Flu Vaccination Rates Dropping in States With Low COVID-19 Vaccination Rates

Attitudes to COVID-19 vaccinations spread to public health perception

A health care worker fills a syringe with Pfizer's COVID-19 vaccine in a file image. (Robyn Beck/AFP via Getty Images)

Researchers are seeing a divide in adult flu vaccine uptake between states, with low flu vaccination uptake in states that had low COVID-19 vaccination rates, whilst states that had high COVID-19 vaccination have increased flu vaccine uptake.

The study by the University of California suggests that attitudes toward COVID-19 vaccinations have also spilled over to the public’s general health behaviors, demonstrated by the low uptake of influenza in low COVID-19 vaccinated states.

“Many Americans who never before declined a routine, potentially life-saving vaccine have started to do so,” said the study’s lead author Dr. Richard Leuchter, expressing his alarm in the university’s media release.

Though flu vaccination uptakes of adults were polarized amongst different states, ranging from 50 percent to 80, the authors still observed a general negative trend in the public’s perception of public health.

Flu vaccination uptake in children also collectively dropped across both the 2019 to 2021 flu seasons, regardless of the state of COVID-19 vaccination.

“This supports what I have seen in my clinical practice and suggests that information and policies specific to COVID-19 vaccines may be eroding more general faith in medicine and our government’s role in public health.”

Researchers compared the Centers for Disease Control and Prevention’s publicly available data on uptake of the influenza vaccine in 2019—prior to the pandemic—and during the pandemic in 2020 and 2021.

States were split into quartiles based on the percentage of their COVID-19 vaccination uptake. The states in the top two quartiles had the highest COVID-19 vaccination uptake whilst the states in the bottom two quartiles constituted the bottom 50 percent for vaccine uptake.

The authors observed that in 2020, even prior to the dispatch of COVID-19 vaccines, there was a slight decline in influenza vaccine uptake for each of the quartiles, but the average percentage for vaccine uptake remained close.

By 2021, after the release of the COVID vaccines, influenza vaccine uptake resulted in a split with the states in the top 2 quantiles for COVID-19 vaccine uptake increasing their influenza vaccine uptake to the highest levels since at least 2010, whilst the bottom two quantiles saw a steep decrease, lower than levels in 2019 and 2018.

The authors suggest that the two polarizing attitudes toward the COVID-19 vaccines are influencing polarizing behavior toward other public health measures; those that approved of the COVID-19 vaccines readily took up the influenza annual vaccine, whilst those that declined the COVID-19 vaccines also declined subsequent vaccines.

The authors proposed a “belief generalization,” giving the example that just like how someone may not wear a mask to signal their beliefs publicly, those that oppose or support the COVID-19 vaccine may “feel that they should in turn oppose or support other vaccines.”

Though the study did not make any direct associations between specific pandemic policies and promotion of COVID-19 vaccines, it indicated that “safety concerns and mistrust of COVID-19 vaccines or government” may have been factors associated with the COVID-19 vaccination rates and the decrease in influenza vaccine uptake.

The United States Accountability Office previously called for (pdf) improved transparency in vaccine emergency use authorizations to improve trust in the public health system. Additionally, a 2021 study by the University of Maryland also suggested transparency in clinical trials and policymaking for COVID-19 vaccinations to improve patient trust.