Working Through Vaccine Fatigue— Influenza and Its Potential for Widespread Morbidity and Mortality Haven’t Gone Away

Do we really need a reminder? Nearly 4 years have passed since the last “normal” influenza season. Recent influenza seasons were associated with low rates of illness, hospitalization, and death,¹ likely due to COVID-19 mitigation measures such as social distancing and the use of masks. However, preliminary estimates from the 2022 to 2023 season suggest that the burden of influenza is returning to a prepandemic level.² Interestingly, the marked increase in influenza vaccination rates that one might expect was not observed alongside COVID-19 vaccination efforts.³ Although more than 90% of adults have received at least 1 COVID-19 vaccination over the past 3 years, influenza vaccination rates have held steady over the same time period (hovering around 50%), with nary a percentage-point difference over the past 4 years.^3,4

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Therefore, we still have work to do to prevent the burden of influenza, which remains a threat to life, wellness, and economic productivity. During the 2019 to 2020 influenza season (which paralleled the early phase of the COVID-19 pandemic), approximately 36 million people developed influenza infection; there were 16 million associated health care provider visits, 390,000 hospitalizations, and 25,000 deaths.¹ Without vaccination efforts, there would have been an estimated 7 million more illnesses, approximately 3.5 million more health care provider visits, 100,000 more hospitalizations, and an additional 7000 deaths.⁵

We Could Do Better

Data suggest that current efforts prevent approximately one-third to one-fourth of the potential morbidity and mortality associated with influenza in any given season. Two changes are needed for better influenza prevention: (1) manufacturers should better anticipate and match strains for the season and produce improved vaccines; and (2) health care providers and public health officials need to figure out means to increase vaccination rates. If manufacturers can improve vaccine effectiveness to 70% or better, dramatic reductions in influenza morbidity and mortality would likely be achieved.

Comingling of InfluInflua and COVID-19 Mitigation is Likely, at Least This Fall

Recently, the Vaccines and Related Biological Products Advisory Committee of the FDA recommended removing the original COVID-19 strain and focusing on 1 of 3 variants for this fall’s COVID-19 vaccine composition.⁶ The anticipated rollout of an updated COVID-19 vaccination this September will likely coincide with influenza distribution and availability. However, questions remain regarding the recommended populations who should receive COVID-19 vaccination, with immunocompromised and elderly patients being the most likely candidates. Among scientists, debate continues on COVID-19 topics from development to deployment, especially about whether COVID-19 vaccination should become a yearly matching and mass-immunization exercise like influenza vaccination.

How to Address Staff Fatigue? Flip the Script.

Regardless, this fall should be a busy time for pharmacies for “seasonal” vaccination efforts. Respiratory-focused vaccinations tend to push pharmacy staff and workflow beyond their normal bounds. Still, vaccination and testing efforts (not to be forgotten) have carried many pharmacies’ care delivery impact and economic sustainability over the past few years. Staff may be better motivated and prepared if team leads help staff understand that immunizations are no longer an added burden to prescription workflow to generate more prescriptions. Rather, the opposite is likely to be true: for a period of time each year, the principal driver of the pharmacy’s care delivery and economic success is vaccinations, not prescription fills. It has become prudent to make immunizations the main stage event and no longer the emerging-artists stage.

How to Address Patient Fatigue and the Unengaged? Provide Care and Convenience

Many of our neighbors, patients, and patrons are growing tired of hearing about vaccinations. Yet pharmacy staff are some of the most influential voices in communities, particularly with underserved and low-health-literacy populations. Providing a trusted and care-centered approach to offering and administering vaccinations with unrivaled convenience is now community pharmacies’ calling card.

Pharmacy is Now the "Go-To" Health Care Provider for Vaccinations

Approximately 90% of adult vaccinations are currently administered at the pharmacy.⁷ It has become the “go-to” place for vaccine care delivery and public health efforts related to adult immunizations, with teenagers and younger children emerging as important populations. As the influenza season nears, it is important to be educated on the latest data, efforts, and strategies to employ a successful fall immunization effort with your patients.

About the Author

Troy Trygstad , PharmD, PhD, MBA, is vice president of Pharmacy and Provider Partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

References

1. Past seasons estimated influenza disease burden. CDC. Updated October 18, 2022. Accessed June 21, 2023. https//www.cdc.gov/flu/about/burden/past-seasons.html
2. 2022-2023 U.S. flu season: preliminary in-season burden estimates. CDC. Updated May 26, 2023. Accessed June 21, 2023. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
3. Flu vaccination coverage, United States, 2021-22 influenza season. CDC. Updated October 18, 2022. Accessed June 21, 2023. https://www.cdc.gov/flu/fluvaxview/coverage-2022estimates.htm#figure4
4. COVID data tracker. COVID-19 vaccinations in the United States. CDC. May 11, 2023. Accessed June 21, 2023. https://covid.cdc.gov/covid-data-tracker/#vaccination-states-jurisdictions
5. Estimated influenza illnesses, medical visits, and hospitalizations prevented by vaccination in the United States – 2019-2020 influenza season. CDC. Updated December 20, 2022. Accessed June 19, 2023. https://www.cdc.gov/flu/about/burden-averted/2019-2020.htm#:~:text=CDC%20estimates%20that%20during%20the,died%20with%20influenza%20(7)
6. FDA briefing document. Vaccines and Related Biological Products Advisory Committee Meeting. Selection of strain(s) to be included in the periodic updated COVID-19 vaccines for the 2023-2024 vaccination campaign. FDA. June 15, 2023. Accessed June 21, 2023. https://www.fda.gov/media/169378/download
7. Trends in vaccine administration in the United States. IQVIA. January 13, 2023. Accessed June 19, 2023. https://www.iqvia.com/insights/the-iqvia-institute/reports/trends-in-vaccine-administration-in-the-united-states