Attitudes Of Older Adults Toward Getting the Seasonal Flu Vaccine And The Novel COVID-19 Vaccine During The 2020-2021 COVID-19 Pandemic: A Cross-Sectional Study

Objective: Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018 it was estimated that 80,000 people died of influenza-related illnesses. Infants and elderly people are among the most vulnerable populations. In the 2018-2019 flu season, only 34.9% of individuals in these age groups received the influenza vaccine [1]. Studies indicate that 7.52 million illnesses, 105,000 hospitalizations, and 6,300 deaths due to influenza were avoided by the vaccine, during the 2019-2020 season [2]. However, national vaccination coverage is consistently lower than 50 percent in adults, despite the widespread availability of multiple influenza vaccines [3,4]. Moreover, a new study by the National Infectious Diseases Foundation showed that over 40% of U.S. Adults do not plan to get the flu shot during the 2020- 2021 season [5]. Vaccine hesitancy is linked, along with safety issues, to public perceptions of low efficacy [6]. During the 2019-2020 influenza season, the Centers for Disease Control and Prevention (CDC) reported that 38 million infections, 405,000 hospitalizations, and 22,000 deaths were associated with influenza. Older adults ≥65 years, alone, accounted for 43% of hospitalizations and 62% of deaths [2].

More recently the COVID-19 virus has quickly become a major global threat infecting more than 92 million people worldwide and causing almost 2 million deaths [7]. Facing these facts, and as an effective COVID-19 vaccine is unlikely to be widely implemented until mid or late 2021, the CDC stressed on the importance to be vaccinated for seasonal influenza and prioritized the health care workers and older adults, to help reduce the strain on healthcare systems responding to the COVID-19 pandemic.

Two newly experimented COVID-19 vaccines were just proven to be more than 90% effective [8,9]. Compared to influenza, the severity of COVID-19 infection indicates that the public health benefit of corona virus vaccination may be much greater. However, despite the need of an urgent vaccine, many people seem to be hesitant about receiving it because of the perceived rush in development and the undisclosed demographics of the trial subjects, mainly elderly and people with co-morbidities. Surveys of 493 and 2200 individuals showed that only 30% would agree to be vaccinated against COVID-19 after availability [10].

In order to align with these efforts, the WHO had developed a detailed framework for vaccine distribution and prioritization to ensure equity and safety [11]. However, it remains unclear if vaccine resistance can be surpassed by the unexpected and drastic effects of COVID-19 in the United States. More specifically, this season, the decision of getting the flu shot might be affected by the coexistence of COVID 19 virus. Therefore, it is necessary to foresee and minimize obstacles to COVID-19 and flu vaccines widespread administration especially among the most vulnerable population of older adults.

The objective of this study was to evaluate the attitudes of older adults regarding receiving the flu vaccine and the new COVID-19 vaccines during the 2020-2021 flu season, and to determine the effectiveness of an educational handout on encouraging patients who declined receiving the flu vaccine to reconsider their choice.


Rami Tarabay MD, Riwa Al Aridi, Pharm D, Fassil Gemechu, MD, Mary Corrigan, MD, James Campbell, MD, Aleece Caron, PhD*

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