Study: Rate of Flu Immunizations Could Parallel COVID-19 Vaccine Acceptance


Age, insurance status, and having a primary care provider are all important determinants, but short- and long-term interventions are necessary to increase vaccination rates.

With flu season approaching and continuing concerns about the coronavirus disease 2019 (COVID-19) pandemic, understanding which demographics are more likely to receive immunizations is vital. New research from the University of California at San Francisco suggests that age, insurance status, and having a personal physician are all important determinants.

According to the investigators, only 1 in 3 US adults received the flu vaccine in 2018, a statistic that could have major implications for the 2020-2021 flu season. Keeping flu-related hospitalizations as low as possible is especially important this year, as the COVID-19 pandemic threatens to overwhelm health systems.

In the study, researchers evaluated self-reported flu vaccination rates from 2018. They included data from the 2018-2019 season, which showed 61,000 deaths, and the 2018-2019 season, which showed 34,200 deaths. The data were recorded in the Behavioral Risk Factor Surveillance System, which includes more than 400,000 adults in the United States.

Perhaps most notably, the study authors found that none of the subgroups exceeded the minimum vaccination rates for herd immunity.

“To achieve herd immunity, we would need to reach about an 80% vaccination rate, but no subgroup in our study exceeded 60%,” said senior author R. Adams Dudley, MD, MBA, in a press release. “While social distancing, mask-wearing, and staying away from crowds will mitigate the spread of the flu, a dangerous type of the flu—such as the Spanish flu of 1918—could result in more than 61,000 fatalities.”

Age, insurance status, and having a personal physician were all important factors in whether an individual received their flu shot. Specifically, 22.6% of those aged 18 to 24 years received the vaccine, compared with 59.3% of those over 75 years of age.

Among patients without insurance, just 16.1% were vaccinated compared to 41.6% of those with insurance, and just 19.4% of patients without a personal physician were vaccinated compared to 43.6% with a physician.

Having a chronic condition was also linked to higher rates of immunization. Just 31.6% of those without a chronic condition were vaccinated, compared to 52.7% of those with 4 or more chronic conditions.

Variations among income groups were smaller, however. Approximately 33.9% of those with a household income of less than $15,000 were vaccinated, compared to 41.8% of those with an income of more than $50,000. Variations were also seen between states, with the lowest vaccination rates in Texas (26.4%) and the highest rates in Washington, DC (44.2%).

Finally, the researchers found lower rates among Black and Hispanic patients (33.9% and 28.9%, respectively), and among men (36.7%). White and Asian patients had rates of 41.5% and 38.3%, respectively, whereas women had a 41.6% vaccination rate.

In order to increase vaccination rates for all subgroups, the researchers recommended both short- and long-term interventions.

“We need a concerted public health campaign that includes public health officials, health care providers, and local communities, and reaches those groups most at risk for not getting vaccinated,” said first author Brandon Yan, a third-year medical student, in a press release. “And we need a proactive primary care outreach strategy to address patient concerns and provide information on how and where to get vaccinated.”

Long-term goals may be more difficult to achieve but are no less important, Yan said. They include making the vaccines more accessible and making them free of charge for those who are uninsured.

“The ongoing pandemic also raises the issue of whether the flu vaccine and the future COVID-19 vaccine should be mandated,” Yan said. “While a federal mandate may be difficult politically, private organizations like colleges and employers could make attendance and employment contingent on getting up-to-date with vaccines.”


COVID-19 Vaccines Are Moving Fast, But Will Americans Agree to Get Them? [news release]. University of California at San Francisco; August 26, 2020. Accessed August 31, 2020.

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