Booster drop-off alarms health officials as NB.1.8.1 and LP.8.1 variants gain ground

Global health agencies are raising alarm over a sustained drop in COVID-19 booster vaccination rates worldwide, despite the continued emergence of highly transmissible variants such as NB.1.8.1 and LP.8.1. The World Health Organization confirmed this week that global booster coverage has stalled below 50%, with some regions registering booster uptake rates as low as 20% amid growing public disengagement and shifting government policies.

According to updated WHO epidemiological tracking data, more than 72% of the world population has received a primary vaccine dose since 2021. However, booster compliance—defined as receiving at least one additional dose beyond the initial series—has declined steadily since late 2023. This is occurring even as countries like the United States and India report rising detections of the NB.1.8.1 subvariant, which the WHO recently classified as a Variant Under Monitoring.

How Have Vaccination Trends Shifted Since the Pandemic Emergency Ended?

In the two years since the global COVID-19 public health emergency was lifted, vaccination patterns have shifted dramatically. While early pandemic phases saw mass compliance driven by urgency, mandates, and public health infrastructure, the 2025 landscape reflects widespread pandemic fatigue and declining risk perception.

In the United States, the Centers for Disease Control and Prevention reported in its April 2025 data release that fewer than 21% of adults had received the updated 2024–25 season booster targeting JN.1 sublineages. Comparable figures were cited by health authorities in the United Kingdom and Australia, with booster rates in both countries dropping to their lowest levels since mid-2021. Canada’s Public Health Agency also reported below-target uptake in all provinces, particularly among adults under 50.

In emerging economies, the situation is more severe. Booster coverage across sub-Saharan Africa remains under 10%, while in parts of Southeast Asia and Latin America, logistical barriers continue to inhibit access to updated formulations.

What Are the Key Drivers Behind Global Booster Fatigue?

Public health experts and behavioral scientists have identified multiple converging causes behind the global decline in COVID-19 booster uptake.

One of the most cited factors is risk fatigue. With overall hospitalization and mortality rates much lower than in earlier waves, especially among previously vaccinated individuals, the perceived need for a booster has diminished. This is compounded by the absence of mandates or employer incentives, which had previously driven compliance.

Another critical factor is the persistence of misinformation. Despite major platform moderation efforts, vaccine skepticism remains prevalent on social media. Disinformation campaigns have adapted to target booster formulations specifically, suggesting without evidence that additional doses offer “diminishing returns” or carry elevated risk—claims repeatedly debunked by the WHO and national agencies.

Accessibility also remains a problem, particularly in remote or underserved regions. In India, where NB.1.8.1 has been detected in Tamil Nadu and Maharashtra, rural healthcare providers report lower patient engagement due to appointment shortages and vaccine supply gaps. In many African nations, second-dose campaigns never reached full scale, let alone third or fourth booster programs.

What Are the Variant Risks Driving This Urgency?

NB.1.8.1, first reported in China and now identified in the United States, India, and Singapore, has quickly risen to global attention due to its high transmission potential and mutations that moderately reduce antibody neutralization. It descends from the JN.1 lineage and shares properties with LP.8.1, the dominant U.S. strain as of May 2025.

The WHO has emphasized that while current vaccines—including upcoming JN.1/LP.8.1 boosters—continue to offer strong protection against severe illness, declining uptake could create immunity gaps. These, in turn, increase the risk of wider transmission, more hospitalizations among the unvaccinated or elderly, and the potential evolution of even more evasive variants.

How Are Countries Responding to the Drop in Booster Uptake?

In the United States, the Food and Drug Administration has approved a new LP.8.1-targeted booster for fall 2025, manufactured by Pfizer, Moderna, and Novavax. The CDC is launching a targeted campaign aimed at seniors, healthcare workers, and high-risk individuals, but has stopped short of recommending universal boosting for healthy adults under 50. Instead, it is calling for an evidence-based, risk-stratified approach.

In the United Kingdom, the National Health Service has consolidated its COVID-19 booster effort into its winter flu and RSV vaccination program. Officials there have highlighted reduced turnout for spring boosters and are trialing new communications strategies to build trust with younger adults and ethnic minority groups.

In India, the Ministry of Health and Family Welfare is evaluating data on variant transmission and considering a renewed urban vaccination push ahead of the July monsoon season, when respiratory infections typically rise. However, officials cited budget constraints as a limiting factor for nationwide outreach.

Australia and Canada are expanding access to boosters through general practitioners and pharmacies, while also bundling COVID-19 shots with annual influenza campaigns.

Is Booster Messaging Still Resonating With the Public?

Public health analysts note that current messaging strategies may be too muted or inconsistent to change behavior. Unlike during the pandemic’s peak, when daily briefings and emergency alerts dominated the information environment, 2025’s communications are often fragmented or deprioritized. In several countries, public health agency budgets have been slashed, limiting both staffing and media buy capacity.

Furthermore, scientific messaging about variants and immunity often struggles to cut through to non-expert audiences. As a result, many individuals, especially those who experienced only mild illness in past infections, are opting to skip additional doses altogether. A Kaiser Family Foundation survey released in April found that 44% of U.S. adults did not plan to receive a COVID-19 booster in 2025 unless “required” or “strongly advised” by a healthcare provider.

What Are Experts Recommending to Reverse the Trend?

WHO and CDC officials are urging countries to reinvest in community-based vaccination infrastructure and targeted outreach. Suggestions include bundling COVID-19 boosters with routine immunizations, improving mobile vaccination efforts in remote areas, and ramping up digital education campaigns.

Additionally, some public health researchers are advocating for rethinking the framing of boosters—not as an emergency response, but as part of a long-term respiratory illness management strategy, similar to annual flu shots.

Ultimately, experts believe reversing the trend will require both policy recalibration and renewed public health trust-building. Without it, COVID-19 could remain a persistent, if manageable, source of global health disruption.