Pharmacists Are Key to Addressing Flu Vaccine Hesitancy

Influenza is an acute respiratory infection caused by the influenza A and B viruses and is associated with substantial clinical and economic burden. In the 2022-2023 season, the CDC estimated that the incidence was close to pre–COVID-19 pandemic levels with approximately 31 million cases, 14 million physician visits, 360,000 hospitalizations, and 21,000 flu-related deaths.¹

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Annual influenza vaccines, commonly called flu shots, are an important public health measure for preventing influenza. The vaccines are formulated to protect against the 4 influenza viruses that researchers identify will be most common in the upcoming season.² The CDC recommends that everyone 6 months and older receive the flu vaccine. There are several types of flu vaccines licensed for different age groups and recommended for use in the US.^2,3 Vaccination is also very important for individuals at higher risk for complications, including adults older than 65 years, those with chronic health conditions, and individuals who are pregnant.⁴

The effectiveness of influenza vaccines can vary from season to season; protection is also partially dependent on the age and health status of the individual. During years when the flu vaccines match the circulating strains, substantial benefits in terms of preventing flu and complications can be measured.^4,5 In years when the match is not as strong, there is still evidence to support the vaccines, such as fewer hospitalizations. Regardless, the flu vaccine can prevent individuals from getting influenza, reduce severity of infection, and decrease hospitalizations.⁴ Lastly, getting immunized can protect those in close contact with the recipient, highlighting the broader public health benefits.

In 2019, the World Health Organization (WHO) listed vaccine hesitancy as one of the top 10 threats to global health.⁶ The WHO Strategic Advisory Group of Experts on Immunization defines vaccine hesitancy as “delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context-specific, varying across time, place, and vaccines. It is influenced by factors such as complacency, convenience, and confidence.”⁶

The WHO has also estimated that between 2 million and 3 million deaths are prevented due to vaccines each year. A study found that high levels of vaccine hesitancy could result in a mortality rate that is 7.6 times higher than average over a 2-year period in the absence of nonpharmaceutical interventions.⁷

Barriers to Vaccination

Understanding barriers to vaccination is an important measure for improving influenza vaccination coverage. Common deterrents can be divided into 3 categories: complacency, convenience, and confidence.^6,7 Complacency refers to the idea that the perceived risk of getting the flu is low. Convenience includes lack of access, time constraints, and cost. Confidence encompasses issues such as avoidance due to medical reasons or religious beliefs, fear due to public misinformation or lack of information, lack of trust in health care, concern about adverse effects, or other beliefs.^6,8 Demographics also can play a role. For example, younger adults aged 18 to 24 years reported greater hesitancy compared with adults 75 years and older.⁹ Members of racial and ethnic minority populations also have reduced uptake of the influenza vaccine.¹⁰

Some of the more common, specific reasons for vaccine hesitancy include the following:

• “I do not think the flu vaccine is safe.”
• “The flu vaccine may make me sick.”
• “The flu vaccine does not work.”
• “I have never gotten the flu before, so I do not need it.”

Addressing Vaccine Hesitancy

Effective communication is key to dispelling fears, addressing concerns, and promoting acceptance of vaccination.^10,11 For health care professionals, it is important to be knowledgeable about the different barriers to vaccination so that they can be addressed. Additionally, a strong recommendation from a provider has been shown to have an influence on vaccination rates.²

One of the first steps to addressing concerns is to listen to the patient’s fears and hesitations. Based on that, a provider can talk through the specific reasons an individual is wary. Educating on the safety and effectiveness of the vaccine as well as current recommendations is important for uptake. Another area of education is to provide patients with information on how vaccines work and how the immune system responds to build immunity. Lastly, it is important to emphasize the benefits to the individual and the community.

Another strategy, endorsed by the CDC, is to follow the SHARE approach when educating patients¹²:

• Share the reasons a vaccine is right for a patient, including their age, health status, occupation, and other risk factors.
• Highlight positive experiences with the influenza vaccine, as appropriate, and reinforce the benefits.
• Address patient concerns, including adverse effects, safety, and effectiveness, in simple terms.
• Remind patients that flu vaccines can help protect them and their loved ones from serious illness or complications.
• Explain the potential costs associated with getting influenza. This includes health effects for the patient, time lost from work, financial costs, and potentially spreading the flu to loved ones.

A common reason for hesitancy involves fears about the vaccine’s safety. In this example, pharmacists could apply the SHARE technique by saying something like this: “This vaccine can prevent you and your loved ones from getting the flu. Because of this, the CDC recommends individuals get the flu vaccine each year. A flu vaccine cannot cause the flu, and the most common adverse effects are mild, like redness, swelling, soreness, or a low-grade fever. These symptoms should go away within a few days. The flu vaccine can protect you and others from the potential complications and costs of being sick, including missed work, missed school, additional doctor visits, and hospitalizations.”

Pharmacists’ Role

Vaccination is the best way to reduce the chance of illness and complications from influenza, including hospitalization and death. More individuals are turning to pharmacists for their immunizations. For health care providers, it is important to understand a patient’s experiences and needs to properly educate them. Confidence and trust are critical components for vaccine acceptance by patients. Pharmacists are accessible, knowledgeable, and trusted health providers positioned to educate patients and address immunization concerns.

References

1. Disease burden of flu. CDC. Updated February 28, 2024. Accessed April 18, 2024. https://www.cdc.gov/flu/about/burden/index.html

2. What are the benefits of flu vaccination? CDC. Updated September 13, 2022. Accessed April 18, 2024. https://www.cdc.gov/flu/prevent/vaccine-benefits.htm

3. Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices — United States, 2023-24 influenza season. MMWR Morb Mortal Wkly Rep. 2023;72(RR-2):1-25. doi:10.15585/mmwr.rr7202a1

4. Seasonal flu vaccines. CDC. Updated March 12, 2024. Accessed April 18, 2024. https://www.cdc.gov/flu/prevent/flushot.htm

5. Vaccine effectiveness: how well do flu vaccines work? CDC. Updated February 8, 2023. Accessed April 18, 2024. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm

6. Ten threats to global health in 2019. World Health Organization. Accessed April 18, 2024. https://www.who.int/news-room/spotlight/ten-threats-to-globalhealth-in-2019

7. Olivera Mesa D, Hogan AB, Watson OJ, et al. Modelling the impact of vaccine hesitancy in prolonging the need for non-pharmaceutical interventions to control the COVID-19 pandemic. Commun Med (Lond). 2022;2:14. doi:10.1038/s43856-022-00075-x

8. Kumar S, Shah Z, Garfield S. Causes of vaccine hesitancy in adults for the influenza and COVID-19 vaccines: a systematic literature review. Vaccines (Basel). 2022;10(9):1518. doi:10.3390/vaccines10091518

9. Nuwarda RF, Ramzan I, Weekes L, Kayser V. Vaccine hesitancy: contemporary issues and historical background. Vaccines (Basel). 2022;10(10):1595. doi:10.3390/vaccines10101595

10. Robinson R, Nguyen E, Wright M, et al. Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations. Humanit Soc Sci Commun. 2022;9(1):416. doi:10.1057/s41599-022-01439-3

11. Shen SC, Dubey V. Addressing vaccine hesitancy: clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-181.

12. Make a strong flu vaccine recommendation. CDC. August 2020. Accessed April 18, 2024. https://www.cdc.gov/flu/pdf/professionals/vaccination/make-strongflu-vaccination-rec-2020.pdf