NC's definition of up-to-date vaccination includes boosters

The guide concludes with a glossary of terms, with a modification written in red. It defines "Up-to-date on COVID-19 vaccines" as "Status of a person who has received all recommended doses of a COVID-19 vaccines, including additional doses and boosters."

The latest state data shows that fewer than half of the North Carolinians eligible for a booster dose have gotten one, and interest, as measured by those getting vaccinations,has been waning since the beginning of the new year.

North Carolina Coronavirus dashboard - Maps, charts and data

The pace of booster doses going into arms is the lowest it has been in months – since the US Centers for Disease Control and Prevention first recommended boosters for seniors and other at-risk adults in September, according to a CNN analysis of CDC data. The agency expanded its recommendation for booster doses in November to include all adults.

Overall, about 65% of North Carolinians have had at least one vaccine shot, with that percentage soaring to 96% in those age 65 and up. Sixty-one percent of the population has two doses of Pfizer or Moderna vaccines or a single dose of the Johnson & Johnson vaccine.

The slow uptake of coronavirus vaccine booster doses has been "a bit of a mystery" to Andy Pekosz, professor at the Johns Hopkins Bloomberg School of Public Health, he said, especially since boosters appear to improve protection against emerging variants such as Omicron.

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"When Omicron came through, it became very clear that a booster was a tremendous help in terms of keeping people out of the hospital, and you would think that people who have done the first set of vaccines would be the ones who would be more than willing to line up for a third one that would get them much better immunity," Pekosz told CNN.

"It seems like people consider it something extra or something optional, as opposed to, it really is almost critical when it comes to Omicron infections," he said.

Even if the majority of a community is fully vaccinated with two doses, that would not offer nearly as much protection as if the majority were boosted with three doses, Dr. Saju Mathew, an Atlanta-based primary care physician, told CNN, adding that he is very concerned about how few people in the United States are boosted right now.

Because of this, as more states examine their vaccination rates while deciding to roll back mask mandates and other Covid-19 mitigation measures, Mathew said, they should take into consideration how much of their population is boosted against Covid-19.

"If I was governor, I think that would make a huge difference," he said. "The metrics would be more accurate."