Op-Ed: 'Vaccine Fatigue' Is Hindering the Flu Shot Rollout

Shamard Charles, MD, MPH, is an assistant professor of public health and health promotion at St. Francis College. Here, he explains why the COVID-19 vaccine rollout should—and will—improve the flu shot rollout, but why it’s not happening this year.

Experts worry that we could be heading into a big flu season, especially if enough Americans do not get their annual flu shot, which is now widely available. With over 700,000 deaths credited to COVID-19 in just 18 months, a rebound influenza epidemic is the last thing we need.

All the talk about COVID-19 vaccines and boosters has caused an alarming shift in public focus—seasonal influenza has all but disappeared as a subject of discussion in the global sphere.

For clinicians and public health researchers, there is hardly ever any excitement surrounding flu season, but for many, including myself, we believed this year would be different. The prospect of repurposing COVID-19 efforts to meet flu vaccine demand gave us the possibility to expand flu vaccination far beyond levels we’ve ever seen. But so far, flu vaccine deployment has not met expectations due to plateaus in the COVID-19 vaccination rates and the appearance of the highly infectious Delta variant.

Around the country, it seems as if the prospect of increasing flu vaccination rates, which is critical in the immunocompromised and those over the age of 65, is more aspirational than an actuality. I am a doctor and professor of public health at St. Francis College in Brooklyn, New York. Most of my research and outreach support efforts to increase vaccination and other primary preventative measures target Black and Brown communities in the New York City area. Despite media reports citing the contrary, COVID-19 vaccination rates have remained high, which corresponds to decreasing hospitalizations and deaths. To remain in this space, a robust flu vaccine rollout is needed, because those at highest risk for COVID are also at high risk of the flu. But convincing people to get yet another jab has proven difficult.

For starters, Americans have come to accept that COVID-19 is here to stay, which brings with it an air of naivety. When a disease becomes commonplace, it is more likely for people to downplay its threat to society. As a result, I have seen that some people make the incorrect cost-benefit analysis of choosing one vaccine over the other, or no vaccine at all. During these times, I’ve had to remind patients that both the flu and COVID-19 virus are potentially deadly, so vaccination against both is needed to protect them from illness and death.

Secondly, an acceptance that COVID-19 and the flu are intimately linked means that healthcare professionals often have to talk about two distinctly different threats in one visit. Like the flu, we can expect that COVID-19 will become endemic—meaning that it will continue to circulate in pockets of the global population for years to come. Many of the interventions put in place to quell the COVID-19 pandemic will be used to drive flu vaccine efforts. Therefore, more “manpower,” which is presently non-existent in the health community, will be needed to continue these efforts. 

The future will therefore depend on the type of immunity people acquire through infection or vaccination, how the virus evolves, and society’s ability (or inability) to contain the virus by wearing masks and social distancing, both of which decrease viral transmission.

As COVID rates dwindle, public health campaigns will be able to space out health promotion campaigns more appropriately so people do not feel bombarded with redundant messages and shots. Having a strategic plan to roll out flu vaccines is essential given the many factors that determine influenza’s burden of disease. This burden varies widely based on characteristics of the dominant flu virus strain, the timing of the season, how well the flu vaccine is working to protect against illness, and how many people got vaccinated.

The healthcare infrastructure, communication, and promotion of the COVID-19 vaccine are not the only things that need to be repurposed in the future. It would be wise to reengineer the technology used to quickly create the safe and effective COVID-19 to develop a universal flu vaccine. The flu mutates from year to year, requiring the administration of a new vaccine each year to address new predicated strains. Current flu vaccines in the market aim to stimulate antibodies that protect against the specific strains of the flu, but these antibodies can wane over time and are ineffective against less dominant strains.

Currently, flu shots, whether built around inactivated viruses or recombinant proteins, typically offer only 40–60% protection from infection, but mRNA technology used in COVID-19 vaccines could provide broader coverage and incorporate large numbers of antigens, increasing our immune system’s ability to address multiple strains at the same time.

Mobilizing flu vaccines after battling COVID-19 for two years is exhausting. It’s not an excuse for slow-moving initiatives, but it is indicative of vaccine fatigue. I sometimes have to remind myself that this is the first year where I have to consider the flu and COVID-19 viruses at the same time, while vaccines for both are widely available. And I also have to take into consideration how others must be feeling during these troubling times.

While the long-term goal is to jab as many arms as possible to help cover people from both COVID-19 and the flu virus, learning how to navigate around the thoughts, opinions, and even fears of people in the community is a short-term goal worth achieving in the process.