Millions of Older Adults Are Skipping Flu Shots Every Year

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The challenges that have long marked flu vaccination take on added importance in the context of the COVID-19 pandemic, when public health experts are urging everyone to get the flu vaccine for protection and to prevent hospitals from being overwhelmed with sick patients. As older adults forgo medical visits, shift prescriptions to mail order, and generally limit community activity in an effort to avoid adverse health outcomes related to COVID-19, they will likely have fewer opportunities to receive a flu vaccine. Nevertheless, now is the time for older adults to get vaccinated.

Flu season officially started October 1.  While we don’t yet know how severe this season will be, or how the flu will compound the impact of the COVID-19 pandemic, we do know the influenza virus infects millions of Americans every year. In 2018 alone, more than 12.3 million adults ages 50 and older contracted the flu. Older adults are also among those most at risk of serious illness and death from the flu. Of the up to 61,000 Americans who die each year from the flu, at least 90 percent are over the age of 50.

Flu vaccines, which are widely available each year, reduce infections and deaths and help limit how sick an infected person can get. Nevertheless, flu vaccination rates among older adults remained stubbornly low over the past decade. In 2018, according to our new report, slightly more than half (56 percent) of adults ages 50 and older received a flu vaccine—only an 11 percent increase from 50 percent in 2009. A range of factors has kept this rate low over the past decade and contributed to racial, ethnic, and insurance coverage disparities. Vaccination rates may remain steady or dip during the 2020–21 flu season and beyond unless these factors are addressed. This is of particular concern this year, when older adults face a double threat from the flu and COVID-19.

To get a Flu Vaccine or Not: That is the Question

Year after year, roughly 50 million older adults go without a flu vaccine. A recent AARP survey of adults ages 50 and older showed that the attitudes and beliefs that drive personal choice were driving factors. Respondents forgoing the vaccination cited the strongest factors in their decision to be a lack of interest in getting vaccinated (44 percent), concern about possible side effects (38 percent), concern about safety and efficacy (38 percent), and a belief that the flu vaccine isn’t needed (31 percent).

Additional, significant obstacles to vaccination are the lack of access to health care providers, costs associated with flu vaccines, and missing, inconsistent, or misleading information.

Racial and Ethnic Disparities in Flu Vaccinations

Flu vaccination rates vary by race and ethnicity. Over the past decade, older adults identifying as White or non-Hispanic were consistently more likely to be vaccinated against the flu than their Black or Hispanic counterparts.

Our report found that White adults ages 50 to 64 were consistently more likely to get a flu vaccine than their Black counterparts between 2009 and 2018, while non-Hispanics were more frequently vaccinated against the flu than Hispanics. In 2018, flu vaccinations in adults ages 50 to 64 were 18 percent higher in Whites than Blacks and 15 percent higher in non-Hispanics than Hispanics.

These racial and ethnic disparities persisted in adults ages 65 and older, with Whites and non-Hispanics more likely to get a flu vaccine than Blacks and non-Hispanics every year over the past decade. In 2018, flu vaccinations in adults ages 65 and older were 17 percent higher in Whites than Blacks and 10 percent higher in non-Hispanics than Hispanics.

These findings may, in part, be rooted in systemic barriers that prevent some individuals from accessing preventive services and contribute to a lack of trust in the health care system.

Insurance Coverage Impacts Vaccination Rates

While vaccines are covered by most types of health insurance, the type of health coverage that older adults have may also influence their likelihood of getting a flu vaccine. Among adults ages 50 and older, those with private insurance (including Medigap, the insurance that supplements Medicare coverage) were most likely among their age cohort to receive a vaccine—46 percent for persons ages 50 to 64 and 69 percent for those 65 and older. Older adults with Medicaid coverage were overall less likely to receive a vaccine—44 percent for adults ages 50 to 64 and 50 percent for those ages 65 and older. And less than a quarter of adults ages 50 to 64 who lacked insurance coverage received a flu vaccine in 2018, translating to fully 3.8 million uninsured adults going without a vaccine.

The “Twindemic”

The challenges that have long marked flu vaccination take on added importance in the context of the COVID-19 pandemic, when public health experts are urging everyone to get the flu vaccine for protection and to prevent hospitals from being overwhelmed with sick patients. As older adults forgo medical visits, shift prescriptions to mail order, and generally limit community activity in an effort to avoid adverse health outcomes related to COVID-19, they will likely have fewer opportunities to receive a flu vaccine. Nevertheless, now is the time for older adults to get vaccinated.