Oct. 21, 2024 -- Ron Saritzky, 70, wasted no time as he walked into the Kaiser Permanente Medical Center in Panorama City, CA, near Los Angeles. With a bright-blue table and “Be protected” banner greeting him, he headed straight for his flu and updated COVID vaccines.
Minutes later, a nurse had injected both into his left arm, just as he’d requested. “It’s super great,” Saritzky said, appreciating the convenience for walk-ins like him.
Outside, at another vaccination table near the weekly farmer’s market, another nurse offered Rafael Orellana, 49, a flu shot. He sat right down. “We need it,” he said, making it clear he never skips his flu vaccine.
Despite their enthusiasm, Saritzky and Orellana are in the minority. Surveys find that vaccine fatigue is rampant for both flu and COVID, with many delaying or skipping the shots. The latest trends bear that out: Only about 22% of adults have received a flu shot so far this year, while 12% have gotten the updated COVID vaccine, according to the CDC.
People say vaccinations are a good idea, but words don’t always translate to action. In a survey from the National Foundation for Infectious Diseases, two-thirds of people said getting a flu shot is a good idea -- yet 45% didn’t plan to get it or were unsure. Just 26% planned to update their COVID vaccine as the CDC recommends.
Fighting Vaccine Fatigue
Acceptance of the flu vaccine has always been ho-hum, as statistics suggest and doctors confirm. For the 2023 to 2024 flu season, just 45% of U.S. adults and 55% of children 17 and under got the flu shot.
Vaccination programs like Kaiser’s, which started in 2010, try to fight that ambivalence with strategies that focus on convenience.
Besides the vaccination tables at the Panorama City facility and at many of the organization’s other centers, Kaiser offers a drive-through vaccine clinic and makes vaccines available at any doctor’s visit, said Dustin Ashenfelter, a registered nurse and department administrator of family medicine and of flu and COVID operations at Kaiser Permanente. Kaiser also has clinics in Target stores, for those who wish to get vaccinated and shop for a few essentials while they’re at it.
Still, the mission is an uphill climb, Ashenfelter said, and it only gets steeper as the weeks and months pass.
“Early in the season, it’s the people who know they want the flu shot, so they are happy to come in,” Ashenfelter said. “As time goes on, I think we will see more of that vaccine-hesitant group — and they’re still questioning whether they want to receive it or not.”
Why You’re Hedging on the Shots
Public health experts cite many reasons why people put off or skip vaccines.
For one thing, a sense of urgency is lacking these days, four years into the pandemic, said Suruchi Sood, PhD, director for communication sciences and senior scientist in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. That’s understandable, as COVID infections have declined.
But the risk is still real, she said. COVID is still causing nearly 2% of U.S. deaths, according to the CDC. The test positivity rate – or number of tests performed that showed someone was positive -- was 10% for the two weeks ending Oct. 5. And more evidence is linking COVID infections to an increased risk of heart problems.
Early in the pandemic, public health was priority one. But now, Amesh Adalja, MD, an infectious disease specialist at the Johns Hopkins Center of Health Security, encourages patients to think of themselves.
“Do it because it’s going to improve your life,” he said. “We live in a world with lots of respiratory viruses, and the vaccines are an important tool to better navigate that world.”
Another potential disincentive: Vaccines aren’t perfect. Vaccine makers must make an educated guess months in advance regarding which COVID variant and flu strain to target. They don’t guarantee you won’t get sick, and their protection doesn’t last forever.
“I acknowledge that these are not our best vaccines for preventing illness in the first place,” said Gretchen LaSalle, MD, a family doctor in Spokane, Washington, and author of Let's Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. “They do help, but you can get the vaccine and still get the illness. I remind [patients] that this is because these viruses keep mutating, so neither immunity from illness nor immunity from a vaccine lasts very long.”
But vaccines are very good at preventing serious illness, hospitalizations, pneumonias, and death, LaSalle said. Plus, illness prevention alone isn’t the only reason to get vaccinated, she said — it could also prevent you from missing a vacation or holiday party.
Keeping track of the recommended vaccination schedule can be a challenge. (This year’s recommended COVID vaccine schedule can be found here. For flu, the CDC recommends everyone 6 months and older get a flu vaccine every year with rare exceptions, and adults 65 and up should get one of three enhanced flu vaccines.)
Reminders can help, but there’s a balance between helpful and annoying. A recent study found that sending text messages increased COVID vaccine uptake by 21% in the next month, but offering free rides to the vaccination sites did not have an effect. The study authors concluded that transportation isn’t a barrier to vaccination.
Many people simply don’t like needles. “People don’t like shots,” said Sood. In fact, 25% of U.S. adults have a fear of needles, and of those about 16% may skip a procedure due to this fear. If that’s you, you can ask for numbing creams or sprays, try to distract yourself, bring a support person, or focus on the fact that the pain is brief. Next year, the needle-less nasal flu vaccine, FluMist, will be available for home use, according to the FDA.
But perhaps the biggest reason people don’t get vaccinated? No one asked. Many primary care doctors and other health care providers don’t bring it up, said Steve Furr, MD, a family doctor in Jackson, Alabama.
Furr asks patients if they want to get vaccinated. “Just this last week, I had four different people say, ‘Why not? I’m here.’’’ If spouses are along for the visit, Furr invites them to roll up their sleeves, too.
Vaccines are widely available at doctors’ offices. So if you happen to be visiting your doctor, feel free to ask if you can get one.
Meanwhile, Ashenfelter and his Kaiser crew will keep asking. Their goal is to vaccinate 44% of the 230,000 members in their area with the flu vaccine by June 2025. As of Oct. 10, 19% had received it.
The goal for COVID vaccines? As many as possible, he said.
