Why are COVID-19 vaccination rates so low right now? It’s complicated.

Remember getting that first COVID-19 vaccine, back in the thick of the pandemic? After so much suffering, there was finally a sense of relief.

That mostly happened, but, of course, COVID-19 is still very much with us. The virus has evolved, and so has our behavior. As we enter what has now become the flu and COVID-19 season, people aren’t lining up to get their shots anymore. One in five Massachusetts residents has gotten a COVID-19 vaccine this season, according to state data, while two in five have gotten their flu shot.

At the beginning of the pandemic, Dr. Nahid Bhadelia, founding director of the Boston University Center on Emerging Infectious Diseases, shed light and provided guidance on how to navigate the early stages on GBH’s In It Together. She returned to GBH’s All Things Considered to discuss with host Arun Rath about how we should be facing COVID-19 today. What follows is a lightly edited transcript of their conversation.

Arun Rath: I’ve got to say, to start off, that I didn’t give your full introduction there. In the years since we last had you on the show — in 2022 and 2023, you were the senior policy advisor for the White House COVID-19 response team. Do you have any big takeaways from having worked at the White House? You know, lessons about how we dealt with the pandemic [that we can] maybe bring going forward?

Dr. Nahid Bhadelia: Yeah. I mean, I’m sure there are books that have been written already, and many won’t be ready for probably decades because we did just live through a very exceptional time that was both devastating and, in some ways, brought us together. And then, in other ways, sort of created divisions, as crises often do.

I think some of the bigger lessons for emerging infectious diseases were really the importance of the connectivity of the infrastructure that we used during COVID — and how important that will remain moving forward.

We increased our capacity to detect new variants. It’s going to be important to keep that kind of laboratory capacity for future threats. We strengthened our international partnerships so that, if there is a new crisis, we can more equitably share new medical countermeasures. I think that’s going to be important. And how we do it more equitably moving forward is going to be important.

You and I spoke when I was in West Africa responding to the Ebola virus disease epidemic. We talked about trust, and so much of those principles were sort of carried out and made obvious during COVID-19 about, you know, building trust with our communities, and that remained kind of consistent, in my experience, through COVID-19.

It was very interesting — during COVID-19, I played multiple roles, right? I was a frontline clinician. I was part of our hospitals’ and our state’s preparedness. But then, you know, I also played a role in being a communicator.

I mean, it’s been equally educational, as for everybody else, in terms of looking at the same problem from different perspectives — and, from those perspectives, realizing how complex it is to respond to these threats beyond just coming up with vaccines, diagnostics and treatments. You need so much more connective tissue.

I think one of the reasons I continue to work in my center, which focuses on exactly this kind of stuff, is that silver bullets are one thing, but, you know, connecting everything and ensuring that implementation happens and equity is something that we start with at the very beginning.

Rath: Looking at where we are now, in the fall of 2024, we’re hearing that with the new COVID shots, vaccination rates are not great. I’m curious: since you’ve worked at all levels, what’s your sense of what’s going on right now?

Bhadelia: Yeah, I think there are a few elements. The good news part of this is that we are seeing, more than any other year before, the hospitalizations and deaths are lower around this time of year compared to prior years. The bad part of this is that COVID-19 has now become a continuous burden. It will continue to be a burden in the foreseeable future because we can’t eradicate it.

Really, the best thing we can do is ensure that we decrease its impact on our society and on our health, and vaccines are a really critical part of that. They continue to provide sort of almost a level-up with the changing variants that are out there. [It’s] very similar to what we do as a strategy for influenza, although COVID is a very different disease — it’s, you know, more severe in some ways and has a lot of more obvious long-term impacts with long COVID, for some folks.

To your point about what’s happening, what we saw coming out of this pandemic is that we’re not even just seeing a decrease in people’s interest in taking the COVID vaccines, but unfortunately, with dis- and misinformation, you’re kind of seeing a drop in other vaccinations.

You’re seeing childhood measles vaccination rates go down. Particularly among pregnant women, the influenza vaccination rates have gone down, which is really worrisome. A little less of a drop in terms of the general population, but also in kids, the influenza vaccination rates have gone down. So it’s not just COVID. I fear that some of it is all this politicization that we saw during COVID-19 around vaccinations and misinformation around vaccinations in general.

One of the things that we did when I was at the White House was we spoke to a bunch of historians about prior plagues and what happens at the end of plagues. Without fail, one of the things that they said was coming out of large plagues, people almost go through an amnesia, right? They don’t want to deal with the trauma of the last few years. I wonder if we’re going through that period where people want to shut out the risk that the continued presence of COVID faces.

And then, the last thing, of course, is that the process through which you access vaccines has changed. It used to be, you know, all these different centers you could go get vaccinations with, and now you have to kind of navigate where to get vaccinations, which — by the way, if you’re looking to get vaccines: vaccines.gov. Find a close vaccination center near you.

For those who are underinsured or uninsured, there are multiple programs in the government, and then your insurance should coverage those shots as well. Here in Massachusetts, of course, everybody’s covered with health insurance.

Rath: I’ll give you a moment to underscore to people or explain why it’s still important to get the COVID shots, even though it may not seem as deadly or as threatening at the moment.

Bhadelia: Arun, I think what’s important to underscore is that vaccinations are an integral part of how we continue to keep COVID from becoming a severe disease that could overwhelm our health systems. Taking vaccinations helps reduce the severity of disease, which means the chances of you ending up in the hospital — particularly if you’re someone who’s high-risk — decreases when you take vaccinations.

And then because, over time — even if you got a shot last year — over time, because the virus is evolving and because your own immune system’s memory might fade, you do need that repeated shot to help you get ready, particularly now as we’re looking at the winter months, the holidays, people gathering, people traveling — it is so, so critical that we shore up our immunity with a shot.

Rath: I think one of the best arguments, for me at least, for getting this shot is that really awful fear of long COVID. Do we have a better sense of long COVID now, at this point, and where things might go with that?

Bhadelia: Yeah, we have a lot more understanding of the range of symptoms that people are presenting with. Unfortunately, I don’t know that we have a rock-solid reason for why long COVID happens in some folks versus not. I mean, there’s a lot of hints. There are multiple studies that have shown — in fact, as you just hinted to — that being vaccinated may reduce your chance of long COVID.

But what hasn’t happened is a hands-on treatment. We have a better understanding of how long — and, in most cases, actually, people feel better after six months. But there’s a whole range, so we don’t yet have one treatment that could cure everybody.

We have supportive care, which is what we’re still doing, but there are ongoing studies right now looking at the use of antivirals. We don’t know yet if any of these things work, but I would definitely say that I would recommend to my patients to take the vaccine because it reduces the severity of disease. And what I’ve seen for most emerging infectious diseases is that if you reduce the severity early on, there’s less damage to your body and, hopefully, less chances of long COVID.