How to Talk to Your Employees About Getting a Flu Shot in the COVID-19 Pandemic
October is typically the start of “flu season” with an increase in influenza viruses that circulate all year. With COVID-19 still present in many communities, health officials worry how a serious influenza season might complicate efforts to provide care for all who need it. You worry about the health of your workforce. As we plan for the 2020-2021 flu season, these questions arise: How will months of coping with the COVID-19 pandemic affect employee response to annual flu vaccination campaigns? What factors will motivate individuals to get a flu shot? What factors will serve as barriers? The answers to these questions may depend, in part, on how you talk to your teams, listen to their concerns, and respond to their questions. This article is intended to aid the conversation in the first flu season concurrent with a pandemic since 2009.
Vaccine response in the 2009 pandemic
An influenza A virus, subtype H1N1, originating in swine was responsible for the 2009 pandemic, colloquially referred to as “swine flu.” From April 12, 2009 to April 10, 2010, the Centers for Disease Control and Prevention (CDC) estimated there were 60.8 million cases, 274,304 hospitalizations, and 12,469 deaths.1 The U.S. Food and Drug Administration (FDA) approved four H1N1 (“swine flu”) vaccines in September 2009 after an H1N1 peak in May and June; a second wave of the virus occurred in late October. The FDA approved a fifth H1N1 vaccine on November 16. In late December, the H1N1 vaccination became available to anyone who wanted it. The World Health Organization proclaimed the end of the H1N1 pandemic on August 11, 2010.2
Did 100 percent of people get the H1N1 vaccination once it was available? Hardly. British researchers explored the reasons for “a low H1N1 vaccination rate in the United Kingdom” by interviewing 1,320 adults in five national telephone surveys.3 In summary, 69 percent of respondents were positive about the vaccine (55.6 percent got it and 13.4 percent said they were either very likely or fairly likely to get it). Thirty percent were either not very likely or not at all likely to get it; and one percent didn’t know.
The main reasons for not getting a vaccination were vaccine safety concerns and respondents who felt they did not need the vaccine because they were generally healthy. H1N1 vaccination was less likely when people:
- Had no chronic illness
- Had declined the seasonal flu vaccine in prior years
- Felt too much “fuss” was being made over the pandemic
- Believed the vaccine was ineffective
Some of these factors, and a few others, affect whether individuals in the United State get a seasonal flu shot (vaccine uptake) or not (vaccine hesitancy), as we shall see.
Reasons for seasonal flu vaccine hesitancy
One of the most comprehensive assessments of adults’ flu shot behaviors comes from German researchers who reviewed 29,630 independent studies or articles and intensely investigated 470 of these to identify 72 “barriers” that kept adults, primarily Americans and Europeans, from getting a flu shot. They also found factors that motivated flu shot acceptance.4 Their research was exhaustive and included more than 500 citations to independent research studies that contributed to the overall findings. The leading factors (both for getting and for not getting a flu shot) are summarized in the table below. Following the table are suggestions for managers to promote respectful discussions about flu shots among employees who have these concerns.
The factors in this table are derived from the following research study: Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016. PLoS One. 2017; 12(1): e0170550. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268454/
Interestingly, researchers found that age, gender, ethnicity, race, and marital status did not have a conclusive effect on whether an individual chose to get a flu shot or not. The one exception was that single women living with one or more children were more inclined to get a flu shot.
Using the three groupings on the left in the “Unlikely to Get a Flu Shot” column, let’s look at these concerns and how you as a manager (or an occupational health provider assisting you, like Concentra®) might address these beliefs and potentially motivate an individual to reconsider and get a flu shot this year.
Group 1 Beliefs: Personal Invincibility
Some employees are healthier than others, and this may cause them to embrace beliefs in Group 1 in the table. Their good health may be reflected in good attendance and strong productivity. But no one is invincible. Circulating influenza viruses change continuously, and the flu bug may find a way to vault over the wall of any immune system response. Encourage your employees in healthy practices – whatever their health record – and explain about constantly evolving flu viruses. Since a flu vaccination is available, why not use it as a first line of protection? It is also worth mentioning to them that the CDC has consistently said “a flu vaccine is the first and best way to reduce your chances of getting the flu.”5
Let your employees know you value them and want to protect their health to the best of your ability. Discuss any extra safety measures new in the workplace because of the COVID-19 pandemic; those practices (social distancing, hand/sneeze/cough hygiene, etc.) may also help stymie potential transmission of influenza. But the flu shot is a valuable line of defense, as well.
