How to keep 'vaccine fatigue' from getting in the way of a flu shot

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After nearly three years of nearly nonstop talking about viruses and vaccinations, some people might be ready to tune out.

That would be a mistake, health experts say.

Amid warning signs of a potentially severe flu season ahead, those experts worry "vaccine fatigue" will keep people from getting their flu shot – and with it, a simple, safe way to protect themselves from life-threatening conditions, including heart attacks and strokes.

Australia, where winter is wrapping up, often serves as a crystal ball for influenza in the United States, and the signs are not good, said Dr. Martha Gulati, director of cardiovascular disease prevention in the Smidt Heart Institute at Cedars-Sinai in Los Angeles.

"The Southern Hemisphere had a bad flu season, and it came early," said Gulati, who co-wrote a 2021 review of research on the flu vaccine in people with cardiovascular disease in the Journal of the American Heart Association. "So we should be concerned that the exact same thing is going to happen here. That's why I'm specifically encouraging people to get their flu shot as early as possible."

September and October are indeed an ideal time, according to the Centers for Disease Control and Prevention. The CDC, American Heart Association and other health organizations advise annual vaccination for everyone six months of age and older, with rare exceptions.

But even before the pandemic, many people in the U.S. ignored such advice. In 2018-19, the last flu season unaffected by COVID-19, only about 63% of children and 45% of adults were vaccinated, according to the CDC.

The root of the problem is misinformation about vaccine safety, which also predates COVID-19, said Amelia Boehme, an assistant professor of epidemiology in the division of neurology clinical outcomes research and population sciences at Columbia University in New York City. She said politicization of the COVID-19 vaccines amplified those unfounded fears.

That has led to more discussion, which promotes more fatigue, she said. "People are tired of hearing about how it's safe. People are tired about hearing about studies on COVID outcomes."

She's heard people and read studies suggesting that fatigue about vaccines also stems from exhaustion with the pandemic itself. She understands.

"We all are tired of the pandemic," Boehme said. "We all wish it was over. But wishing it was over does not mean it is over."

The flu vaccine has always been a tough sell, she said. The idea that it is not 100% effective at stopping the flu, and that you need to take it yearly, doesn't sit well with some people, "and there have always been thoughts surrounding, 'Well, the flu is not that bad.'"

But it is serious. Between 2010 and 2020, the flu killed between 12,000 and 52,000 people annually. The CDC says flu can lead to bacterial pneumonia, ear infections, sinus infections and worsening of chronic medical conditions such as asthma, diabetes and congestive heart failure. A 2018 study found that the risk of having a heart attack was six times higher within a week of a flu infection.

A flu vaccine's effectiveness at preventing infection varies from year to year, as the formula changes to keep up with mutations in the virus. But vaccination lowers the odds you'll get seriously ill. According to the CDC, vaccination is associated with a 26% lower risk of ICU admission and a 31% lower risk of dying from the flu.

The CDC estimates that during the 2019-20 flu season, flu vaccinations prevented 38 million flu cases, 400,000 hospitalizations and 22,000 deaths.

Benefits from vaccination don't end with the flu itself, Boehme said. Research, including her own, has highlighted how the flu vaccine helps protect against heart attack, stroke and deaths related to heart disease.

The cumulative effects of being vaccinated year after year add up, Boehme said. "If a person has been vaccinated for influenza 10 years in a row, they have more protection over influenza in the next year than someone who had only been vaccinated for two years."

Given the benefits, it's no surprise that Gulati emphasizes the flu vaccine's safety and importance to her patients.

"The biggest reason that people tell me they don't want it is they're convinced it will make them sick," she said. But flu shots can't give you the flu, she tells them. She reassures them that side effects – which can include arm soreness from the shot, headache, fever or nausea – are usually mild and go away on their own. For people who are worried about how they'll feel afterward, she recommends taking acetaminophen ahead of time.

She'll encourage them well into the flu season, because getting a shot late is better than never.

Gulati and other doctors also recommend getting a new COVID-19 booster that targets the now dominant omicron subvariants of the coronavirus. COVID-19 has become one of the nation's leading causes of death and can cause a variety of problems, including heart inflammation, heart attack, stroke and blood clots in the legs or lungs.

But the flu and COVID-19 vaccines help protect both the vaccinated person and those around them by limiting the spread of the viruses. The CDC says it's safe to get both vaccinations at the same time. This year, higher-dose formulations of the flu vaccine have been approved for people 65 and older.

Health care workers could do more to promote flu vaccinations, Gulati said. A 2021 survey by the National Foundation for Infectious Diseases found that less than half of health care professionals recommend annual flu shots for most of their patients with chronic health conditions.

"Everyone should be bringing this up with their patients, but particularly, those who take care of patients with chronic diseases must do better," she said.

Boehme urges people to not let their frustration with the pandemic cloud their thinking about the importance of all kinds of vaccinations. "Discussions around vaccines are necessary for public health," she said. "And especially as we're seeing polio reemerge, and monkeypox, we'll be seeing discussions about other vaccines."

Gulati is grateful to be able to have such discussions, though. "I think if somebody approached me and said, 'Oh, I'm sick of talking about vaccines,' I would say, 'How lucky are we to live in an era where we have so much modern medicine and technology that has helped protect us?'"

But she added, "Of course I'm biased. Because I see the sickest people, when they don't get vaccinated, and what the consequences are."

Editor's note: Because of the rapidly evolving events surrounding the coronavirus, the facts and advice presented in this story may have changed since publication. Visit Heart.org for the latest coverage, and check with the Centers for Disease Control and Prevention and local health officials for the most recent guidance.

If you have questions or comments about this American Heart Association News story, please email [email protected].