Physician and CEO, Chicago Allergy Center, and board director at American Lung Association

Juanita Mora, MD

 vaccination rates remain low even as the virus settles into a predictable twice-a-year pattern. In this 

 interview, allergist Juanita Mora, MD, unpacks the American Lung Association's COVID-19 prevention campaign, including who qualifies for a booster now, an underused antiviral prophylaxis option, and the specialist's role in closing persistent vaccination gaps.

ALA: Why COVID-19 Boosters Matter Now, With Juanita Mora, MD

Our vaccination rates have been low throughout the country for COVID-19 vaccinations, and I think out of sight is out of mind for a lot of people. Many people [feel] we're done with the pandemic, so we don't have to worry about COVID 19 anymore. What I tell patients though is COVID 19 has become like the flu; it's coming back every season. It's here to stay.

COVID-19 vaccination rates among adults remain low even as the virus has settled into a predictable, twice-yearly seasonal pattern. According to CDC data cited in the American Lung Association's recently launched prevention campaign, only 18% of adults received a COVID-19 vaccine during the 2025–26 respiratory virus season — dropping to 31% among adults aged 65–74 and 37% among those 75 and older, the groups at highest risk for severe disease and hospitalization.1 Antiviral treatment is similarly underutilized: use remains below 15% among eligible patients, and only 16% receive treatment within the recommended 5-day window from symptom onset.1

Mora, of Chicago Allergy Center, and a medical expert spokesperson for the American Lung Association, spoke with 

 about the campaign and what specialist clinicians can do to close those gaps in their own practices.

COVID-19 antiviral use remains under 15%, and adult vaccination rates were only ~18% this past season

High-risk groups (age 65+, chronic lung/heart/kidney disease, diabetes, immunocompromised) should consider a summer booster, since antibody protection lasts about 6 months

Antiviral prophylactic treatment is available for high-risk adults and immunocompromised children 12 and older

Specialists can help close vaccination gaps by reviewing COVID-19, flu, and RSV status at every visit

Patients can check eligibility for the updated COVID-19 vaccine at lung.org

COVID-19 has evolved from a pandemic threat into a predictable endemic respiratory virus — one that now circulates in 2 distinct seasonal waves per year, much like influenza and RSV. That shift has direct implications for how clinicians should counsel patients about booster timing. Vaccine-induced antibody protection against severe disease typically wanes over approximately 6 months, meaning the twice-yearly pattern of circulation aligns closely with the protection window from a single vaccine dose. For high-risk patients — those aged 65 and older, and those with chronic lung disease (including asthma, COPD, interstitial lung disease, cystic fibrosis, and pulmonary hypertension), heart disease, diabetes, chronic kidney disease, or immunocompromising conditions — a summer booster is a clinically reasonable consideration even if they received the fall/winter vaccine. Adults 65 and older are now formally recommended to receive 2 doses of the 2025–26 COVID-19 vaccine at least 6 months apart.1

Beyond vaccination, the ALA campaign highlights 2 prophylactic options that remain largely unknown to patients and underutilized even among clinicians. Ensitrelvir is an oral antiviral approved for post-exposure prophylaxis in individuals aged 12 and older who have had close contact with a COVID-19-positive person. It is taken over 5 days, with 3 tablets on day 1 and 1 tablet on days 2 through 5. Pemivibart is an intravenous monoclonal antibody approved for pre-exposure prophylaxis in moderately or severely immunocompromised patients for whom vaccination is likely to be insufficient. Both options represent an underappreciated layer of protection for high-risk populations who may not mount adequate vaccine responses or who face particularly high consequences from breakthrough infection.1

For specialists — pulmonologists, allergists, rheumatologists, cardiologists, and others managing patients with the chronic conditions that confer high COVID-19 risk — Mora emphasized that every clinical encounter represents an opportunity to address vaccination status comprehensively. Reviewing COVID-19, flu, and RSV vaccination status at each visit, correcting misconceptions about whether COVID-19 vaccines are still needed, and directing patients to the ALA's eligibility checker at lung.org are all actionable steps that do not require adding time to an already compressed appointment.