Group 2 Beliefs: Concerns About the Flu Vaccine’s Safety, Effectiveness
This group of beliefs is highly complex, and that’s a good reason to enlist the help of the occupational health experts at Concentra. Before tackling the topics of vaccine safety and effectiveness, it’s wise to set a ground rule that all views will be given a respectful hearing. There are a variety of reasons for vaccine hesitancy and a Swedish bioethics researcher has found that only respectful communication can foster and maintain trust, as well as leave open the door for people who are vaccine hesitant to change their minds.6
First, address safety. The CDC says “flu vaccines have a good safety record. Hundreds of millions of Americans have safely received flu vaccines over the past 50 years, and there has been extensive research supporting the safety of flu vaccines.”7
It is true that sometimes side effects will be experienced after getting a flu shot – most commonly redness or swelling at the injection site. Headache, nausea, and muscle aches also are possible. Any person who is allergic to flu shots or their ingredients or who has a history of Guillain-Barre syndrome is advised to consult a doctor.8
Before a flu vaccine is approved, the Food and Drug Administration (FDA) evaluates its safety and effectiveness and ensures compliance with good manufacturing practice regulations. The CDC and FDA also continuously monitor for any adverse effects.9
Employees who question the effectiveness of the flu vaccine may be surprised to learn that the CDC acknowledges flu vaccines have never been 100 percent effective (but are still the single best step for preventing illness). From 2009 through 2018, estimates of the effectiveness of flu vaccines ranged from a low of 19 percent in 2014-2015 to a high of 60 percent in 2010-2011.10 For the 2019-2020 flu season, preliminary estimates indicate vaccine effectiveness for A and B flu viruses varied from 35 percent in the 18-to-49 age group, 42 percent for ages 50 to 64, and 37 percent for people 65 and older.11
Major benefits of the flu shot include avoidance of illness, medical visits, and death. Consider a five-year period from the 2014-2015 flu season to the 2018-2019 flu season.12 The CDC estimates flu shots averted an annual average of:
- 4.5 million cases of symptomatic flu illness
- 2.3 million medical visits
- 66,000 hospitalizations
- 4,800 deaths
Another point of assurance you can give employees who are concerned about flu vaccine effectiveness is this: Concentra’s preferred supplier is the only US-based vaccine manufacturer using cell-based technology that potentially improves the effectiveness of the vaccine compared to egg-based vaccines. Vaccines produced by growing influenza viruses in eggs can introduce “egg-adapted changes” that interact with an individual’s immune system to produce antibodies that are less effective at preventing disease caused by the specific flu viruses in circulation. The FDA approved cell-based technology to help improve vaccine effectiveness.13 That is a good reason to come to Concentra for your flu vaccination program.
Finally, in this group of beliefs about flu vaccinations, there is a persistent myth, and you may have already guessed what it is: “I think the flu shot will give me the flu.” A flu shot cannot give a person the flu because it does not contain a live virus. A flu shot (depending on the vaccine) contains either an inactivated virus or a particle designed to look like the virus to the immune system. A nasal spray vaccine does contain live virus but it is changed so it cannot give you the flu, the CDC explains.14
Group 3 Beliefs: Barriers in Trust, Support, and Logistics
People are motivated to act – to get a flu shot – when encouraged by people and organizations they trust. In the absence of encouragement by a spouse, family (or the presence of children in the household), friends, or employer, people are less inclined to get a flu shot, German researchers discovered.15 Even the word of local, state, or national health officials may not be enough this year because public trust has eroded due to widespread confusion and misinformation about the COVID-19 pandemic.16
Kaiser Health News (KHN) is a nonprofit news service that covers health care policy and health issues.17 KHN reported on an effort to track down internet misinformation. It identified 217 websites in Europe and the United States that dispensed “materially false” information about COVID-19.18 As a result, there may be more confusion this year about health information. Advise your employees to rely on scientific research and authorities like the CDC. Enlist an occupational health provider, such as Concentra, that is science-based in its practices and educational outreach. Emphasizing science-based information will serve you well in another way. Public trust in medical scientists and medical research scientists has increased, according to an April 2020 national survey by the Pew Research Center. Public confidence in medical scientists to act in the best interests of the public has increased since the COVID-19 pandemic began; public confidence in medical scientists generally has held steady, perhaps increased slightly, from 2019 to the spring of 2020.19
There may be a tendency to numb ourselves to information about the flu because it occurs every year. This may be especially true when something new and different emerges, such as the COVID-19 pandemic. Take a few minutes during a team meeting to quickly review together the CDC’s influenza information page to raise awareness about the facts.
Logistical barriers – lacking a primary care physician, transportation, and cost – can be addressed by setting up a flu vaccination program with Concentra. Your employees can come into any nearby Concentra center or, if you have an onsite program, flu shots can be provided at your worksite.
Who should NOT get a flu shot
The list of people who should not get a flu shot is small20:
- Anyone younger than six months of age
- Anyone with life-threatening allergies to the flu vaccine or its ingredients
- Anyone with a history of Guillain-Barr syndrome should first consult with their doctor
Good news about the 2020-2021 flu season
Given a choice, most of us would have been happy to forego months of following CDC-recommended self-care practices to help prevent virus transmission – things like hand/cough/sneeze hygiene, social distancing, and sanitizing surfaces. Nonetheless, we’ve been to school on these practices now and the COVID-19 pandemic has been a mighty teacher. Continue to encourage employees in using self-care practices, in the interest of their health and the health of people around them.
