Tired of vaccines? They still matter

It’s fall and there are new flu vaccines and Covid-19 boosters available. The advice from the Centers for Disease Control (CDC) is clear: Virtually everyone should plan on getting both shots.^{1, 2}

The need for both vaccinations/boosters is especially important this year:

• Some experts believe that the U.S. 2022-2023 flu season will be severe. One contributing factor is that the previous two flu seasons have been much less severe than usual. As a result, overall immunity against the flu is down.³
• The new Covid boosters are aimed at the most contagious subvariants (BA.4/BA.5) of the Omicron virus yet seen.⁴
  
  

Is fatigue setting in?

Unfortunately, after nearly three years of non-stop discussion about viruses and vaccines – some of it extremely contentious – there are very real signs of vaccination fatigue.⁵ Vaccine fatigue is defined as “…people’s inertia or inaction towards vaccine information or instruction due to perceived burden and burnout.” ⁶

Whether people are tired of talking about vaccines in general, or tired of the Covid-19 pandemic itself, the concern is the same: People will simply tune-out vaccination campaign communications – not just for Covid-19, but also for the flu.⁷

Note that vaccine fatigue is not associated with those who hold vehement anti-vaccination views. Rather, fatigue is more common in people who hold pro-vaccination views. In other words, the very people who have been the most conscientious about tracking and responding to public health messaging are the very ones who are suffering from fatigue.⁸

We can see this happening right now.

Despite CDC-backed public education campaigns and separate marketing efforts by vaccine makers, a recent survey finds that half the public says they’ve heard either little or nothing at all about the new COVID-19 boosters.⁹

Worse, the contentious discussion around the Covid-19 vaccines is beginning to have a spillover effect on people’s willingness to get the flu vaccine. Compared to pre-pandemic times, adult flu vaccination rates have dropped by 4.5% in states that have low rates of Covid-19 vaccination.¹⁰

Vaccination fatigue seems to stem in part from an overemphasis on the technical details of vaccination – complex dosing schedules, efficacy, side effects, etc.¹¹

With this in mind, here are four considerations in favor of timely vaccination with a somewhat different approach. Instead of focusing on the science behind the vaccines, their emphasis is on some demonstrated benefits that show why vaccination is in each individual’s best interest.

[NOTE: This article is for informational purposes only. It is not intended as medical advice. Anyone who has questions or concerns about getting either a flu vaccine or a Covid-19 booster should consult their care provider.]

1. Flu and Covid-19 vaccination/boosters offer your best protection against serious illness or death.

Whether we’re talking about the flu or about Covid-19, we often hear that vaccination is the simplest step to make a drastic difference in one’s personal protection.

This graph concerns Covid-19 vaccination and/or booster uptake. Look at the January 2022 segment. People who were unvaccinated against Covid-19 faced a risk of death more than 1,400% higher than those who were up to date. ¹²

[image cite: Adapted from STAT News. A third Covid autumn is upon us. Here’s a look at where we stand. Published September 1, 2022.]

Flu vaccines have a similar impact. Studies in the U.S. and around the world show that even if someone does get sick, flu vaccination can reduce the severity of illness.¹³

Two studies showed that these results persist over time:¹⁴

• From 2004–2020, influenza vaccines reduced influenza requiring medical care by 10% to 60% in the U.S. (Variation due to vaccine match to circulating virus strains.)
• A 2021 study showed that vaccination reduced ICU admissions by 26% and lowered mortality by 31% among adults with influenza-associated hospital admission.

Finally, the benefits of annual flu vaccination are cumulative. Someone who has been vaccinated 10 years in a row will have more protection from the flu in the coming year than someone who has been vaccinated for only a couple of years. Consistency matters.¹⁵

2. Flu vaccination may reduce chances of testing positive for Covid-19 infection

Clearly, we need both a flu shot and a Covid vaccine/booster.¹⁶

But an intriguing new study has uncovered an unexpected possible benefit from getting a flu shot. Stressing that this is just one study that remains to be proven, it did appear that patients who received the flu vaccine had a reduced chance of testing positive for Covid-19 compared to those who did not receive the flu vaccine.¹⁷

The same study also showed that less medical care was needed for those who tested positive for Covid-19 despite receiving the flu vaccine. There are a number of factors that could have contributed to these finding, of which the flu vaccine is only one. Still, it’s encouraging that doing the right thing just might be rewarded. Time – and further study – will tell.

[Image: adapted from the American Journal of Infection Control. Impact of the influenza vaccine on COVID-19 infection rates and severity. Published February 22, 2021.]
 

