Although more than two-thirds of US adults believe that annual influenza (flu) vaccination is the best protection against infection, 41% said they are unsure or do not plan to get an influenza vaccine during the 2022-2023 season, according to results from a national survey by the National Foundation for Infectious Diseases (NFID). The key reason cited was the belief that flu vaccines do not work well, infectious disease experts said at a news conference.

“Based on what we have seen in parts of the Southern Hemisphere, flu has the potential to hit us hard this year,” said NFID Medical Director William Schaffner, MD.

Rochelle P. Walensky, MD, MPH, Centers for Disease Control and Prevention (CDC) director, discussed worrisome drops in influenza vaccination over the past 2 years, particularly among older adults and those with chronic health conditions who are at higher risk for related complications. During the 2021-2022 flu season, 51% of the overall US population aged 6 months and older received a flu vaccine, which was similar to coverage during the 2020-2021 season, Dr Walensky noted. This flu season, 49% of US adults report that they plan to get vaccinated against flu, according to the NFID findings. Annual flu vaccination is recommended for everyone age 6 months and older.

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Approximately 94% of US adults who were hospitalized with flu-related complications during the 2021-2022 flu season had at least 1 underlying medical condition. Flu vaccine uptake in this subgroup was relatively low during the last flu season with 43% of adults aged 18 to 49 years with at least 1 chronic health condition receiving the vaccine. Of concern this year, 1 in 5 individuals (22%) who are at higher risk of developing serious flu-related complications reported that they were not planning to get vaccinated against flu during the 2022-2023 season. The most common reasons for not planning on getting an influenza vaccine this year are shown in the Table.

Table. Top Reasons for Not Getting a Flu Vaccine During the 2022-2023 Season

41% do not think flu vaccines work very well
39% are concerned about potential side effects from the vaccine
28% said that they never get the flu
24% are concerned about getting flu from the vaccine
20% do not think flu is a serious illness

Declining rates of flu vaccination were found among children aged 6 months to 17 years with coverage rates of 58% for the 2021-2022 flu season, which is an approximately 6% decrease from the 2019-2020 season. The 58% rate is the lowest vaccination coverage seen in children in the last 8 seasons, Dr Walensky said.

“We need to remind parents and caregivers that flu can be dangerous for children, especially children younger than 5 years old and children of any age with certain chronic conditions who are at higher risk of developing serious flu-related complications,” Dr Walensky said.

“Some of the sickest children I have seen in my career had influenza, and most children who are hospitalized with influenza are unvaccinated,” said Patricia A. Stinchfield, RN, MS, CPNP, NFID President, and moderator of the press conference.

Why Are Pregnant Women at High Risk for Complications From Influenza?

For pregnant women, vaccination coverage dropped to 50% compared with approximately 55% in the previous season and 58% in the 2019-2020 season. Now is the time to turn around the declining rates in influenza vaccination among pregnant persons, said Tamika C. Auguste, MD, chair of Women’s and Infants’ Services at MedStar Washington Hospital Center. 

“The flu vaccine is an old vaccine. It’s been around and it has been tested on pregnant women, and we know it to be safe,” Dr Auguste said. When counseling pregnant persons, she explains that pregnancy increases the likelihood of influenza complications because of the decreased lung capacity and pseudo-immunocompromised state that occurs during pregnancy.

“The flu shot during pregnancy has been shown to reduce a pregnant person’s risk of being hospitalized with the flu by an average of 40%,” Dr Walensky said.

Dr Auguste described the vaccine as a 2-for-1 deal in that it protects the mother against hospitalization and death and allows the mother to pass antibodies onto the newborn, offering protection against influenza complications for up to 6 months after birth.

“Take the time. Listen to your patients. What are their concerns? Talk about everything,” she said. Pregnant persons can be vaccinated during any trimester, postpartum, or while breastfeeding, she noted.

For those who say the flu vaccine isn’t always a perfect match to the circulating strains each season, Dr Walkensky said that even during the 2021-2022 flu season in which the vaccine was not a perfect match, the vaccine reduced the risk of illness by 35%. And among those who are infected with influenza, the vaccine can reduce the length and severity of that illness, the experts said.

One new change this flu season is that the CDC recommends that adults age 65 years and older should preferentially receive 1 of 3 higher dose or adjuvanted influenza vaccines: Fluzone High-Dose Quadrivalent (HD-IIV4, Sanofi), Flublok Quadrivalent recombinant (RIV4, Sanofi), and Fluad Quadrivalent adjuvanted (aIIV4, Seqirus) influenza vaccines. If none of these preferred vaccines are available, any age-appropriate flu vaccine may be used in older patients.

Concerns About Flu and COVID-19 Vaccine Coadministration

Concerns over coadministration of flu and COVID-19 vaccines were common among the survey respondents; 41% said they would not receive the vaccines at the same time, 36% said they would receive both vaccines at the same time if offered, and 23% were unsure. The survey data showed a lack of confidence in the safety of vaccine coadministration:

  • 32% were extremely/very confident about the safety of receiving flu and COVID-19 vaccines at the same time
  • 37% were not very or not at all confident in the safety of getting the flu and COVID-19 vaccines at the same time
  • 30% were only somewhat confident in the safety of getting vaccinated against both flu and COVID-19 at the same time

“These survey data are concerning. The updated COVID-19 boosters are safe and convenient to get at the same time as a flu vaccine,” said Stinchfield.

Lack of confidence in vaccine coadministration was more common in Black and Hispanic adults with 48% of these adults saying that they have little or no confidence in the safety of coadministration compared with 35% of White adults. Education level also played a role with 42% of those without a college degree having little or no confidence in coadministration safety compared with 27% of college graduates.

Barriers to Pneumococcal Vaccination: Clinicians

Less than a third (29%) of adults aged 65 years and older and those with an underlying health condition who are at higher risk for pneumococcal disease reported having been advised to get vaccinated against pneumococcal disease, representing an area for improvement among clinicians.

The survey also found gaps in knowledge about pneumococcal disease and vaccination among older adults and other high-risk groups; highlighting another area of improvement for clinicians. Among those who are unsure or do not plan to get a pneumococcal vaccine, the top reason (57%) cited was that their doctor has not recommended it.

“As health professionals, our recommendations matter,” said Dr Stinchfield.

More Adults Will Wear Mask During Flu Season

“On a positive note, we have more preventive behaviors in our toolbox than we did before the COVID-19 pandemic. We are more accustomed to wearing masks and staying home when sick,” said Dr Schaffner. Most adults (58%) reported that they will wear a mask at least sometimes during flu season, a preventive behavior that represents a major change compared to prepandemic flu seasons.

About the Survey

This NFID-sponsored survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak Omnibus, a monthly multi-client survey using the NORC probability-based panel designed to be representative of the US household population.

Interviews for this survey were conducted between August 11 and 15, 2022, among adults aged 18 years and older representing the 50 states and the District of Columbia. A total of 1005 participants randomly drawn from AmeriSpeak completed the survey.


National Foundation for Infectious Diseases. 2022 Annual Influenza and Pneumococcal Disease News Conference; October 4, 2022.

This article originally appeared on Clinical Advisor