We Must Lead on the Flu Vaccine

As family physicians, we know firsthand that influenza is not the common cold.

The CDC estimates that, during the previous flu season, some 34 million cases of influenza in this country led to 15 million medical visits, 380,000 hospitalizations and 17,000 deaths.

We also know that there’s a simple, evidence-based tool to lessen influenza’s danger to public health: the flu vaccine. During the 2022-23 respiratory-illness season, again according to the CDC, influenza vaccination prevented almost 45,000 hospitalizations among those 50 and older and approximately 2,500 deaths among those 65 and older.

Annual flu vaccination is the best tool available to reduce the burden of respiratory illness on patients — especially older adults and individuals with chronic health conditions — as well as on health care systems and communities. Family physicians must make the most of the tool and our knowledge about it.

I emphasize that empirical aspect because of something else we unfortunately know: Flu vaccination rates have fallen. Despite the availability of safe, effective, low-cost vaccines, many Americans fail to seek that protection and consequently put their health — and our health care systems — at unnecessary risk.

One key reason for this is rampant misinformation about the seriousness of influenza, and about the safety and efficacy of vaccination. Another is that many patients have grown tired of hearing about and getting vaccines after the COVID-19 pandemic, and with even more respiratory vaccines now available. Between the 2020-21 and 2022-23 respiratory seasons, vaccination fell from 75% to 70% among those 65 years and older, and from 54% to 50% among those 50 to 64 — age groups at high risk of respiratory complications due to chronic conditions.

We have the opportunity to lead against this trend. Family physicians are uniquely qualified to counsel their patients, whose whole health histories they’re familiar with, about the flu vaccine and any other vaccines they may need. We have the clinical experience, and the familiarity with supporting data, to explain that influenza poses serious risk and that vaccines — which have been available for more than 50 years and have a well-documented history of safety and efficacy — do not cause the flu. Rather, they provide significant protection against complications, hospitalization and death.

Evidence shows that our recommendation makes a significant difference in whether a patient gets vaccinated. And we play a critical role in addressing misperceptions and countering vaccine hesitancy and fatigue. By engaging in empathetic conversations, providing evidence-based information and sharing personal testimonials, we can build trust and encourage more patients to get vaccinated against influenza. Even if you don’t provide vaccines in your office, it is important to strongly recommend vaccination — and direct patients where they can get the vaccines.

It is especially critical to encourage vaccination among older adults and individuals with chronic conditions, as well as their family members. The influenza vaccine is recommended annually for everyone 6 months of age or older.  While influenza vaccination can be lifesaving for people in all age groups, it is a priority for those over age 50, many of whom have one or more chronic medical conditions. Influenza not only puts them at higher risk for respiratory complications but can also exacerbate chronic conditions and may increase the risk of persistent catastrophic disability.

Especially as we prepare for the “silver tsunami,” these threats cannot be taken lightly. By 2030, some 20% of the U.S. population will be older than age 65. Establishing the habit of annual vaccination for patients of all ages, especially adults in their 40s and beyond, can help make it a routine behavior by the time they develop chronic conditions and are in most need of protection. And it can help protect their family members who may be more vulnerable to influenza or unable to get vaccinated themselves.

Offering this guidance can feel thankless sometimes, but we know the rewards, too. When an older patient with one or more chronic medical conditions contracts influenza and is unwell for a week or so, they may tell us the vaccine “didn’t work.” This is when we can smile inwardly and think: “I am glad this patient is here to complain rather than at the hospital — or worse.” 

Our strong recommendation for annual vaccination, and helping vaccination to become routine among those who are most vulnerable to serious outcomes, is important. So is setting an example by getting vaccinated ourselves. We have a moral and professional obligation to promote preventive measures that safeguard our patients and public health. Influenza vaccination is such a measure: a  straightforward, evidence-based intervention that can reduce health care costs, prevent unnecessary suffering and save lives.

Warren A. Jones, MD, FAAFP, served as AAFP president in 2001-2002. Walter Orenstein, MD, MPH, FAAP, is an emeritus professor at the Emory School of Medicine’s Division of Infectious Diseases