The U.S. has come a long way from two years ago when COVID-19 vaccines first became available and people were cutting the line to get their shots.

Now, many have shrugged off the need to get updated boosters. Only 15% of people eligible for the COVID booster shot that targets the omicron variant have gotten it — a rate that is even lower than the perennially disappointing rates for flu vaccine uptake. Vaccine fatigue seems to have spread to other shots, too — including those to prevent measles and polio — according to a recent poll by the Kaiser Family Foundation.

"That is very concerning," says Claire Hannan, who helps immunization officials from all 50 states run vaccination programs as the executive director of the Association of Immunization Managers.

As the country trudges towards the end of its third pandemic year, NPR talked to experts on immunization, health communication and public health, to learn how we should all be thinking about COVID vaccines now.

1. Realize that vaccines are still a good tool

Two years ago, a lot of questions about the new COVID vaccines had no answers, but now, we have answers. Do we need more than two shots? Yep. Will protection be long lasting? Nope, antibodies wane over time. Is reinfection after a bout of COVID and a full course of vaccination possible? Yep, it's become more likely than when the pandemic first began, as the virus continues to evolve and produce variants that can partially get around the vaccine.

Those answers have been disappointing and may have dented demand for the latest round of COVID boosters. But the CDC advises that adults and most children get the booster. And vaccination remains an especially important tool, experts say, to protect those most at risk of a severe COVID infection — people over 65 and those with underlying health conditions.

"It's just really critical that [people] — especially those at high risk — understand the value of getting vaccinated and making sure they stay up to date on their boosters," Hannan says.

Vaccines, good treatments and the fact that so many people have been infected, all help keep people out of the hospital. But every week in America, more than 2,500 people continue to die of COVID.

"Personally, I am not a fan of needless suffering and death," says Dr. Kelly Moore, CEO of Immunize.org, which does vaccination education and advocacy. A recent analysis from the Commonwealth Fund found that the vaccination campaign prevented more than 18 million hospitalizations and 3 million deaths in the U.S., and saved the country more than $1 trillion.

"We've got an effective tool that can prevent a great deal of suffering, hospitalization and deaths, and we should still be using it," Moore says.

2. Target vaccines to where they count most

One answer for dealing with vaccine fatigue is to target efforts to the people who are at highest risk, including seniors. Only 35% of people over age 65 have gotten an updated booster. Three quarters of COVID deaths in the U.S. are among people in this age group.

Hannan of the Association of Immunization Managers says when vaccines first came out, there was a huge effort to go into nursing homes and get everyone vaccinated. That doesn't work anymore, she says, not just because of low demand and lack of infrastructure, but because everybody is on a different schedule in terms of when they need a booster. "You go there one day and you might vaccinate a handful of people," she says.

Now, the public health approach is changing. For instance, Hannan says, "the CDC is doing an initiative to put a number of single-dose vials in long-term care facilities that have the right storage equipment." That way, even if one resident of the facility is ready for a booster, staff at the nursing home could get a single dose out of the pharmacy-grade fridge and vaccinate that person on the spot.

With the winter holidays upon us and people gathering with loved ones, Sandra Lindsay says to think about Grandma. Lindsay was the first person in the U.S. to receive a COVID-19 vaccine in December 2020 as a critical care nurse, and now she's vice president of public health advocacy at Northwell Health in New York. "We all have a responsibility to our loved ones," she says. "If you are sick, stay home. Grandma — take her to get vaccinated as a Christmas gift."

3. Listen more carefully to concerns

Part of the reason people are no longer jumping at the chance to get vaccinated is that they don't think COVID-19 is a big risk anymore, says Cynthia Baur, who directs the Horowitz Center for Health Literacy at the University of Maryland.

"People have to believe they need it and they have to believe that whatever's going to happen is going to be bad enough that they should take that action," she says. At this point, they don't — restaurants are open, people are going out and gathering and shopping, and vaccination is no longer a requirement to get back to normal life like it once was in many places.

Baur has worked with community health workers who are out in Maryland pounding the pavement, talking to people about vaccination, and it's slow going. "I don't think that we or anybody else doing this work has found any particular message or fact or phrase that is kind of really changing hearts and minds," Baur says.

The mass vaccination system that popped up during the pandemic isn't how most adults get vaccinated, she points out. So as those systems close down, it may be time to put the focus back on health care providers, like doctors, who can have a relationship with patients and really hear their concerns and answer their questions.

"Providers are still the number one source for vaccine recommendations," she says. "If providers are recommending vaccines, at least it's opening the door to a conversation and the likelihood that somebody might think a little bit more carefully about it."

4. Make vaccinations less scary

There are a lot of ways to combat vaccine hesitancy, including focusing on misinformation or politicization or trust in public health. "I decided to take an angle that's a little bit different, which is to look at how to improve the vaccination experience," says Moore of Immunize.org.

About a quarter of adults are afraid of needles, she points out. "How many of those people who are refusing to come in for vaccination are saying, I don't want it, I don't have time or I don't think it works? For how many of them is that really just an excuse?"

She says the Autism Society for America has been pioneering strategies to help families and kids with autism get vaccinated, since it can be especially stressful and upsetting for people with autism. They have some simple, low-cost ideas like putting on headphones, listening to your favorite music, or using a little plastic "shot blocker" to make the shot hurt less.

I recently tried a variation of this when I took my 7-year-old daughter, Noa, to get her bivalent booster. (Fear of needles among kids is even higher than among adults — more like 2 in 3.) I bought an over-the-counter lidocaine patch (marketed for back pain) at the drugstore and cut it to fit her bicep. I stuck it on her upper arm about 30 minutes before we left. Then I drew an outline on her skin around the patch, so the immunizer could give her the shot in that area. Noa said the shot didn't hurt — she was thrilled and proud that she hadn't cried. And she asked if we could use it for every shot from now on.