Factors behind low COVID-19 vaccination spilled over into lower flu vaccination rates, study finds

A new study from UCLA researchers points to a previously undocumented impact of widespread promotion of the Covid-19 vaccine on other public health behaviors. Adult flu vaccination rates have declined in states with low Covid-19 vaccination rates, which the authors say could be a harbinger of declining confidence in the public health, suggesting that vaccination behavior against Covid-19 has extended to vaccination behavior against influenza. The finding is published in The New England Journal of Medicine in the form of a letter to the editor.

“It is alarming that the controversy surrounding the Covid-19 vaccination could undermine separate public health efforts that save thousands of lives each year,” says study lead author Richard Leuchter, MD, resident physician. at UCLA Health and the David Geffen School of Medicine. . “Many Americans who had never refused a routine, potentially life-saving vaccine, have begun to do so. This confirms what I have seen in my clinical practice and suggests that information and policies specific to Covid-19 vaccines can erode broader trust in medicine and our government’s role in public health.

The authors used publicly available Centers for Disease Control and Prevention (CDC) data collected through January 2022 to assess changes in flu vaccination rates during the pandemic based on Covid vaccination rates. -19 statewide.

Flu vaccination rates for the first flu season of the pandemic (2020-2021), which preceded the widespread availability of Covid-19 vaccines, remained relatively stable in all states. However, during the second flu season of the pandemic (2021-2022), which took place after widespread promotion of Covid-19 vaccines, flu vaccination rates fell by 4.5 percentage points (from 43.7% to 39.2%) in states with high Covid-19 vaccination rates. Conversely, states with the highest use of Covid-19 vaccines saw an increase in average flu vaccination rates of 3.8 percentage points (from 49.0% to 52.8%).

The authors say that these results taken together suggest that vaccination behaviors against Covid-19 have spread to other public health behaviors, in this case flu vaccination. They explain that this relationship works both ways: the factors driving low Covid-19 vaccination rates (e.g. distrust of Covid-19 vaccines, concerns about the effects secondary, lack of trust in government) are linked to declines in flu vaccination relative to pre-vaccinations. in times of a pandemic, when the factors driving high Covid-19 vaccination rates spill over to increase flu vaccination rates.

The authors propose that these two tendencies can be explained by what is called the generalization of beliefs. “Just as a person’s decision to wear or forgo a mask in public at the start of the pandemic was linked to their more general beliefs through the idea of ​​’belief signalling’, we propose that the ‘generalization of beliefs “may explain views specific to the Covid-19 vaccine be generalized to other vaccines,” says Leuchter. “People who feel pressured to oppose or support Covid-19 vaccines may feel they should in turn oppose or support other vaccines.”

Complete vaccination rates for Covid-19 (i.e. both doses of a two-dose vaccine or one dose of a single-dose vaccine) ranged from 50% (Alabama) to 81% ( Rhode Island) through January 2022. Influenza vaccination rates through January of the 2021-2022 influenza season were also highly variable, ranging from 31% (Mississippi) to 59% (Connecticut). The study authors found that 60% of the variation in a state’s flu vaccination rate could be explained by that state’s average Covid-19 vaccination rate alone. “This is compelling evidence that flu vaccination behaviors and Covid-19 vaccines are inextricably linked,” Leuchter said.

The authors note that these results only apply to the general adult population. Childhood flu vaccination rates dropped evenly and precipitously during the 2020-2021 and 2021-2022 flu seasons, regardless of when Covid-19 vaccines were introduced or Covid vaccination rates -19 statewide. The authors point out that previous studies have reported similar dramatic national declines in childhood vaccination rates for measles, mumps, and rubella (MMR). Leuchter says that while the generalization of beliefs in the negative direction may partly explain why parents are forgoing routine vaccines for their children, the fact that childhood flu vaccination has declined even among states with high rates of vaccination against the Covid-19 suggests that the generalization of beliefs from Covid-19 vaccines does not fully account for this trend. Reassuringly, influenza vaccination rates among adults over 65 have remained relatively stable over these two influenza seasons compared to the 2019-2020 season, albeit consistently underutilized in this population.

This study had certain limitations. For example, it did not directly measure individuals’ beliefs or reasons for forgoing vaccination. As an observational study, it does not prove that lack of trust in vaccines or the government caused the further decline in flu vaccination rates. Additionally, the CDC reports flu vaccination rates based on self-report surveys and has not made county-level data available for the 2021-2022 flu season, so only statewide data was used.

Despite these limitations, the researchers say these findings should sound alarm bells and prompt rigorous study of the causes of declining non-Covid-19 vaccination rates to inform urgent actions and corrective policies.

This research was supported by the NIH-National Heart, Lung, and Blood Institute — Stimulating Access to Research in Residency (StARR) program at UCLA, the NIH-National Institute on Aging, the National Center for Advancing Translational Science (NCATS) UCLA Institute for Clinical and Translational Sciences (CTSI) and the UCLA Value-Based Care Research Consortium (VBCRC).

The co-authors of the study are Drs. Nick Jackson, John Mafi, and Catherine Sarkisian, all faculty members of the UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research.

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