that interval is going to be."

Some long-term care advocates are concerned that because the need for a booster shot will be based on evidence that the vaccine is no longer as effective to individuals, nursing homes and other long-term care facilities could see a resurgence in cases before a booster shot is approved by the FDA, recommended by the CDC, and then distributed. Before boosters are administered for specific variants or because of waning immunity, scientists will want to make sure the added vaccines are safe and necessary -- and it's not yet clear how prevalent COVID-19 cases will be in the future.

"The shame of this is that when COVID-19 runs rampant in a nursing home, the mortality rate is significant," Dr. Mike Wasserman, the past president of the California Association for Long Term Care Medicine and a member of California's Vaccine Advisory Committee, told ABC News. "Hence, if and when the residents' immunity wanes, we must be on high alert, lest we relive the horrors of the past year."

Long-term care facilities, in which elderly and often sick residents live in congregate settings, are among the most fertile environments for the spread of COVID-19. Since the start of the pandemic, more than 183,000 nursing home residents and staff have died, according to an analysis by the American Association of Retired Persons. Approximately 1.4 million people live in nursing care in the U.S.

"We learned that nursing homes weren't prepared for the pandemic and there is a lot of work to do to improve the quality of care in nursing homes," said Wasserman. "We must start planning now."

For Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, a nonprofit that provides legal assistance for the elderly, the responsibility to prepare for booster shots lies with the facilities themselves.

"Nursing homes should absolutely be planning for booster shots, if those become medically necessary and appropriate," Edelman said. "The COVID-19 pandemic made clear the critical importance of facility leadership anticipating and planning for contingencies."

Some nursing home providers told ABC News that not knowing when residents will need booster shots means that they will need to continue to closely monitor cases and be prepared with the necessary protective equipment.

"We will absolutely continue to monitor vaccine effectiveness and are in contact with CDC, as well as state and local departments of health, regarding cases that occur among vaccinated residents," Dr. Richard Feifer, chief medical officer for Genesis HealthCare, said in a statement. "We agree that nursing homes may be the first place to see immunity wane, simply due to timing related to this population being among the very first to receive the vaccine."

A spokesperson for the American Health Care Association/National Center for Assisted Living, which represents more than 14,000 long-term care facilities, told ABC News that it will continue to call on public health officials to prioritize the long-term care population in monitoring the effectiveness of the vaccines.

In the meantime, said Stappenbeck, it's critical that everyone get vaccinated to protect themselves and those around them.

"We have seen how effective the vaccines are in reducing the level of virus in the community," Stappenbeck said. "If we can keep this trajectory through the summer and keep getting people vaccinated, there will be much less risk for the elderly in long-term care facilities."