Vaccine hesitancy risks a 2023 tripledemic


This is the first year that patients can get vaccines to protect themselves against COVID, the flu, and RSV (respiratory syncytial virus), but a tripledemic could still be on the horizon. According to a survey commissioned by the National Foundation on Infectious Disease (NFID), many adults in the US are not planning to get vaccinated this autumn and still poorly understand the risks associated with respiratory diseases. 

Vaccination by the numbers

When it comes to vaccination rates this season, education and vaccine hesitancy are dancing a dangerous tango. 

According to the survey, even though 65% of patients understand that the best protection against the flu is to get vaccinated, “43% say they do not plan to or are unsure they will get vaccinated against flu this season.” The survey also found that “only 22% of US adults are very or extremely concerned about themselves or someone in their family getting infected with flu.”

These numbers improve somewhat in older populations (65 and over), where 72% of patients say they are planning to get their annual flu vaccine, compared to only 52% of adults aged 18-64 years. However, more concerning, “More than 1 in 4 US adults (28%) who are at higher risk for flu-related complications said that they were not planning to get vaccinated this season.”

When it comes to COVID, the numbers do not improve. “Only 23% of US adults are very or extremely concerned about themselves or someone in their family getting infected with COVID-19 [and] only 40% of US adults plan to get an updated COVID-19 vaccine.” 

These numbers seem additionally surprising after COVID rates spiked in mid-September, seemingly hinting at a high COVID burden this winter. 

When it comes to RSV, patient intentions are at their lowest, despite the fact that there are now four new RSV vaccines on the market (two for seniors and two to protect infants). According to the survey, “Only 19% of US adults are very or extremely concerned about themselves or someone in their family getting infected with RSV [and] among adults age 60 years and older, only 40% plan to get an RSV vaccine.” 

So what is driving these numbers?

Vaccine hesitancy

The numbers coming out of the NFID study imply that the low vaccination rates are driven by vaccine hesitancy and a lack of understanding around the risks around getting versus not getting vaccinated.

According to the study, when it comes to the flu:

  • 32% are concerned about potential side effects from the vaccine,
  • 31% do not trust vaccines,
  • 27% do not think vaccines work very well, and
  • 27% are concerned about getting sick from vaccines.

When it comes to COVID vaccinations:

  • 34% do not trust vaccines, 
  • 28% do not think that vaccines work very well 
  • 27% are concerned about getting sick from vaccines, and
  • 13% do not think COVID-19 is a serious illness.

Lastly, when it comes to RSV:

  • 33% have concerns about side effects from the vaccine 
  • 28% do not trust vaccines 
  • 27% have not been advised to get an RSV vaccine, and 
  • 25% have concerns about getting sick from the vaccine.

While it is easy to blame low vaccination rates on misinformation or a cavalier attitude towards getting sick (both of which may be true in some instances), the reality for patients is much more complex. 

For example, as STAT news reported, “The latest rollout of COVID-19 vaccines has been messy, with people facing more challenges getting one of the updated shots than they may have experienced since the frantic start of the very first vaccination campaign in late 2020 and the first half of 2021.” 

Undoubtedly, when vaccine appointments are canceled, the rate of vaccinations for patients goes down, either because patient confidence is reduced, or because life simply gets in the way of making a second appointment (as well as other reasons). 

There is also a very understandable concern that patients have around getting multiple vaccines at the same time, with “only 38% of US adults would get a flu and COVID-19 vaccine at the same time, if offered.” This is a concern that is incredibly valid as weaker, or even normal, immune systems can be strained when dealing with multiple vaccinations in one go (as this writer has experienced personally). And yet, again, with the need to schedule multiple vaccinations, the rates for 100% vaccine uptake naturally go down. 

And when it comes to RSV, ignorance is an understandable factor. Most patients are unaware of RSV, and the highest risk populations are infants and patients over 65 (for which the only two vaccines exist, creating a gap in age range-based surveying). 

But there is another pertinent issue that these numbers highlight: vaccine education is paramount (and effective), and no one else is more trusted than physicians. 

Physicians educating patients

As Bio.News recently reported, during the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) greenlighting Pfizer’s RSV vaccine, Abrysvo, study groups found that “12% of pregnant people said they would accept no [RSV] vaccine, while 49% said they would accept 1–2 vaccines. In addition, 9.9% of respondents were unsure, while 19.9% said they would get up to four vaccines.” 

And a factor driving that number was the fact that “two-thirds of obstetricians did not feel that providing information about routine childhood immunizations was part of their role.” This is despite the fact that, “Studies continue to demonstrate that healthcare providers are pregnant people’s most trusted source of information on vaccines, and provider recommendation is a strong predictor of vaccination.”

The NFID study found similar trends in their survey as well. According to the study, when it came to the flu vaccine:

  • Most US adults (75%) trust healthcare professionals a great deal or a lot, far more than other sources,
  • 54% of US adults trust the CDC a great deal or a lot, and
  • 47% trust state and local health departments a great deal or a lot.

It is notable however, that the study also found that “adults age 18-64 years are less trusting of doctors (63%) than adults age 65 years and older are (80%).” 

In some ways, the answer is simple—or at least, the first steps toward answering the problem are simple: physicians need to talk to their patients about getting vaccinated, as well as spend time helping them understand the risks.

Larger education and outreach programs are still necessary, and while such programs are reaching patients, unfortunately, the numbers imply that more needs to be done. 

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