Now, more than ever, U.S. policies should reflect the value of flu vaccines

The following is a guest post by Erin Keizur, Jeffrey D. Klausner, MD, MPH.

While the devastating impacts of COVID-19 to individuals, to our most vulnerable populations, to our lives, our infrastructures and our economies have highlighted the harms that an efficiently transmitted respiratory viral illnesses can bring, the current pandemic also has demonstrated the value of a vaccine. Without a vaccine, we confront COVID-19 with all we have -- what public health experts call NPIs – non-pharmaceutical interventions – which include staying home and staying away from each other, bringing lives, commerce, recreation and rites of passage to a halt in the process.

But, in the interests of easing burdens on our health systems, and reducing risks to each other, it is crucial that we also make better use of the vaccines we do have, including the flu vaccine. That is why, as this pandemic began to emerge, the U.S. Centers for Disease Control and Prevention urged Americans to get vaccinated against the flu.

Every year seasonal influenza virus affects millions of individuals and takes thousands of lives. In the current flu season, the CDC estimates at least 39 million influenza-related illnesses, 400,000 hospitalizations, and 24,000 deaths have occurred. In the previous 2018-2019 flu season, the CDC estimated there were over 10 million symptomatic illnesses, 45,000 hospitalizations, and 450 deaths among children age 0-17 years.

The influenza vaccine can substantially reduce negative health outcomes and protect millions of individuals from influenza-related illness. It has been shown to reduce the risk of flu-associated death by 65% among healthy children. Even with modest vaccination coverage, the CDC estimates that during the 2018-2019 flu season, the influenza vaccine prevented 4,400,000 people from having symptomatic illness, 2,300,000 medical visits, 58,000 hospitalizations, and 3,500 deaths. If influenza vaccination reached a 95% population coverage, a feat we have achieved with other vaccines, we would see an even greater prevention of illnesses, hospitalizations, and deaths from influenza.

The influenza vaccine is recommended by the Advisory Committee on Immunization Practices and the CDC yearly for all individuals age six months and older, yet vaccination rates remain modest. In the previous 2018-2019 season, only 62.6% of children six months-17 years and only 45.3% of adults 18 years and older were vaccinated. That lack of vaccination is a major missed opportunity to prevent hospitalizations and deaths from influenza. Along with the negative health outcomes for individuals, influenza also places substantial economic burden on the United States through medical visits, hospitalizations, loss of work and productivity. One study estimated the average total economic burden of influenza was $11.2 billion annually. We can afford that less now than ever before. The need to update influenza vaccination policies in the United States is urgent.

To begin, the Federal government and ACIP must reinforce the recommendation that all persons aged six months or older receive a yearly influenza vaccine. Additionally, to reach 95% vaccination coverage, the influenza vaccine should be required yearly for all individuals in high risk settings such as schools, hospitals and medical settings, nursing homes, assisted living facilities, jails, prisons, immigrant detention centers, and all businesses that employ more than 50 employees.

Only six states require the influenza vaccine for childcare enrollment, and no state requires influenza vaccination for grade school entry. States currently require vaccines for school entry for a limited number of preventable diseases such as measles, rubella, and varicella, and the influenza virus should not be an exception. The influenza vaccine should be an annual requirement for school entry among all grades.

Efforts to update influenza vaccine requirements must begin now to ensure new policy implementation for the Fall of 2020. State officials should use their authority to enact these policy changes and prevent another year of unnecessary hospitalizations and deaths from influenza. Some states, such as California, allow for the addition of new vaccines for school entry requirement through public health departments if recommended by the ACIP and approved by the U.S. Food and Drug Administration. That allows for more opportunities for disease prevention at the state level. States must take action to protect the health of all individuals through greater requirements surrounding the influenza vaccine. The Department of Health and Human Services should convene a policy group to monitor, facilitate, and help regulate those requirements. Congress should consider expanding the Vaccines for Children Act to cover costs for influenza vaccination for all U.S. residents, not just those under the age of 19 years.

Increasing uptake and access to the vaccinations we have has never been more important. Failure to implement a strong, comprehensive influenza vaccine policy will cause the United States to be highly vulnerable in upcoming seasons, leading to additional economic losses and deaths that could have been prevented.