Before any employees get sick, here are some important tips to remember:
- A flu shot program in September or later can help protect your workforce all flu season. This not only keeps employees healthy and working but helps conserve potentially scarce health resources during the COVID-19 pandemic.
- Flu and COVID-19 symptoms are very similar and usually can only be distinguished with a COVID-19 test. Decreased access to testing may lead to a longer time away from work. Getting a flu shot may help your employees avoid all that.
- Although a flu shot will not protect employees from COVID-19, it has been shown to reduce the need to visit a hospital or other medical facility by 40 to 60 percent21, possibly avoiding exposure to COVID-19-infected people.
- Flu shots help avoid flu illness and can reduce worsening of chronic heart and lung conditions and diabetes.22
- It is possible to be infected with both flu and COVID-19. Co-infection may increase the severity of COVID-19.
- Employees suspected or confirmed with COVID-19 should not get a flu shot until they have met the criteria to discontinue isolation.”
The best news is, you can partner with Concentra for all your flu vaccination program needs and get occupational health expertise backed by more than 40 years of experience.
1 2009 H1N1 Pandemic. Centers for Disease Control and Prevention. Last reviewed: June 11, 2019. https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html
2 2009 H1N1 Pandemic Timeline. Centers for Disease Control and Prevention. Last reviewed: May 8, 2019. www.cdc.gov/flu/pandemic-resources/2009-pandemic-timeline.html
3 Han YKJ, Michie S, Potts HWW, Rubin GJ. Predictors of influenza vaccine uptake during the 2009/2010 influenza A H1N1v (‘swine flu’) pandemic: Results from five national surveys in the United Kingdom. Preventive Medicine. 2015; 84: 57-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766366/
4 Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of Influenza Vaccination Intention and Behavior – a Systematic Review of Influenza Vaccine Hesitancy, 2005-2016. PLoS One. 2017; 12(1): 30170550. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268454/
5 Flu Vaccine Safety Information. Centers for Disease Control and Prevention. Last reviewed: September 17, 2019. https://www.cdc.gov/flu/prevent/general.htm
6 Fahlquist JN. Vaccine hesitancy and trust. Ethical aspects of risk communication. Scandinavian Journal of Public Health. 2018; 46(2): 182-188. https://pubmed.ncbi.nlm.nih.gov/28847220/
7 Flu Vaccine Safety Information. https://www.cdc.gov/flu/prevent/general.htm
9 “What are the benefits and risks of flu shots?” Medical News Today. Last medically reviewed: March 26, 2020. https://www.medicalnewstoday.com/articles/flu-shots-pros-and-cons#safety
10 CDC Seasonal Flu Vaccine Effectiveness Studies. Centers for Disease Control and Prevention. Last reviewed: July 1, 2020. https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm
11 US Flu VE Data for 2019-2020. Centers for Disease Control and Prevention. Last reviewed: July 29, 2020. https://www.cdc.gov/flu/vaccines-work/2019-2020.html
12 Past Seasons Estimated Influenza Disease Burden Averted by Vaccination. Centers for Disease Control and Prevention. Last reviewed: January 7, 2020. https://www.cdc.gov/flu/vaccines-work/past-burden-averted-est.html
13 Cell-Based Flu Vaccines. Centers for Disease Control and Prevention. Last reviewed: October 11, 2019. https://www.cdc.gov/flu/prevent/cell-based.htm
14 Flu Vaccine Safety Information. https://www.cdc.gov/flu/prevent/general.htm
15 Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005-2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268454/
16 “Conflicting COVID Messages Create Cloud of Confusion Around Public Health and Prevention. US News and World Report. June 19, 2020. https://www.usnews.com/news/healthiest-communities/articles/2020-06-19/conflicting-coronavirus-messages-create-confusion-misinformation
17 Kaiser Health News. https://khn.org/about-us/
18 “How Mis- And Disinformation Campaigns Online Kneecap Coronavirus Response,” Kaiser Health News. June 29, 2020. https://khn.org/news/conflicting-covid-messages-create-cloud-of-confusion-around-public-health-and-prevention/
19 “Trust in Medical Scientists Has Grown in the US, but Mainly Among Democrats.” Pew Research Center, May 21, 2020. https://www.pewresearch.org/science/2020/05/21/trust-in-medical-scientists-has-grown-in-u-s-but-mainly-among-democrats/
20 Who Should and Who Should NOT get a Flu Vaccine. Centers for Disease Control and Prevention. Last reviewed: October 11, 2019. https://www.cdc.gov/flu/prevent/whoshouldvax.htm
21 What are the benefits of flu vaccination? Centers for Disease Control and Prevention. Last reviewed: December 3, 2019. https://www.cdc.gov/flu/prevent/vaccine-benefits.htm