The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network Health Advisory on low vaccination rates against influenza, COVID-19 and RSV (respiratory syncytial virus).
The “low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased health care capacity strain in the coming weeks,” says the advisory, which includes conversation guides, scripts and other tools for physicians and other health professionals to address the various reasons why patients forgo these essential vaccines.
Doubts about safety and effectiveness of vaccines, vaccine fatigue and time constraints are common reasons for low uptake. But in some cases, it’s because physicians aren’t bringing the subject up with their patients.
Doctors in particular “are the lynchpin” to patients getting vaccinated, said Mandy Cohen, MD, MPH, director of the CDC. As one of the most trusted sources for patients, physicians can reframe conversations to encourage uptake, she said.
Physicians, for example, can remind patients that the U.S. has distributed over 700 million doses of the COVID-19 vaccine.
“Yes, it is new but is one of the most looked at and studied vaccines that we've had in history,” said Dr. Cohen, who joined Demetre Daskalakis, MD, MPH, acting director of CDC’s National Center for Immunization and Respiratory Disease, for a fireside chat on the respiratory virus season.
Sandra Fryhofer, MD, the AMA’s liaison to the CDC Advisory Committee on Immunization Practices and immediate past chair of the AMA Board of Trustees, moderated this event. It was sponsored by the AMA and Project Firstline, a national collaborative led by the CDC that provides infection-control training and education to front-line health care workers and public health personnel, and hosted on the AMA Ed Hub™.
Respiratory virus cases are going up …
Combined trajectories on flu, COVID-19 and RSV aren’t that reassuring, although RSV is showing signs of a peak following six to eight weeks of rising infections.
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Flu season started just before Thanksgiving and has been rapidly accelerating. COVID-19, however, is yielding the most cases, hospitalizations, and deaths week after week. “We all wish we could leave COVID in the rearview mirror, but it is still here with us. We need to make sure that we are continuing to take it very seriously,” said Dr. Cohen.
… But vaccine uptake is low
Seven million fewer flu vaccines were administered to adults in 2023 compared with 2022. Only 16% of adults have gotten the updated COVID-19 vaccine. The new RSV vaccine for adults 60 and over only has an uptake rate of 15–16%.
Reasons for low uptake vary among the different vaccines.
With COVID-19, it’s a question of trust. CDC survey data reveals that unknown serious side effects (18%) is the top concern, followed by vaccine effectiveness. For the flu vaccine, the majority (27%) said they hadn’t had the time to schedule an appointment. But for RSV, 29% said their physician never recommended any action. Thirteen percent said the RSV vaccine was too new.
Visit the AMA COVID-19 resource center for physicians for clinical information, guides and resources, and updates on advocacy and medical ethics.
An opportunity for a conversation
The voice of the physician matters so much in whether folks decide to get vaccinated, said Dr. Cohen. With flu and COVID-19 cases on an upward trajectory, “we have an ability to impact those two curves here in particular,” she added.
The CDC has created evidence-based conversation guides that physicians can use to address patient questions and concerns. Part of this strategy is approach, said Dr. Cohen.
Instead of asking a patient whether they want to get a flu shot during a visit, physicians instead can say, “Hey, you’re due for your flu or your COVID vaccine today. I’ve gotten them and I recommend them for you too,” noted Dr. Cohen. If patients are unsure about getting a vaccine, the physician can walk them through the evidence-based reasons for getting a vaccine, assuring them that side effects are usually mild and temporary.
For patients who keep forgetting to schedule their shot, the CDC has new tools for reminder languages physicians can use via patient portal or by text.
Persistence is also key, noted Dr. Daskalakis. Success may not happen during the first interaction. But if you don’t succeed on the first round, then “try, try again,” he urged. Transparent communication and putting vaccination on the agenda may lead to success on the second or third try.
See a complete list of resources (PDF) highlighted during the fireside chat, and stay updated with the AMA on COVID-19 and vaccine development.