Editor’s note: Mora has no relevant disclosures to report.

American Lung Association. American Lung Association highlights therapeutic options available to prevent and treat COVID-19 [press release]. July 30, 2026. 

https://www.prnewswire.com/news-releases/american-lung-association-highlights-therapeutic-options-available-to-prevent-and-treat-covid-19-302835975.html

American Lung Association. Prevent COVID-19. 

https://www.lung.org/lung-health-diseases/lung-disease-lookup/covid-19/prevention

Articles

COVID-19 vaccine uptake remains poor despite a now-endemic, twice-yearly circulation pattern resembling influenza/RSV. Only 18% of adults received a 2025–26 season dose, with modestly higher coverage in older high-risk groups; antiviral treatment is also underused and often delayed beyond five days. Antibody-mediated protection wanes around six months, supporting consideration of a summer booster for high-risk patients; adults ≥65 are recommended two 2025–26 doses six months apart. Additional prophylaxis includes ensitrelvir post-exposure and pemivibart pre-exposure for select immunocompromised patients.

Allergist Juanita Mora, MD, breaks down the ALA's COVID-19 prevention campaign — who needs a booster now, and how specialists can close the gap.

ALA State of the Air 2026: Clinician Action

The American Lung Association (ALA)'s 2026 State of the Air report documents a continued and in some measures worsening picture of air quality across the United States. The 27th edition of the annual assessment finds that 44% of Americans — 152.3 million people — live in counties that received failing grades for unhealthy ozone or fine particulate matter (PM2.5) levels, with nearly 4 million more people breathing unhealthy ozone compared with the prior year's report.¹ Failing ozone grades now cover 219 counties across 36 states, the broadest distribution since 2016.¹ The report attributes the trend in part to the compounding influence of climate change on ozone formation conditions, as well as to wildfire smoke events with expanding geographic footprints.¹

Children represent both the most exposed and the most physiologically vulnerable population in these findings. Some 33.5 million children — 46% of those under 18 — live in counties that failed at least one air quality measure, and 7.3 million live in communities failing all 3.¹ Developing lungs are uniquely susceptible to the effects of chronic pollution: children breathe proportionally more air for their body size than adults, spend more time outdoors, and face cumulative developmental consequences from exposure during periods of active lung growth. Hispanic and Latino children bear a disproportionate share of this burden, with the report finding they are approximately 3 times more likely than white children to live in a community that fails all three pollutant grades.¹ Bakersfield, California — which carries both chronic ozone and particle pollution burdens — ranked as the metropolitan area with the worst year-round particle pollution for the seventh consecutive year.¹

 spoke with Juanita Mora, MD, allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center, and Vin Gupta, MD, MPA, pulmonologist and Managing Director of Health Innovation at Manatt, also of Virginia Mason Medical Center and MS NOW news, about what the 2026 findings mean for patients and for the field. Mora, a medical expert for the ALA, focused on the clinical stakes for children with developing lungs and called on clinicians to engage legislators on maintaining EPA funding and clean air protections. Gupta, an ALA board member, framed the report's value primarily as a public education opportunity, while expressing skepticism that the current administration's regulatory posture will shift in response to it — and arguing that the more effective path forward lies in communicating about air quality in non-divisive, fact-centered terms capable of reaching a broader public over time.

“How do we smartly animate people? I think a lot less of it is stoking division and creating conflict, and it's more about persuasion through just informing… I do think there's a majority of this country, when given facts in a calm, rational, apolitical way, will be able to at least receive that message,” Gupta said.

The full 2026 State of the Air report is available at lung.org/SOTA.

American Lung Association. State of the Air 2026. Published April 21, 2026. 

Videos

Drs. Vin Gupta and Juanita Mora discuss the recent report and how it should inform clinician actions.

