February 2011 HEALTH HOT TOPICS

What Can Be Done to Boost Low Flu Vaccination Rates in the United States?

Seasonal flu is a significant public health threat in the United States. Yet, seasonal flu can be prevented by annual vaccination, which has been proven safe and effective. Despite this, fewer than half of U.S. adults received flu vaccinations last year, according to analysis by RAND Health researchers. A nationally representative survey of 4,000 adults conducted by RAND in March 2010 found that only 39 percent of U.S. adults received seasonal flu vaccinations during the 2009–2010 flu season. Among adults age 50 or over and other high-risk individuals for whom vaccination is specifically recommended, such as pregnant women and health workers, rates were only slightly higher: 45 percent overall.

What explains these low rates, and what can be done to improve them? Separate studies found that more than 53 million U.S. adults made at least one contact with a health care provider between October and December 2008 but went unvaccinated. If providers could take advantage of these "missed opportunities" to vaccinate patients, overall adult vaccination rates would increase to approximately 62 percent. However, only about 60 percent of these adults indicated that they were amenable to being vaccinated based on a recommendation from a health care provider. An additional survey of adults who went unvaccinated found that more than half cited negative perceptions of the flu vaccine as their main reason for not being vaccinated, including a perceived lack of need (28 percent), a lack of belief in flu vaccines (14 percent), and a perceived risk of illness or side effects (14 percent).

These results highlight the need for policymakers and the public health community to develop more effective ways of informing and motivating the public to get vaccinated for the flu. Simple reminders to be vaccinated and greater convenience may prompt those who are positively predisposed to vaccination to follow through. However, convincing skeptical individuals to be vaccinated is likely to require substantially more effort, such as face-to-face counseling with health care providers. Understanding the public's motivations to be vaccinated is as vital to public health as the development of safe and effective vaccines.

READ THE RESEARCH BRIEF: Seasonal Flu Vaccination: Why Don't More Americans Get It?

Hispanic Seniors Are Less Likely to Receive Flu or Pneumonia Vaccine

RAND research suggests that the generally low flu vaccination rates among U.S. adults may be even lower among specific populations. A study led by RAND researcher Amelia Haviland found that Hispanic residents ages 65 and older are less likely to be immunized against flu or pneumonia compared to similar white seniors.

The study analyzed information from more than 244,000 seniors surveyed in 2008 as a part of the Medicare Consumer Assessment of Healthcare Providers and Systems, a federal project that regularly collects information from a large number of American seniors about health care issues. Results showed that immunization rates for pneumonia were substantially lower among both Spanish-speaking and English-speaking Hispanics when compared to Whites of the same age: 74 percent for white seniors compared with 56 percent of English-speaking Hispanic seniors and 40 percent of Spanish-speaking Hispanic seniors.

Findings for seasonal flu vaccination also showed disparities, though they were less dramatic. While 76 percent of white seniors received vaccination against the flu, just 68 percent of English-speaking Hispanic seniors and 64 percent of Spanish-speaking Hispanics seniors did so. Communities with a longstanding Hispanic population had significantly smaller disparities in influenza vaccination rates, regardless of language preference.

The results suggest that Hispanic seniors and other subgroups with significant disparities should be targeted with special outreach efforts in the future. Geographic targeting of subgroups at risk for not being vaccinated and related efforts such as health literacy mapping would also help improve the targeting of vaccine resources.

READ MORE: Hispanic Seniors Less Likely to Be Immunized Against Flu and Pneumonia

Flu Pandemics Are Rare but Pose a Constant Threat

When a flu virus mutates in such a way that an entirely new strain emerges, it may trigger a pandemic—the rapid, global spread of the disease. A commentary by Dr. Melinda Moore, natural scientist and public health expert at RAND, explains why.

The most common flu virus mutations are small, and immunity from prior infection or vaccination gives people some protection from new flu strains; however, flu viruses' natural tendency to mutate requires production of a new flu vaccine each year. Moreover, there is always a chance that a new strain of flu, entirely unfamiliar to human immune systems, may emerge. The last century witnessed three flu pandemics; the 1918–1919 pandemic was especially lethal, killing an estimated 50 million people worldwide.

In spring 2009 a new flu strain (2009-H1N1) emerged in North America. Because this virus was new to humans and readily transmissible, it quickly reached pandemic proportions. The pandemic caused milder illness and fewer deaths than the 1918 pandemic, partly due to the lower severity of the flu strain and to drugs for treating bacterial pneumonia, a secondary infection that can further complicate a flu case. Good planning and pandemic preparedness also helped countries detect cases and respond quickly. Government public health agencies tracked cases and risks worldwide and mobilized public health interventions to protect communities. They also ensured medical care and effectively educated citizens to take proper precautions to prevent disease.

Yet, the global health community must remain vigilant and prepare itself to respond even more effectively to the next pandemic. In 2009, a vaccine was produced quickly, but not fast enough to beat the first two waves of H1N1 in Europe and the Americas. In a world in which viruses can spread at jet speed, governments need to share timely information and ensure the timely production and delivery of sufficient doses of vaccine.

READ COMMENTARY: Flu and Far Between

RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health.html.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND focuses on the issues that matter most such as health, education, national security, international affairs, law and business, the environment, and more. As a nonpartisan organization, RAND operates independent of political and commercial pressures. We serve the public interest by helping lawmakers reach informed decisions on the nation's pressing challenges. Learn More »

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