SAN RAFAEL, Calif. - Booster shots, which got off to a rocky start nationally, have yet to take hold among people age 65 and up.
"I think at the end of the day we might have lost the forest for the trees," said Dr. Matt Willis, Marin County Public Health Officer, remarking on how booster demand has lagged behind expectations.
In Marin County, with a robust 92 percent vaccination rate, only about one-quarter of those eligible to add a third shot have done so.
Willis attributes some of that to conflicting messaging about eligibility at the federal level in the beginning.
"And we were telling people to wait their turn and there may be some of that left over in people's thinking," said WIllis. "The fact is now we have ample supply."
By week's end both the FDA and CDC are expected to fully authorize Moderna and Johnson and Johnson boosters, which will widen access and interest.
Until now, only the Pfizer booster was available.
"I'm waiting for Moderna. Yeah, I'm not going to mix," said San Rafael resident Bart Saling, who is over 65 and has lost family members to COVID-19.
"I'm trying to be diligent, trying to be conscientious," continued Saling, frustrated after being turned away in his booster search. "I've asked Kaiser, I've been to the Safeway pharmacy, and they had no clue about availability, one said yes, one said no, one didn't know."
Federal regulators are also poised to approve a mix and match vaccine option, so that the third dose does not have to be the same maker as the first two.
"I think confusion is a large part of it, " said Manuel Mier, who was getting his Pfizer booster at a clinic in San Rafael's Northgate Mall Tuesday afternoon.
"People don't understand it and they don't talk to their doctor, for goodness sakes, talk to your doctor and he'll tell you to get a booster."
The clinic, inside a former Victoria's Secret store, offered COVID boosters and flu shots into the evening.
Aimed at those 65 and older, it attracted some younger people too.
"I know immunity is less efficient over time, so I came right in," said Cody McDonald, 36, who works in IT at a private school and has regular contact with students.
McDonald wonders if people are being lax about boosters because of the high degree of protection Marin County already has.
"I think we did a really good job with that," said McDonald, " but I don't doubt it will turn around and start to go up, it's just because there is such a high vaccinated rate already."
Willis worries that complacency or confusion could cost lives.
People over 65 make up three of four breakthrough cases in Marin County, and nine of 10 COVID deaths overall.
Local hospitals are seeing an uptick among older people, whose immunity fades faster and who suffer more serious illness and outcomes.
"Despite the fact you're vaccinated, if you're an older resident there is still risk, and the good news is that a booster can really mitigate that risk," urged Willis.
"It's important we don't be falsely reassured in our individual lives because the virus is still circulating."
Still, some vaccinated seniors say the urgency they once felt has turned to skepticism.
"I don't see a reason for it, just another step toward tyranny, get the American people used to doing what they're told," said retired realtor Jack Wilkinson, 80.
"I'm not going to participate in boosters, if I die hell I've had a good life, that's okay."
But Willis notes, widened access and acceptance of boosters are coming just in time.
"If you want to celebrate the holidays with family and friends, especially indoors having the protection of the booster will let that happen more safely."