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New variant-specific COVID-19 boosters should be available in Minnesota this week, but don't expect them to be wheeled to your neighborhood in a city bus or come with a chance at a college scholarship.

Federal and state funding has dried up for the incentives that helped motivate hesitant recipients and boosted Minnesota's COVID-19 vaccination rate over the past two years. The Minnesota Department of Health has other plans in mind, though, including outreach to people at greatest risk of severe COVID-19 and the opening of more pop-up vaccination sites this month.

"We might not have the incentives and the mobile buses but the state is making a very strong effort to make it geographically available and also really focusing on our underserved populations and communities to make sure they have access to the vaccine," said Jennifer Heath, MDH immunizations program manager.

Federal guidance this week made 3.5 million vaccinated Minnesotans eligible for new bivalent boosters, which increase protection against initial coronavirus strains and add protection against the now dominant BA.5 and BA.4 variants. People 12 and older are encouraged to seek the shots three months after infections or two months after completing the initial vaccine series or receiving older boosters.

An eager first wave of people is likely to snap up initial vaccination appointments — as happened with earlier COVID-19 vaccine expansions in Minnesota. Some people delayed recommended boosters this summer on the promise of the new Moderna and Pfizer versions this fall.

CentraCare's Dr. George Morris said he still gave older boosters this summer to patients with high COVID-19 risks but told others to wait. He encouraged eligible Minnesotans to seek the shots, because COVID-19 still is causing around 40 deaths per week in the state despite the perception that the pandemic has receded.

"It's still deadlier than influenza," said Morris, incident commander for St. Cloud-based CentraCare's COVID-19 response. "It's not as deadly as it was with some of the earlier variants, and it's not as deadly as before we had vaccines ... but it's still no picnic."

Two-thirds of Minnesota's initial allotment of 300,000 bivalent doses will go to pharmacies, which will start vaccinations next week. The rest will go to clinics and public health sites. The health department on Friday alerted providers to stop giving existing vaccines as boosters to people 12 and older and only use them going forward for initial COVID-19 vaccinations or for boosters in children 5 to 11.

The state expects 80,000 doses per week to follow the initial shipment, Heath said: "We think the demand is going to be pretty good in Minnesota. We have a highly motivated 65-plus population."

How popular the shots will be among a second wave of Minnesotans — those with less concern over COVID-19 and some hesitancy over vaccines — is unclear. The state appealed to this largest group of Minnesotans over the past year with celebrity endorsements and incentives such as free fishing licenses and gift cards. Converted city buses brought vaccines to lower-income neighborhoods where people faced transportation barriers or other problems in getting shots.

The effort helped, driving Minnesota to the 19th highest rate of fully vaccinated residents among U.S. states and the second-highest rate of booster recipients, according to the Centers for Disease Control and Prevention. The state reported equity progress as well, with an elevated vaccination rate among historically hesitant Black adults and Asian adults.

The Minnesota Legislature earmarked $190 million this summer to continue COVID-19 response efforts, but that is a reduction compared to earlier levels of federal and state pandemic aide — making incentives less likely.

Morris provided COVID-19 vaccinations at churches, mosques, homeless shelters and other locations with needy populations in central Minnesota. He expects less outreach and more traditional vaccinations through pharmacies and clinics now. CentraCare will use its electronic medical records to identify eligible patients and notify them.

Staying up to date with COVID-19 vaccines will only provide marginal protection against infection, but it will substantially reduce hospitalizations and deaths, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

Funding for incentives is less of a problem than the hard-wired perception that the pandemic is no longer a threat, Osterholm said.

"It's the psychology of the pandemic vs. the epidemiology of the pandemic," he said. "And the psychology is, 'We're done, we're over.' People believe we've moved on, the virus isn't a problem any more."

Osterholm said he is working with health departments in Minnesota and other states to study who has died from COVID-19 this year. Age is a leading factor — 90% of Minnesota's 426 COVID-19 deaths since May 28 have involved seniors — but there are other factors. Understanding those factors could help steer vaccination efforts with limited funding to the neediest people, Osterholm said.

More COVID-19 cases could drive worried people to seek boosters, but it's unclear whether the pandemic will surge again this fall. Thursday's COVID-19 state situation update showed little change — with Minnesota seeing around 1,400 newly diagnosed infections and five COVID-19 deaths per day this summer.

The variants accounted for in the boosters are driving current COVID-19 levels. The Metropolitan Wastewater Treatment Plant in St. Paul found BA.5 and BA.4 made up 99% of the viral material in sewage samples over the past week. The viral load was down 19% from the prior week.

The variants often have knifed through existing immunity levels. Booster recipients made up 34% of publicly reported infections among adults in the first half of 2022, according to state breakthrough data. They made up 50% of lab-confirmed infections since mid-June, when BA.4 and BA.5 became dominant.

COVID-19 death and hospitalization rates are low compared to earlier in the pandemic, and lower still among vaccinated individuals. But the breakthrough infections could compel people to seek boosters, said John Pastor, executive pharmacy leader for Minneapolis-based Fairview Health.

"There is fairly good public awareness that the current booster doesn't have a lot of activity against this strain that is circulating right now," he said.

Another concern: New variants that aren't targeted by the boosters could emerge in the evolving pandemic.

Heath from the state health department said the boosters likely would still offer some benefit — just as the current boosters reduce risks of severe COVID-19 even though they are poorly matched to the dominant variants. There is a long history of mismatched flu vaccines offering protection as well, she noted.

"It is the best tool we have," she said, "to fight a very dangerous disease."