COVID-19, Flu, and RSV Vaccine Skepticism Still an Issue Among Many Americans


During a podcast hosted by Permanente Medicine, Sandra Fryhofer, MD, chair-elect of the Board of Trustees for the American Medical Association and a liaison to the CDC’s Advisory Committee on Immunization Practices, discussed the importance of vaccines for the fall and winter seasons.

There is little doubt among health care professionals that vaccination is by far the most effective public health measure to prevent infectious diseases. There are numerous examples of safe and efficacious vaccines throughout history that have improved the quality of life for people around the world by reducing or outright eliminating deadly infections.

However, vaccine hesitancy remains a threat to global health and has intensified with the wide availability of both good and bad information on the internet. This was particularly apparent during the COVID-19 pandemic when misinformation about vaccines proliferated on social media.1

The CDC said that it’s expecting higher rates of hospitalizations this fall and winter compared to those before the COVID-19 pandemic, but that hasn’t seemed to sway the vaccine sceptics. Only 40% of adults in the US plan to get vaccinated against COVID-19, according to a new poll from the National Foundation for Infectious Diseases (NFID).2

The survey, conducted by NORC at the University of Chicago, also found that 43% of adults said they do not plan on or are unsure if they will get the flu vaccine. And only 40% of adults aged 60 or older said they plan on getting vaccinated for the respiratory syncytial virus (RSV).

During a recent podcast hosted by Permanente Medicine, called PermanenteDocs Chat, Sandra Fryhofer, MD, chair-elect of the Board of Trustees for the American Medical Association and a liaison to the CDC’s Advisory Committee on Immunization Practices, sat down with host Alex McDonald, MD, to talk about the importance of flu, COVID-19, and RSV vaccines for this year’s cold and flu season.

“[T]he results are very disturbing,” Fryhofer said regarding the NFID survey. “This survey found that many adults underestimate the seriousness of these viruses. They don't have confidence in the safety of vaccines. They don't have confidence in the effectiveness of vaccines. [A]s a result, many say they don't plan to get vaccinated. [T]his is very concerning.”

Although the COVID-19 public health emergency has ended, getting vaccinated against the virus is still important. Several variants—including EG.5, FL.1.5.1, and various XBB strains—are driving case counts and hospitalizations up. The FDA has approved 2 updated mRNA COVID-19 vaccines from Pfizer and Moderna, as well as a protein-based adjuvanted version from Novavax. All 3 of the vaccines are approved for individuals aged 12 years and older.

Having 2 different vaccine platforms available is exciting, Fryhofer said. The mRNA technology in Pfizer and Moderna’s vaccines is relatively new and some people are still uncomfortable with it. The approval of Novavax’s COVID-19 vaccine gives people a choice about which type they prefer to get, which could help increase rates of vaccination.

Fryhofer, who operates an internal medicine practice in Atlanta, said that some of her patients signed up to get one of the COVID-19 vaccines but were unable to due to short supply. She said this is likely because the US government is no longer fully funding the vaccines, which are now instead on the commercial market. There has so far been a greater demand then there has been availability, which she says is good in some ways because it shows people are more interested in getting vaccinated.

In regard to RSV, Fryhofer explained that there are currently 2 vaccines approved from GSK and Pfizer, which are approved for use in people aged 60 and older. Abrysvo, GSK’s RSV vaccine, is also approved for maternal use before or during RSV season, during weeks 32 through 36 of pregnancy. For infants 8 months or younger, the monoclonal antibody nirsevimab is approved for use during or entering the child’s first RSV season. Nirsevimab is also approved for infants and children 8 to 19 months old who are at an increased risk for severe disease and are entering their second RSV season.

While flu vaccines have a long history of protection and are well known, Fryhofer reminded the audience that everyone 6 months and older needs to get a dose each year. She then discussed some new developments with flu vaccines, which included that people who are allergic to egg no longer require additional safety measures and can get their flu shot anywhere it’s provided.

“We've got to raise awareness and address any misconceptions,” Fryhofer said. “These vaccines are safe and effective and they've gone through extensive safety testing before they're licensed or authorized. Understand these vaccines can keep you out of the hospital, they can save your life and this is a message we've got to make sure that our patients understand.”

Fryhofer likes to employ the AIMS approach when discussing vaccines with patients who might be a little hesitant. AIMS stands for announce, inquire, mirror, and secure. It’s designed to help providers engage “in more productive conversations with patients/caregivers to secure trust, a key behavior leading to higher vaccination rates.”3

“There's a there's a lot of misinformation out there,” Fryhofer said. “[A]s physicians, we are a trusted source of information. I [also] encourage patients to check websites with trusted sources of information… But you know, physicians are a trusted source. So, the AIMS method, I found in my practice, is really helpful.”

1. Lu Y, Wang Q, Zhu S, et al. Lessons learned from covid-19 vaccination implementation: How psychological antecedents of vaccinations mediate the relationship between vaccine literacy and vaccine hesitancy. Soc Sci & Med. 2023;336:116270. doi:10.1016/j.socscimed.2023.116270
2. 2023 National Survey: Attitudes about Influenza, COVID-19, Respiratory Syncytial Virus, and Pneumococcal Disease. News Release. NFID. September 28, 2023. Accessed October 6, 2023.
3. Parrish-Sprowl J, Thomson A, Johnson RD, Parrish-Sprowl S. The aims approach: Regulating receptivity in patient-provider vaccine conversations. Front Public Health. 2023;11. doi:10.3389/fpubh.2023.1120326
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