Vaccination rates for the new COVID-19 booster are dragging in El Paso, a troubling pattern that’s happening across the country.

The updated vaccine, known as the bivalent booster, has been available to people ages 12 and up since early September. It targets BA.4 and BA.5, some of the most dominant and highly contagious strains of the Omicron variant that are circulating.

But the slow uptake concerns El Paso public health authority Dr. Hector Ocaranza, who anticipates an increase in COVID-19 transmission in the next few months.

More than 31,000 people ages 12 and older in El Paso County had gotten the bivalent booster as of Monday – only 4.6% of the eligible population, according to Texas Department of State Health Services data. That’s slightly higher than the state’s bivalent booster vaccination rate of 4%, which is on par with the national average.

Ocaranza said some people are tired of the pandemic and do not want to get another vaccine. Others may not feel it’s an urgent priority because of lower case numbers.

COVID-19 cases have fallen in El Paso after a summer bump, according to the county’s data. But Ocaranza cautioned that El Pasoans should still prepare for a possible winter surge because that is the ideal time for respiratory viruses like COVID-19 and the flu to spread.

While the Omicron subvariants tend to have less severe symptoms than previous variants, the new booster could still offer protection against complications, including long COVID, he said.

Unlike the original coronavirus strain, which spread primarily among adults, the now-dominant strains can infect children as equally as adults, Ocaranza said.

El Paso’s city-run health clinics began offering the updated booster to children aged 5 to 11 on Monday.

Ocaranza strongly recommends that children get the booster, along with parents and other relatives living in the same household.

“It is a family affair,” Ocaranza said. “All should be vaccinated because all should protect each other. The chances that children might develop complications and require hospitalization due to COVID are not as high as the elderly, but they can infect those considered high risk.”

Cristina Rodda, spokesperson for Immunize El Paso, said it’s been challenging to encourage people to get the bivalent booster because many people who’ve already had the original vaccines and the first booster may feel like they’re sufficiently protected.

Immunity against the virus wanes over time, especially as new strains begin circulating. Similarly, this is why the flu shot is updated every year.

Epidemiologists and vaccine experts have criticized the poor public messaging surrounding the rollout of the bivalent booster. A Kaiser Family Foundation survey conducted in September found that half of Americans said they heard “a little” to “nothing at all” about the updated COVID-19 booster. Some respondents said they weren’t sure if they were eligible.

People can get the updated booster at least two months after completing the initial two-dose vaccine series or receiving the original booster dose. People who currently have COVID-19 can get the booster as soon as they feel better and are out of their isolation period, Ocaranza said. The Centers for Disease Control and Prevention recommends that people consider waiting four weeks after getting the monkeypox vaccine before getting the bivalent booster.

Rodda urged children and adults to get the booster now as the holiday season approaches and indoor family gatherings increase.

“The bivalent booster will protect not just children and healthy adults but those who cannot take the booster because of certain medical conditions,” Rodda said.