Vaccine fatigue is leaving the US vulnerable to the flu


Flu season intensified early in the United States this year, but vaccination rates are far from keeping pace.

Flu shots are always a hard sell for Americans. The US Department of Health and Human Services has set a target vaccination rate of 70% in the Healthy People Plan 2030. But less than half the population has received their annual flu shot every year for at least the last decade.

Public health leaders say it’s been especially hard to get people to get a flu shot this year because they’re getting tired of hearing about shots.

What was once an annual push for people to get vaccinated at the start of each flu season has become a near-constant message about vaccines, with an announcement about the availability or eligibility of the new Covid-19 vaccine seeming come every two months.

“There is a lot of vaccine fatigue out there. Asking people this year to get not just a vaccine, but to get the annual flu shot, as well as the Covid booster, has really been what I’ve called a tough sell,” said Dr. William Schaffner , medical director of the National Foundation for Infectious Diseases and a professor at Vanderbilt University Medical Center.

“There’s the old saying, ‘familiarity breeds contempt.’ Well, maybe that’s a bit strong, but the familiarity seems to breed a certain nonchalance,” she said.

Millions less flu vaccine doses have been distributed this season compared to this point in past seasons, data shows from the US Centers for Disease Control and Prevention. Only 26% of adults had gotten a flu shot as of the end of October, a deadline that medical experts have long recommended for optimal protection throughout the season. About 43% of children had received a flu shot by the end of November.

The first year of the Covid-19 pandemic, the 2020-21 flu season, was a notable outlier, experts say.

Flu vaccination rates have spiked higher than usual amid fears of a “twin demic,” with the coronavirus and flu circulating together.

“The public health message, and I think we did that very effectively, was that you can’t protect yourself against Covid right now, but you can definitely take the flu off the table,” said LJ Tan, director of strategy for the Immunization Action Coalition and co-chair of the National Adult and Influenza Immunization Summit, nonprofit organizations dedicated to improving vaccination coverage in the US.

“We were coming out of lockdowns and people wanted to be active instead of passive. So when we told people at the time, ‘You don’t have a covid vaccine, but you can certainly take the flu off the table by getting a flu shot,’ people said, ‘Yes, I will. “

But that double threat did not materialize. Flu seasons have been unusually mild for the past two years, and people have let their guard down, experts say.

“I’ve almost had to remind people about the flu,” Schaffner said. “We have had two very short and very low years of influenza. And of course everyone has been worried about covid, and they want to put covid behind them and get on with their lives.”

Now, the continuous messages about a triple threat of viruses (flu, Covid and RSV) are not affecting in the same way. The urgency is real, as hospitals across the country expand capacity to record levels, but it’s not spurring people to act.

“It strikes me that people have gotten used to bad flu seasons for the elderly. So this is pretty much the same thing, with a few other viruses around. There is a sense that this is what we are going to expect and this is what we have to live with,” said Dr. Jesse Hackell, a pediatrician and co-author of a clinical report. on how to counter vaccine doubts in 2016.

“What we are missing is the fact that children and children’s hospitals are suffering in ways we have never seen before.”

Numerous studies have found that flu and covid-19 vaccines significantly reduce the risk of serious outcomes for those who become infected, including hospitalization and death, reducing the burden on the healthcare workforce.

Exacerbating general vaccine fatigue is decision fatigue, Hackell said.

People must choose whether to get a flu shot each year and, more recently, they must make decisions about covid-19 vaccine updates. Each new decision opens the door for misinformation or disinformation to creep in in the process.

“If it was a vaccine like measles, where it’s really effective and doesn’t recur, it could be different,” Hackell said. “But we have to compare it to the covid and flu vaccines, where the efficacy is less than spectacular, and when there is a lot of controversy, I think that gets out of hand.”

Health professionals are also exhausted, experts say.

“I think there is fatigue, moral damage, call it exhaustion also on the part of the suppliers. We’re not pushing it as hard,” said Hackell, who is also chair of the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine. “It becomes very difficult to keep having these unproductive conversations over and over again. And there are so many more respiratory diseases now that I don’t know if it’s time to have these long discussions when your office is full of sick children.”

Uptake of the updated Covid-19 booster has also been lackluster: Fewer than 1 in 7 eligible people have received one since it was authorized in the fall, according to CDC data.

Ongoing messaging from the White House urges Americans to get their updated Covid-19 booster shot and flu shot at the same time.

But despite the convenience of receiving both vaccines at the same time, there is evidence that linking the two is not the best way to increase coverage rates for either.

There have always been questions about vaccination, but it has become very politicized during the Covid-19 pandemic.

“We still have a lot of people in this country who don’t believe in the flu or the covid vaccine that we haven’t been able to win over,” said Lori Tremmel Freeman, executive director of the National Association of County and City Health. Officials. “The flu is serious in our country, it kills many people, hospitalizes many people and attacks young and old. Therefore, we should pay more attention to it.”

But even when interest in booster shots was greatest, it was rare for people to receive both shots simultaneously.

Self-reports from the CDC’s V-safe monitoring system show that fewer than 1 in 10 people who received a Covid-19 booster between September 2021 and May 2022 got a flu shot at the same time.

“We give our children multiple vaccines at the same time, but we typically haven’t given adults,” said Tan, a former CDC vaccine advisory committee liaison for the American Medical Association.

Trying to persuade people to do something new can add to the hesitancy that has already become so pervasive and make them less likely to jump in. Instead, it seems much more likely that people will accept the offer of a flu shot at an appointment they scheduled to receive a covid-19 booster, or vice versa.

“The direct interaction with a health care provider provides some confidence, in this case the pharmacist or the doctor or the clinician, who can reassure the patient that it’s safe,” Tan said. “In that one-on-one conversation between the provider and the patient, the patient ends up converting and receiving the vaccine. It is a testament to our remarkable healthcare providers as well.”

The message might finally be pasted. At Walgreens locations, co-administration of the flu and covid-19 vaccine is 70% higher this year than it was last year, according to data shared with CNN.

Tan says there have been signs of improvement in recent weeks.

Pharmacies are becoming significantly more popular than doctors’ offices among adults as they choose where to get a flu shot, and CDC data shows that the number of flu shots administered at pharmacies this season is actually outpacing last year. It’s a sign that there are more opportunities to reach a broader group of healthy adults who are less likely to have a primary care provider, Tan said.

“At least we have the rebound now, as opposed to this continued decline that we were seeing four weeks ago,” he said. “But while I sound positive, I want to remind all of us to be better than we are today.”

And while fighting vaccine fatigue is a challenge, it’s not an excuse to let vaccination rates lapse.

“In many circumstances, we can overcome access fatigue,” Tan said.

In public health, “we need to start looking outside the box to figure out what messages need to change so we can think outside the box and motivate people to seek the flu vaccine again. Right now, it’s too much of a convenience vaccine.”

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