Anti-vaccine activists protest outside the residence of former New York Governor Andrew Cuomo in Albany, New York, on June 14, 2020. Credit: Shutterstock

It’s an outing my family dreads. Yet, gathering the kids and trekking to the local pharmacy for flu shots is one of our most important autumn rituals. Flu vaccine season is upon us once again. And this year, we will be seeking out the new COVID-19 booster shots as well.

Staying up to date with flu, COVID-19 and other vaccines, based on age and health conditions, shouldn’t be skipped. But a lot of people will do just that.  

Vaccine hesitancy and refusal have become a public health crisis. This was true even before the pandemic when, in 2019, the World Health Organization named vaccine hesitancy a top-ten threat to global health. Since the rollout of COVID-19 shots, momentum has gathered behind the anti-vaccine movement with a forcefulness few would have predicted.

Lisa Doggett

Nearly two years since the introduction of the first coronavirus vaccines, about one in five adults remains unvaccinated against COVID-19. Less than half of adults have received even one booster shot. Vaccination rates have been even lower in kids, especially the youngest. Only 7% of kids aged six months to four years had received even one COVID-19 shot as of September 7.  

With flu shots, vaccine hesitancy has been a problem at long as I can remember. I recall countless conversations with patients — and even staff — who refused flu vaccines for a variety of reasons, including a conviction that they “never get sick” and their misinformed concern that influenza vaccine causes flu. (It doesn’t.)

Flu vaccination rates rarely rise much above 50% nationwide. According to the Centers for Disease Control and Prevention, as of April 9, 2022 (near the end of the most recent flu season), just 55.3% of people had received a flu shot in United States.

Flu immunizations, like COVID-19 vaccines, aren’t perfect. Breakthrough cases occur with variable frequency, depending on how successful manufacturers are at predicting which strains of influenza virus will dominate during a given year. When the match is close, flu vaccines typically reduce the risk of having to go to the doctor for flu by 40% to 60%.   

Skipping vaccines, despite their limitations, is a gamble. Research shows COVID-19 shots dramatically reduce the risk of hospitalization and death. A study published in JAMA Internal Medicine earlier this month showed that hospitalization rates during the omicron wave, January to April 2022, were 10.5 times higher among those who were unvaccinated compared to those who were fully vaccinated and boosted.

Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston, described the politicization of the anti-vaccine movement last month in Nature Review Immunology. Since May of 2021, he wrote, “at least 200,000 unvaccinated Americans have lost their lives potentially needlessly because they refused to have a COVID immunization.”

Similarly, those who forgo flu vaccines are at much higher risk of illness, hospitalization and death. During the 2019-2020 flu season — the last before the pandemic — vaccines prevented an estimated 7.5 million flu infections, 105,000 hospitalizations and 6,300 deaths.

Carryover to Routine Vaccines

There’s growing evidence that vaccine hesitancy has carried over to routine vaccines.

“I do believe the anti-vaccine movement in the U.S. that accelerated around COVID will now spill over to other vaccines,” Hotez told me. “I’m especially worried about routine childhood immunizations both in the U.S. and abroad.”

A study published in Pediatrics last month found that parental concern about vaccine safety has increased during the pandemic. Although about 90% of parents surveyed consistently agreed that vaccines were beneficial, 31.5% of parents in February to March 2022 believed that “childhood vaccines may lead to illness or death,” compared to 18.3% in April 2020.  

“Vaccines and immunization have now become casualties in the ‘culture wars,’” said Jon Temte, an associate dean at the University of Wisconsin School of Medicine and Public Health. He notes the “rise in purposeful disinformation, circulation of misinformation, and a general tendency — in some quarters — to abandon a science-based and evidence-based approach to protection of self and community.”

The timing of this decline in vaccine confidence is particularly bad, given the number of missed vaccines during the pandemic. In July, the WHO and UNICEF released global data showing 25 million infants missed one or more doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2021. An analysis by Avalere estimated that as many as 37.1 million vaccines in U.S. adolescents and adults may have been missed during the first year and a half of the pandemic. It’s no wonder we are starting to see a reemergence of some preventable infectious diseases like polio.

“We worry a lot about highly contagious viruses such as measles and polio, which require relatively high levels of community-wide vaccination to present re-emergence,” Temte said. If a virus appears in an area with low vaccine coverage, he said, the result can be “quite a mess.”  

If Australia’s flu season is indicative, as it often is, of what we are likely to face this winter, we might be in trouble. Especially if the demand for COVID-19 boosters and flu shots is low, we could face a “twindemic” — a surge in COVID-19 and flu cases at the same time that could overwhelm hospitals. Such a situation was averted these last two winters, likely due, in part, to continued social distancing and mask-wearing, as well as COVID-19 vaccines and growing immunity. But it remains a real possibility this year as we ditch the masks and resume pre-pandemic activities.

What Can You Do?

First, protect yourself by getting vaccinated against flu and COVID-19:

Flu vaccines

  • Flu shots are recommended each year for nearly everyone six months and older.
  • Although mild side effects can occur, flu shots do not, cannot, cause the flu.
  • September and October are usually the best months to get vaccinated.
  • New this season: for people 65+, high-dose flu vaccines are recommended over other types. For other adults, no flu vaccine is preferred over another.

COVID-19 vaccines

  • A new COVID-19 booster shot, designed to fight the newer BA.4 and BA.5 lineages of the omicron variant as well as the original SARS-CoV-2 virus, is recommended to everyone 12 and over, at least two months after completing either a primary vaccination series or receiving a booster shot.
  • COVID-19 boosters can be given at the same time as flu and other vaccines.
  • The CDC has a useful COVID calculator to help determine when you should get that booster.

Second, check with your doctor to make sure you’re caught up with other immunizations. If you’re over 50, have you had the new shingles vaccine? Has it been more than 10 years since your last tetanus shot? Are you at risk for monkey pox or unsure if you received polio vaccines as a child? Immunization recommendations, including special considerations for people with complex medical conditions, are available on the CDC website.

Third, encourage others to get vaccinated. These conversations can be difficult, and messaging should be tailored to the individual. Make sure you have accurate, evidence-based information when broaching the topic. Online resources, such as the CDC and the American Academy of Family Physicians’, can be helpful.  

Combating vaccine hesitancy is essential. To do nothing is to invite what Temte called “needless suffering and death.”

Lisa Doggett, senior medical director of HGS AxisPoint Health, is a columnist for Public Health Watch. The views expressed in her column do not necessarily reflect the official policy or position of HGS AxisPoint Health or Public Health Watch.