ALA State of the Air: Nearly Half of American Children Breathe Poor Air

Nearly half of all children in the United States — 33.5 million, or 46% of those under 18 — live in counties that received a failing grade for at least one measure of air pollution in the 

 (ALA)'s 27th annual State of the Air 2026 report, which evaluates 3 years of EPA-verified monitoring data (2022–2024) across ozone, short-term particle pollution, and long-term particle pollution. Overall, 152.3 million Americans — 44% of the population — live in communities earning a failing grade for at least one pollutant. 

Juanita Mora, MD, an allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center in Chicago, Illinois, and board director of the ALA, described the findings as both a public health indictment and a call to clinical action.

The report grades counties on 3 measures: ground-level ozone (smog), short-term particle pollution spikes, and long-term average particle pollution. Ozone forms when vehicle exhaust, industrial emissions, and chemical compounds react with sunlight; the report found that approximately 4 million more people are now breathing unhealthy ozone levels compared with last year's report — a worsening trend driven in part by warming temperatures that enhance ozone formation. 

Nearly 33 million people live in counties earning failing grades across all 3 measures. Bakersfield, California, ranked as the metropolitan area with the worst year-round particle pollution for the 7th consecutive year; Los Angeles retained its position as the most ozone-polluted city in the nation, a ranking it has held in 26 of the report's 27 years.

Mora described the health consequences of both pollutant categories in clinical terms she communicates directly to patients and families. Ozone causes acute airway inflammation triggering wheezing and cough in children and exacerbating asthma and COPD. Long-term exposure to fine particulate matter has systemic reach that extends well beyond the lung: particles enter the bloodstream and have been associated in the epidemiologic literature with increased cardiovascular risk including heart attack and stroke, dementia and Alzheimer's disease with repeated cerebrovascular exposure, and, in pregnant women, elevated risk of preterm delivery. 

The ALA report frames wildfire smoke as a growing contributor to both ozone and particle pollution burden, with wildfire events in Canada, California, and the eastern United States increasingly affected air quality across broad geographic regions and populations not historically considered at elevated pollution-related risk.

Racial and socioeconomic disparities in air pollution exposure are a central feature of the 2026 report's findings and a theme Mora returned to throughout her comments. According to the report, a person of color is more than 2.4 times as likely as a white individual to live in a community with failing grades across all 3 pollution measures, and Hispanic individuals are more than 3 times as likely. Communities in Texas, California, and across the South carry disproportionate combined ozone and particle pollution burdens. 

Mora called on clinicians to use the report's county-level data — available at 

 — as a tool for contextualizing patient respiratory symptoms and for counseling families about modifiable risk, including indoor air quality, secondhand smoke exposure, and activity timing on high-pollution days. On the policy dimension, Mora expressed concern that current EPA regulatory rollbacks — including changes to economic analyses used to set pollution standards — threaten to undermine the Clean Air Act's multi-decade legacy of reducing air pollution–attributable mortality and morbidity. Children, with developing lungs, are the most biologically vulnerable to the long-term consequences of chronic pollution exposure and continued investment in EPA enforcement and ambient air quality standards are a pediatric health imperative.

“These kids do not have clean air to breathe. Let's do more. We can do more to clean air up,” Mora said. “… Let’s teach our families to keep safe and talk to our legislators about keeping the EPA environmental protection agency funding as is so that way we can continue to make these kids healthy adults.”

American Lung Association. State of the Air 2026. 27th ed. Published April 21, 2026. Accessed May 7, 2026. 

Juanita Mora, MD, discusses The American Lung Association's 2026 report, elucidating a disproportionate burden on people of color.

