BonnieRonk is a public health matriarch at the Mt. There is a center for senior citizens in this suburb.

When Ms. Ronk tells her peers to pull their masks, they do. She ordered everyone to get the same dose of the Covid vaccine when she received it.

The latest Covid booster, which protects against the Omicron variant, has not been given to Ms. Ronk. She said she wasn't aware of it.

According to data from the Centers for Disease Control and Prevention, only 36 percent of people over the age of 65 have received the bivalent booster shot, which is an updated version of the original vaccine. Seniors said they were unaware of it, couldn't find it or didn't think it was worth anything.

Medical experts worry that there is no plan to update the immunizations of the most vulnerable Americans as the Pandemic barrels into its third winter. Two years ago, when Covid shots were first introduced, the federal government sent teams into thousands of nursing homes and community centers to immunize senior citizens.

Many caregivers and nursing home executives said in interviews that the White House has only offered grants to community organizations to get shots into the arms of older people.

The chief executive of Choice in Aging, who helped bring thousands of the initial vaccines to adult care facilities and housing complexes in the East Bay of California in early 2021.

The Covid epidemic in the United States has changed from a threat against the unvaccinated to one against the old due to the diminishing immunity of senior citizens. People over the age of 70 are four times more likely to be admitted to a hospital with Covid than the rest of the population.

According to the C.D.C., 95 percent of people 65 and older got their initial Covid vaccines, but only one-third have received the updated booster.Credit...Jamie Kelter Davis for The New York Times

Almost all of the Covid deaths were among people over the age of 65.

Two years after you got the shot, your immunity has waned. The people who need to hear that have not, according to the chair of the California Association of Long Term Care Medicine. What we have is a perfect storm because of the combination of Pandemic fatigue and no plan from the government.

  • Boosters: Americans who received updated shots for Covid-19 saw their risk of hospitalization reduced by roughly 50 percent this fall compared with certain groups inoculated with the original vaccines, the Centers for Disease Control and Prevention reported.
  • Vaccine Mandates: After the ferocious battles over Covid shots of the past two years, simmering resistance to general school vaccine mandates has grown significantly.
  • Free at-Home Tests: With cases on the rise, the Biden administration restarted a program that has provided hundreds of millions of tests through the Postal Service.
  • Contagion: Like a zombie in a horror film, the coronavirus can persist in the bodies of infected patients well after death, even spreading to others, according to two startling studies.

The Covid plan for the winter includes $125 million in grants to two community organizations, USAging and The National Council of Aging, for programs to vaccine older Americans, a far less direct approach than when it dispatchedCVS and Walgreens workers into care centers after the first shots. The plan includes letters to governors to encourage more nursing home shots and a television ad campaign that targets seniors.

Mary Wall, the chief of staff of the White House Covid response team, acknowledged that the administration was relying on states to shoulder more of the burden, but said that they were doing what they could with limited resources.

She asked them to host on-site clinics.

She stressed that a more robust financial investment would need cooperation from Congress, which has repeatedly refused President Biden's request for an additional $10 billion in health funding.

She said that this isn't something that we have gotten more money for. We have been trying to look at our resources in a good way.

Bonnie Ronk, a participant at Choice in Aging, urged others to become vaccinated as the pandemic raged. But she has not received the bivalent Covid booster, saying she didn’t even know about it.Credit...Jim Wilson/The New York Times

Widespread vaccination is one of the most valuable pillars of a national response. 650,000 hospitalizations and 300,000 deaths were prevented by Covid shots, according to estimates.

The original vaccine formula is no longer a good match for circulating versions of the virus, which can be dangerous to seniors with weakened immune systems.

The bivalent shot is very effective at preventing serious illness and death, even though it has limited ability. According to C.D.C. data, people 50 and older who received multiple boosters had half the risk of dying from the virus.

The chief medical officer of Avalon Health Care Group said that apathy among some senior citizens reflected a misconception about the vaccine's purpose.

People are wondering if there is any point in having the shot and still having Covid. They don't think about the fact that they lived.

The Centers for Medicare and Medicaid Services added a recording about the vaccine to its 1-800-MEDICARE line as part of the federal push.

A survey by the Kaiser Family Foundation found that 40 percent of people over the age of 65 had not heard anything about the new booster. According to surveys, half of homebound Americans 70 and older don't have a computer, and more than half don't use the internet in the past month.

Choice in Aging’s mascot encouraged masking. “Not all heroes wear capes,” a sign declared, “but they do wear masks.”Credit...Jim Wilson/The New York Times

The Mt. is located in the East Bay county ofContra Costa. The politics of public health have turned many American communities against it. There are still signs in front of the house. A parking lot has been turned into a testing area.

Six feet of distance is encouraged by posters in the walkway. A stuffed pig in a rainbow cape is the center's mascot. A sign says that not all heroes wear capes.

Only 40 percent of participants have gotten the bivalent booster, despite the fact that 100 percent of participants received their initial vaccine. Only one in five residents at Pleasant Hill Post Acute are up to date on their immunizations. Almost all of the residents at Vacaville Convalescent and Rehab were up to date with their vaccinations. There were seven people who tested positive for Covid.

Ms. Ronk is at risk of Covid due to her inflammatory lung condition. As she worked out in the center, she used plastic water bottles as weights and country music played in the background.

Had she known about the booster, she would have been happy to receive it.

A friend of Makedonsky's was hospitalized with the virus and he eagerly sought the initial series of Covid vaccines. The fifth shot was better for Omicron.

The eligibility criteria for the new vaccine was not easy to understand.

She said that they didn't know what to tell the people who asked if they should wait longer. The people who advised me couldn't figure it out.

Ms. Toth, left, with Faina Gutkin, who hasn’t yet gotten the bivalent booster. “I feel fine,” she said. “Why do I need it?”Credit...Jim Wilson/The New York Times

Logistical challenges are also a big one. It's too cold to wait on the curb for the van and there's no one to help seniors get dressed, so taking them to vaccination clinics can be nearly impossible.

In Los Angeles County, where half a million people are homebound, the public health department only sends eight nurses to give in- home vaccinations.

Ms. Toth said that you have to bring the vaccine to the arm to get the vaccine. The last mile is the most difficult one.

Seniors who doubt the vaccine's worth are the most difficult to teach. According to a new survey by the Kaiser Family Foundation, one-third of adults 65 and older who received the original series of Covid vaccines but not the booster said they didn't think they needed it.

According to Dr. Noah Marco, chief medical officer of the senior care nonprofit Los Angeles Jewish Health, the federal government has not enlisted marketing experts to create updated messaging.

Coca-Cola spent billions of dollars convincing us to drink bubbles with sugar and caramel in them. Is there anyone around to help out here? Dr. Marco spoke.

There is a mountain at Mt.. The 51 seniors who haven't received the updated shot are in need of a new pitch. Two friends, Tsilya Tankover, 95, and Faina Gutkin, 77, got their initial vaccines, but they are not willing to give up the booster to fight Omicron.

As she shared her plans to tango dance, Ms. Gutkin pushed around the greens on her plate. I don't know why I need it. I need someone to tell me that.