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How Flu Shots Defied COVID-19 Trends

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The list of silver linings to the COVID-19 pandemic is not long. We can count growing the adoption of telehealth, less time spent commuting, and – in some cases – more quality time with our immediate families. Now, we can add one more: increased adherence to the flu vaccine.

Unlike virtually every other form of routine, preventive care – many of which saw volumes plunge by as much as 96% during April of 2020 and still haven’t recovered – flu vaccination rates were actually up amid COVID-19. In fact, according to our data, during the early weeks of September and into the 2020 fall season, flu vaccine rates were nearly 25% higher compared to the same time period in 2019. This trend held for both adult as well as pediatric populations.

We used our Healthcare Map™ to track the weekly rate of flu vaccines dispensed in 2019 versus 2020. As is typical given seasonal fluctuations, rates of flu shots were low during the spring of 2020, but by August they surged well above the rate seen the previous year, and they have not slowed down throughout the peak vaccination season.

Vaccine Project Flu Graph 1 (1)

Widespread Public Health Initiative

On the surface, this trendline makes a lot of sense. Public health officials were vocal about the need for strict flu vaccine adherence this year. For example, in August, then-CDC Director Robert Redfield, MD, warned of a possible “twin-demic” of flu and COVID-19. “This is a critical year for us to try to take flu as much off the table as we can,” he said. “Our hospital capacity could get strained.”

According to CDC data, overall flu vaccine adherence was roughly 51.8% nationwide in the 2019-2020 influenza season and preliminary data suggests that it climbed in the 2020-2021 season, with 193.2 million doses distributed across the U.S. – the highest number ever.

Our data reinforces that thesis, showing a sharp climb in influenza vaccination rates starting the week of August 10 that held steady into October. Preliminary analysis suggests this trend was consistent through the remainder of 2020 as well, despite the winter surge in COVID-19 cases.

The U.S. also experienced historically low incidence of flu activity this season. According to the CDC’s latest weekly Influenza Surveillance Report, the cumulative hospitalization rate for influenza-like illness has been just 0.6 per 100,000 people in the U.S. this season. That rate was 1.6 times higher in the 2011-2012 influenza season, which was the previous historic low for flu infection in the U.S.

Averting a Flu Season Nightmare

Experts have attributed this phenomenon to a combination of factors that include increased vaccination rates and widespread use of masks and social distancing measures due to COVID-19. Some research even suggests that the flu is competing – and losing – to COVID-19 when it comes to infecting hosts.

While all of this makes tremendous logical sense, it does not explain why influenza vaccines are one of the only preventive measures, among dozens we’ve analyzed over the last year, that did not suffer sharp declines as Americans sheltered in place and avoided contact with the healthcare system for all but the most serious conditions.

According to our analysis, mammogram volumes fell 96% during March and April of 2020. Colonoscopies were down 91%, cervical cancer screenings were down 72%, and lipid panels were down 65% during the same period. Routine childhood vaccinations were down, too. Even relatively simple measures like A1c tests fell by 61% during the initial wave of the pandemic, and many of these have still not climbed back to pre-pandemic levels.

What’s the difference?

For one, there is access. The public health community has done a great job of making the flu vaccine widely available through distribution in retail pharmacies, physicians’ offices, and urgent care centers. Thus, unlike other forms of preventive care – which all require interaction with the traditional healthcare ecosystem – flu vaccines can be administered while someone is simply running errands. A Komodo analysis found that the top 2 healthcare organizations delivering the highest volume of flu shots were retail pharmacy chains.

Communication also played a major role. While the healthcare community has recently started to acknowledge the risk of deferred and delayed routine care, the awareness effort around the flu vaccine was choreographed clearly starting in the spring and summer of 2020.

And, of course, there was some good fortune too. The optimal season for getting a flu vaccine happened to coincide with the nationwide push to try to get kids back in school and an ebb in COVID-19 cases, creating a window of opportunity for widespread vaccination to take place.

Lessons Applicable to Other Preventive Measures

These are all important variables to consider as we stare down a new public health vaccination challenge of epic proportions. Making it easy, communicating the value consistently and clearly, and getting the timing right are all important parts of the adherence equation. We must also recognize that there are several preventive measures that are still not happening at the frequency they should be. These will need a similar push as we head toward the 12-month mark living with the COVID-19 pandemic.

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