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Uptake of new variant-specific COVID-19 booster shots has been slow in Minnesota, despite continued evidence that the vaccine protects against severe outcomes from the infectious disease.

Less than 240,000 doses of the bivalent boosters have been administered in Minnesota this month after they were recommended for fully vaccinated people 12 and older. While 3.7 million Minnesotans in that age range have received some COVID-19 vaccine, only 3.9% are considered up to date, according to the state's weekly pandemic update on Thursday.

Up to date means they have completed the initial series or received an older booster within the past two months, or they have received the new booster more recently.

Gov. Tim Walz said he was concerned about the lack of progress on Wednesday, when he received his influenza shot at a public event and encouraged Minnesotans to seek the recommended vaccinations.

"It is more clear, now than ever," Walz said. "The way to stay out of the hospital and certainly to avoid fatality in this [COVID-19 pandemic] is to get the booster."

COVID-19 levels in Minnesota are flat or declining, showing none of the increases yet that occurred after the start of the K-12 school year in the past two years. New coronavirus infections have remained below 1,000 per day in Minnesota in September, down from about 1,400 per day in early August. The infection numbers only show positive results at clinics and testing centers. At-home test results are not publicly reported.

Pandemic pressure has remained low all summer on Minnesota hospitals, which on Tuesday had 416 inpatient COVID-19 cases, including 41 in intensive care. On the same date in 2021, the severe delta variant had pushed Minnesota to 768 COVID-19 hospitalizations, including 196 patients requiring intensive care.

Thursday's pandemic update still showed a disparity by vaccination status in severe outcomes. Unvaccinated Minnesotans make up 24% of the state's adult population, but 37% of the 2,740 COVID-19 patients admitted to hospitals since July.

Seniors remain at greatest risk from COVID-19, making up 88% of the 160 deaths since July. Unvaccinated Minnesotans make up 7% of the senior population, but 21% of recent COVID-19 deaths.

Minnesota ranks 24th among states in the percent of its population that has received any COVID-19 vaccine, according to the Centers for Disease Control and Prevention, but second among states in the share of eligible residents who have received at least one booster.

The lack of interest in the latest boosters — formulated to increase protection against the omicron variants of the coronavirus — stems from a mix of reasons. Some people aren't as motivated, because the rate of severe COVID-19 illness has declined. Others are waiting the recommended three months after coronavirus infections to receive the boosters, or for signs of greater COVID-19 prevalence this fall.

Concerns about vaccine safety and side effects remain, but confusion over eligibility appears to be a notable problem.

Brenda Mulry and her husband are eligible because they received a second COVID-19 booster in April, more than two months ago. (The new booster is recommended regardless of the number of prior boosters.) But they were rebuffed after an hourlong drive from St. Paul to their appointment at the Allina Health clinic in Buffalo, where a clinician said they weren't eligible.

While the drive was pleasant and they received flu shots, Mulry and her husband left frustrated. "They should be happy when somebody is trying to be proactive," she said.

Genetic sequencing of a sampling of positive coronavirus specimens since mid-August has found that almost 99% involved the omicron BA.4 or BA.5 variants — both of which are targeted by the new Moderna and Pfizer bivalent boosters.

While an omicron BA.2.75 variant has been closely tracked, it has yet to produce any uptick in infections. Sequencing found a single infection involving that variant last week. State leaders said the new boosters would enhance protection against that mutation as well.

Globally, there is fresh concern about other variants outside the omicron lineage that could present new threats and evade immunity from recent infections or vaccinations, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Prevention. "These variants have levels of immune evasion we've never seen before."