Novel Therapies, New Guidelines Reshape Asthma Management, With Juanita Mora, MD

 treatment landscape has been fundamentally transformed by the expansion of biologic therapy options, and the decisions clinicians now face in selecting among them have grown considerably more nuanced — a challenge Juanita Mora, MD, an allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center in Chicago, Illinois, frames as a welcome one in a conversation with 

Six FDA-approved biologics are currently available for severe asthma — omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab — with the December 2025 approval of depemokimab (Exdensur, GSK) adding a seventh. Each agent targets a distinct point in the type 2 inflammatory cascade: omalizumab blocks IgE; mepolizumab, reslizumab, and benralizumab target the IL-5 pathway; dupilumab inhibits IL-4 and IL-13 signaling via the IL-4 receptor α chain; and tezepelumab blocks thymic stromal lymphopoietin (TSLP), an upstream alarmin with the broadest applicability across asthma phenotypes. Real-world utilization has shifted markedly in recent years toward dupilumab and tezepelumab, reflecting their broader phenotypic applicability and the growing recognition that TSLP blockade can benefit patients irrespective of eosinophil levels.

Without head-to-head comparative trial data — a persistent gap in the evidence base — Mora relies on a phenotyping-first framework when selecting among agents. Skin testing and specific IgE panels inform identification of allergic asthma phenotypes, where omalizumab remains the established option. Blood eosinophil counts guide selection among anti-IL-5 pathway and anti-TSLP agents. She highlighted the clinical utility of matching biologic choice to coexisting comorbidities: dupilumab, mepolizumab, and omalizumab all carry FDA approval for chronic rhinosinusitis with nasal polyps in addition to asthma, making them preferable single-agent options for patients with that common comorbidity, and dupilumab additionally covers eosinophilic esophagitis — a consideration that often arises in her patient population.

Depemokimab represents a conceptual addition to the severe asthma biologic toolkit beyond just its mechanism. As the first and only biologic for asthma approved with a twice-yearly dosing schedule, it is the first anti-IL-5 antibody engineered with an extended half-life to enable semi-annual administration rather than the every-4-week or every-8-week regimens used by existing agents in the class. In the phase 3 SWIFT-1 and SWIFT-2 trials, depemokimab reduced the annualized asthma exacerbation rate by 58% (rate ratio, 0.42; 95% CI, 0.30–0.59; 

 <.001) and 48% (rate ratio, 0.52; 95% CI, 0.36–0.73; 

 <.001), respectively, versus placebo in patients with severe eosinophilic asthma on standard of care. Mora emphasized the access and adherence implications of twice-yearly dosing in particular: for patients with limited transportation, inflexible work schedules, or infrequent health system contact, reducing the injection burden to 2 visits per year may be the practical difference between consistent biologic exposure and treatment dropout.

On inhaler-based management, Mora noted that the field has also undergone a meaningful shift at the step-down end of the treatment spectrum with the broad adoption of SMART (Single Maintenance and Reliever Therapy). Updated Global Initiative for Asthma (GINA) guidelines now recommend against short-acting β₂-agonist (SABA) monotherapy as rescue in asthma, favoring instead a combination inhaled corticosteroid/formoterol regimen that addresses both bronchoconstriction and the underlying airway inflammation driving the acute episode. 

“I think the more comfortable we get with this new rescue therapy, using SMART therapy as rescue, we will have a lot more transitioning of our primary care doctors also writing it and getting more patients under better control,” Mora said.

Mora has no relevant disclosures to report.

Jackson DJ, Busby J, Pfeffer PE, et al. Twice-yearly depemokimab in severe asthma with an eosinophilic phenotype. 

. 2024;391:2337-2349. doi:10.1056/NEJMoa2406673

GlaxoSmithKline. FDA approves Exdensur (depemokimab-ulaa) for the treatment of severe asthma with an eosinophilic phenotype. Press release. December 16, 2025. 

https://www.gsk.com/en-gb/media/press-releases/exdensur-depemokimab-approved-by-us-fda-for-the-treatment-of-severe-asthma/

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2025 update. 

 The severe asthma treatment landscape has entered a period of rapid evolution — with patient access and adherence increasingly driving clinical decisions.