
Vaccine Hesitancy: COVID-19 to Influenza
Vaccine hesitancy grew more prominently in the wake of COVID-19 and the spread of misinformation. This flu season, seeking out reliable sources of health information will help individuals make the best decisions to protect themselves.
Back in 2019, the World Health Organization (WHO) deemed
While there are a variety of factors that feed into vaccine hesitancy, the fact of the matter is that uncertainties about vaccinations—their safety, efficacy, etc—remain a major public health concern that has affected immunization rates ranging from polio and Ebola to COVID-19 and the flu. As flu season sits right around the corner, post–COVID-19 vaccine hesitancy remains a pertinent issue and a challenge worth exploring to ensure patients remain informed and able to protect their health to the best of their ability.
Elements of COVID-19 Vaccine Hesitancy
A 2023 publication in
Two online forums were conducted, 1 for each group, featuring 30 participants in each. Responses highlighted 5 major factors that contribute to individuals’ reluctance to get the COVID-19 vaccine:
- Safety concerns: participants believed there are a lot of unknowns about the vaccine, undisclosed ingredients, lacking information about the short- or long-term effects, and the belief that it can be directly responsible for one’s death.
- Skepticism about efficacy: reports on surges in cases and new variants led respondents to question how well the vaccine works to prevent infection or transmission, or if vaccination is truly enough to protect public health.
- Risks outweigh the benefits: this perception was accompanied by the belief that infections would be mild, there are other means for protecting oneself (masking), or vaccines are only for the most vulnerable people (the elderly, immunocompromised, etc).
- Mistrust: lacking confidence in medical expertise on the new vaccine, lacking trust in government spokespeople as credible and reliable messengers, and limited trust for public health authorities, like the CDC, whose advice and guidelines changed often.
- How outcomes vary by race/ethnicity: participants reported differing views on whether COVID-19 affects people differently due to ethnicity and, if so, whether that disparity is due to structural factors.
Other analyses on this phenomenon cite similar concerns from health care workers and the public at large, with hesitancies largely stemming from lacking or misguided information, distrust in medical or governmental institutions, preferences for physiological immunity, and a desire for personal autonomy and freedom of choice.4,5
Post–COVID-19 Influenza Vaccine Hesitancy
“The roll-out of COVID-19 vaccines has highlighted the need to comprehensively understand adult vaccine hesitancy and its manifestation within the population,” wrote Victoria Zhang and colleagues in their 2023 article published in the
The CDC reports that flu vaccine coverage throughout the US has continually declined in the post–COVID-19 era, a stark contrast from prepandemic trends that showed flu coverage on the rise year after year.7 In the case of children, the CDC harkens to a 2023 study that discovered over 30% of children in the US have a parent who is hesitant about the flu vaccine; a 2024 pool revealed the proportion of parents who believed “it is extremely important for parents to have their children vaccinated” decreased by 18% since 2019. Similarly to COVID-19 vaccine reluctance, parents have reported concerns about the efficacy and safety of flu vaccines, disbelief that they or their child will get sick, and access or cost issues that prevented vaccination in some cases (these incidents were far less common).
For more information about flu vaccination coverage and its variability across different demographics and states over the years, please visit the
Vaccine Hesitancy Threatens Public Health
“Hesitancy around vaccination is now causing people to refuse or delay vaccination even before vaccines become available. Before the highly anticipated rollout of the COVID vaccines—described as the largest vaccination campaign in history—many didn’t plan to get a COVID vaccine,” wrote
Amidst the varying degrees of vaccine hesitancy, receiving the flu shot ahead of each flu season remains the surest way to prevent and mitigate the severity of infection. If the literature on vaccine hesitancy conveys any lesson, it is that seeking out reliable, evidence-based sources of health information should remain a priority for patients and health workers alike.
For more information on how to spot health misinformation, follow this
References
1. Akbar R. Ten threats to global health in 2019. WHO. Accessed October 18, 2024.
2. Leonardelli M, Mele F, Marrone M, et al. The effects of the COVID-19 pandemic on vaccination hesitancy: a viewpoint. Vaccines (Basel). 2023;11(7):1191. doi:10.3390/vaccines11071191
3. Scales D, Gorman S, Windham S, et al. 'They've all endorsed it…but I'm just not there:' a qualitative exploration of COVID-19 vaccine hesitancy reported by Black and Latinx individuals. BMJ Open. 2023;13(7):e072619. doi:10.1136/bmjopen-2023-072619
4. Fieselmann J, Annac K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany. BMC Public Health. 2022;22(1):846. doi:10.1186/s12889-022-13265-y
5. Four reasons for COVID-19 vaccine hesitancy among health care workers, and ways to counter them. AAFP. April 27, 2021. Accessed October 21, 2024.
6. Zhang V, Zhu P, Wagner AL. Spillover of vaccine hesitancy into adult COVID-19 and influenza: the role of race, religion, and political affiliation in the United States. Int J Environ Res Public Health. 2023;20(4):3376. doi:10.3390/ijerph20043376
7. Flu vaccination coverage, United States, 2023-24 influenza season. CDC. September 20, 2024. Accessed October 21, 2024.
8. How vaccine hesitancy affects vaccination rates and public health. Flu.com. Updated July 1, 2024. Accessed October 21, 2024.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.