The CDC's overstatement of covid booster uptake is becoming more obvious each day. The CDC's NIS-ACM phone survey is currently reporting that 23% of US adults have taken the new booster. That is higher than the 21% share of adults who took last fall's bivalent booster; that defies logic. States are reporting less uptake of the current booster relative to last year's booster while Pfizer, Moderna, and BioNTech have all reported sharply lower revenues for covid vaccines in Q4-2023 compared to Q4-2022. Why is the CDC citing NIS-ACM data when its results are not tethered to reality?

https://www.cnbc.com/2024/01/30/pfizer-pfe-q4-earnings-report-2023.html "Pfizer’s Covid vaccine raked in $5.36 billion in revenue for the quarter [Q4-2023], down 53% from the same period last year [Q4-2022]. ... Pfizer CEO Albert Bourla told CNBC around 15% of the U.S. population received an updated Covid vaccine this fall and winter."
[Note: Bourla's figure comports with what state data is showing.]
https://www.cnbc.com/2024/02/22/moderna-mrna-earnings-q4-2023.html "The biotech company [Moderna] booked fourth-quarter sales of $2.81 billion, with revenue from its Covid shot dropping 43% from the same period a year ago. That decline was primarily driven by lower vaccine volume"
https://www.msn.com/en-us/money/markets/biontech-tumbles-as-q4-profit-sales-trail-estimates-on-falling-covid-19-vaccine-demand/ar-BB1keAWj"BioNTech reported fourth-quarter profit and sales that were well below estimates on falling demand for COVID-19 vaccines. ... revenue slumping 65% to 1.48 billion euros ($1.60 billion) [in Q4-2023] over the same period a year ago [Q4-2022]"

It's interesting to see how this thread’s discussions from last winter resolved. In December 2023, the CDC sent out an urgent health advisory to all medical providers, citing heightened covid risks and highlighting a rise in MIS-C cases in particular: “In addition, a recent increase in cases of multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection in the United States has been reported” https://emergency.cdc.gov/han/2023/han00503.asp

Last week, the CDC released an overview of MIS-C cases for 2023. For all of 2023, there are 117 MIS-C cases and 3 deaths. While tragic for the families involved, almost any other childhood illness records a greater number of annual fatalities than that. There are 72 million Americans under the age of 18 and 3 MIS-C fatalities in 2023, or 0.0000042% of all children. And yet, the CDC sent out an urgent health advisory in December to all medical providers, citing MIS-C as one reason. It is hard to understand their logic. https://www.cdc.gov/mmwr/volumes/73/wr/mm7310a2.htm?s_cid=mm7310a2_w

The NIS survey’s overstatement of adult covid vaccine uptake is not a new phenomenon. A similar overstatement occurred with the 2022 bivalent booster; actual CDC vaccine data showed 21% of adults having received the bivalent booster by May 10, 2023 while the NIS-ACM reported 29% uptake at the same point in time – an eight percentage point overstatement. That is nearly identical to the amount that the NIS-ACM appears to be overestimating uptake of the current covid booster as well, relative to state data. Given that this a known and recurrent problem, why is the CDC using NIS-ACM data to brief APIC on booster uptake? It is particularly odd since the CDC has access to a more reliable IQVIA series that is based on actual covid vaccination data and not based on unreliable, self-reported data from phone surveys.

2022-23 Bivalent booster uptake (adults) – actual vs NIS phone survey
https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop18
https://data.cdc.gov/Vaccinations/National-Immunization-Survey-Adult-COVID-Module-NI/akkj-j5ru/data_preview
(The latter NIS database reports bivalent uptake for adults who had received the primary covid vaccine series. Use an 84% estimate for adult uptake of the primary series to derive the overall adult bivalent uptake.)

News story on CDC's NIS phone survey re: covid vaccine uptake:
"Despite laws designed to prevent them, New Jerseyans still get a spate of weird, unwanted phone calls from scammers looking to swindle them out of money and sales reps looking to legitimately make money. But one call that fall outside of those areas is from the Centers for Disease Control and Prevention. The CDC is calling households as part of its National Immunization Survey, in which it asks a series of questions to assess vaccination coverage in children and COVID-19 vaccinations among adults." https://www.msn.com/en-us/health/other/is-that-cdc-phone-call-asking-about-covid-and-other-vaccines-legit-check-your-caller-id/ar-BB1ja1nO

This approach can explain why so few people answer the covid vaccine survey. The CDC acknowledged in December that the covid NIS phone survey response rate is less than 25%. That could mean anything ranging from a 1% to a 24% response rate. Where in that range does the response rate actually fall? The CDC doesn't say. However, they do acknowledge that "Nonresponse and social desirability bias could result in overestimation of coverage." https://www.cdc.gov/mmwr/volumes/72/wr/mm7251a4.htm?s_cid=mm7251a4_w That's an understatement. When compared to state date, the NIS phone survey is significantly overstating covid booster uptake and yet the CDC continues to cite its results, including presenting them at last week’s ACIP meeting without acknowledging the limitations of the data. (The NIS-ACM adult covid survey is a recent add-on to NIS and is self-reported, unlike other NIS vaccine surveys which verify responses with provider vaccine records.)

The CDC's Advisory Cmte on Immunization Practices (ACIP) met last week and recommended people 65+ get a second covid booster; the CDC made the official recommendation shortly thereafter. In its APIC presentation, the CDC pointed to the fact that people 65+ years have higher hospitalization rates for covid. (slide 7), with rates increasing with age within that group (slide 8) and that people 75+ years have sharply higher death rates than younger cohorts. (slide 10) https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-02-28-29/06-COVID-Wallace-508.pdf
In the Q&A, one ACIP member asked if the CDC had considered limiting the second booster recommendation to 75+ years, since that seemed to be where the worst outcomes from covid occur. The CDC said that was one option discussed, however, they opted for the lower 65+years threshold for equity reasons (e.g. there are differences in hospitalization rates by race and ethnicity).

Monthly deaths per 100,000 population in January 2024 (at the winter season's peak) highlight how covid's risks are currently concentrated in the elderly:
https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
Ages 0-4: 0.02, Ages 5-11: 0.01, Ages 12-17: 0.01, Ages 18-29: 0.03, Ages 30-39: 0.11
Ages 40-49 0.26, Ages 50-64: 1.20, Ages 65-74: 4.67, Ages 75+: 29.90