3. Getting the Covid vaccine/booster is good insurance – now and in the future

Some may argue that they don’t need to get the new Covid booster because they have recently recovered from a Covid infection. This may be true, as long as they’re sure they did in fact have a new variant.¹⁸

But the current variants are already in the process of being replaced with still-newer versions. At that point the question is, what will the next variant look like? ¹⁹

Logically, the next variant of SARS-CoV-2 should be closely related to Omicron BA.4/BA.5. Why? Because these are the most recent and the most successful variants, having caused more infections than any previous version.²⁰

In real life, it already appears that the BA.4/BA.5 variants could be replaced as soon as this fall and winter by even newer omicron subvariants. In fact, these are the most immune-resistant variants ever evaluated.²¹

But regardless of which subvariants prevail, the current bivalent boosters will offer at least some protection, since the entire Omicron lineage shares the same basic architecture. As one expert puts it, while the BA.5 boosters are probably a step or two behind the virus’ evolution, at least they aren’t five steps behind.²²

In other words, the reason to get boosted now is not necessarily because it will protect you now, but because it may well protect you against the next variant.

4. Scheduling questions

Finally, let’s say someone has decided to get both the flu shot and the Covid booster. When should they get them?

From a public health perspective, it makes sense to tell people to get their flu shots and Covid booster at the same time. And that is what we are hearing from, for example, the White House Covid coordinator. (He says, “That’s why we have two arms.”)²³ The CDC has said that there’s no medical reason not to get both shots at once, so that’s not a barrier.²⁴

Thinking back to the idea of vaccination fatigue, people are already feeling overwhelmed by the burden of tracking multiple vaccination schedules.²⁵ This approach makes it more likely people will get both shots, which is the ultimate goal.²⁶

For more information:

• CDC: Vaccines for COVID-19
• CDC: Frequently Asked Influenza (Flu) Questions: 2022-2023 Season

References:

1. Centers for Disease Control and Prevention. Who Needs a Flu Vaccine. Page last reviewed: September 13, 2022. Accessed September 22, 2022.
2. Centers for Disease Control and Prevention. Stay Up to Date with COVID-19 Vaccines Including Boosters. Page updated Sept. 8, 2022. Accessed September 22, 2022.
3. JAMA Network. The Dreaded “Twindemic” of Influenza and COVID-19 Has Not Yet Materialized—Might This Be the Year? Published September 21, 2022. Accessed September 28, 2022.
4. Yale Medicine. Omicron and BA.5: A Guide to What We Know. Published September 7, 2022. Accessed October 2, 2022.
5. American Heart Association News. How to keep 'vaccine fatigue' from getting in the way of a flu shot. Published: September 23, 2022. Accessed September 29, 2022.
6. Frontiers in Immunology. Mind the “Vaccine Fatigue.” Published March 10, 2022. Accessed September 29, 2022.
7. American Heart Association News. How to keep 'vaccine fatigue' from getting in the way of a flu shot. Published: September 23, 2022. Accessed September 29, 2022.
8. Frontiers in Immunology. Mind the “Vaccine Fatigue.” Published March 10, 2022. Accessed September 29, 2022.
9. Kaiser Family Foundation. Half of Public Has Heard Little or Nothing About the New COVID-19 Booster Aimed at Omicron; Many Don’t Know If the CDC Recommends That They Get the New Booster. Published September 30, 2022. Accessed October 2, 2022.
10. American Heart Association News. How to keep 'vaccine fatigue' from getting in the way of a flu shot. Published: September 23, 2022. Accessed September 29, 2022.
11. STAT News. Push to double up on Covid booster and flu shot may have a downside, experts caution. Published September 9, 2022. Accessed September 9, 2022.
12. STAT News. A third Covid autumn is upon us. Here’s a look at where we stand. Published September 1, 2022.]
13. The Lancet. Influenza Seminar. Published August 27 –September 2, 2022. Accessed September 30, 2022.
14. ibid.
15. American Heart Association News. How to keep 'vaccine fatigue' from getting in the way of a flu shot. Published: September 23, 2022. Accessed September 29, 2022.
16. American Journal of Infection Control. Impact of the influenza vaccine on COVID-19 infection rates and severity. Published February 22, 2021.
17. ibid.
18. Medscape. The Best Reason to Get an Omicron Booster. Published September 21, 2022. Accessed September 22, 2022.
19. ibid.
20. ibid.
21. Science Insider. Big COVID-19 waves may be coming, new Omicron strains suggest. Published September 27, 2022. Accessed September 28, 2022.
22. ibid
23. STAT News. Push to double up on Covid booster and flu shot may have a downside, experts caution. Published September 9, 2022. Accessed September 21, 2022.
24. Centers for Disease Control and Prevention. Frequently Asked Influenza (Flu) Questions: 2021-2022 Season. Page last reviewed: May 26, 2022. Accessed September 21, 2022.
25. STAT News. Push to double up on Covid booster and flu shot may have a downside, experts caution. Published September 9, 2022. Accessed September 9, 2022.
26. ibid.

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This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor Optum Rx has accepted any form of compensation for the preparation or distribution of this article.