As the nation continues to grapple with surges in COVID-19 cases, a persistent message has emerged from public health officials: it's vital to get the flu vaccine this year.
Each influenza season puts a strain on the U.S. healthcare system as it leads to hundreds of thousands of hospitalizations. There were an estimated 490,000 hospitalizations last flu season and 810,000 in 2017-2018 when health officials had a difficult time pinpointing which strain would dominate. Concerns are amped up this year that health systems will become overwhelmed if the flu emerges in full force while COVID-19 continues to batter the country.
"The flu vaccine is more important than ever this year in light of the pandemic. If we can prevent influenza and reduce severity of illness through vaccinations, it's a strategy to alleviate stress on our health systems," said Dr. Eve Glazier, president of the UCLA Health Faculty Practice Group.
While pharmacies and public health agencies administer flu shots, data show many vaccinations—67% for children and 34% for adults in 2018-19—are performed at doctors' offices. Health systems across the country are taking up the issue and rethinking their flu vaccine strategy this year to encourage more patients and employees to get vaccinated.
"We would like to avoid a situation where we have a large number of people presenting for hospitalization due to the flu while we are still dealing with COVID-19," said Dr. David Callender, CEO of Memorial Hermann Health System in Houston.
Last flu season, about 45% of adults and 63% of children received the influenza vaccine. Vaccine makers are expecting more of the population to get vaccinated this year due to COVID-19 and they increased production as a result. Similarly, health systems acquired more vaccine doses this season to meet the expected higher demand. New Orleans-based Ochsner Health ordered 25% more flu shots this year than last year when it administered more than 200,000 vaccinations.
Health systems are rethinking how to get more patients and the community to get vaccinated with the added complication that some may doubt a flu vaccine is necessary given smaller social circles and mask wearing.
"I'm a little concerned that people who are always on the fence (about getting the flu vaccine) will say, 'I'm not going to get it, I'm just sitting around in quarantine by myself anyway,' but the flu has been with us for many years and it knows how to get us," said Dr. Jordan Asher, chief physician executive at Sentara Healthcare in Norfolk, Va.
Health systems have started advertising vaccinations earlier to encourage adoption. Ochsner Health usually doesn't begin its marketing for flu shots until November when Louisiana's influenza season kicks off. This year, marketing is beginning in September.
"We are advocating for earlier flu vaccination—to get it as soon as it becomes available," said Dr. Sandra Kemmerly, medical director of hospital quality at Ochsner Health.
The health system isn't spending more on marketing this year or changing its messaging from last year. But Ochsner leaders hope offering the vaccinations and starting the marketing campaign earlier will help increase vaccination rates as well as help clinicians make care decisions, Kemmerly said.
COVID-19 and influenza present similar symptoms, and patients would have to be tested for both viruses if they go to a hospital for treatment. Kemmerly said knowing whether or not a patient has been vaccinated for the flu will help clinicians determine how to approach treatment and testing earlier on. However, there is evidence that a person can test positive for both the flu and COVID-19.
Memorial Hermann Health is mentioning COVID-19 in its flu vaccine messaging to the community. Callender said the system wants the public to know how important the flu vaccine is this year, especially for children, the elderly and people with pre-existing conditions.
Memorial Hermann couldn't provide cost estimates for marketing this year.
Health systems are also revising how flu vaccines are administered to ensure it's safe and comfortable for patients.
UCLA Health in Los Angeles has modified its online patient portal enabling patients to book 15-minute appointments to get vaccinated at a UCLA clinic near them without approval from their primary care doctor. The portal also sends patients push notifications reminding them to get a flu shot. The aim is to enhance convenience for patients by allowing them to schedule appointments at locations best for them, Glazier said. Additionally, UCLA has extended hours at its clinics on weeknights and Saturdays.
"We are really trying to emphasize convenience and access," Glazier said.
In an attempt to increase vaccination rates, Ochsner Health is considering offering flu shots at its free COVID-19 testing sites. Similar to other health systems, Ochsner has partnered with local community organizations such as churches to offer free COVID-19 testing to underserved communities. "It might be a real opportunity to interact with patients that we don't have an opportunity to," Kemmerly said.
Ochsner hasn't decided if it will provide flu shots for free. Most commercial insurance covers flu shots and research shows uninsured patients are less likely to get immunized.
Some health systems such as Baptist Health South Florida and Sentara Healthcare are not charging patients, regardless of insurance status. Baptist Health also donates flu shots to local clinics.
UCLA offers free vaccinations for those who are part of its 50 Plus Program, which offers benefits to those 50 and over such as free health screenings.
Health systems are also rethinking their approach to encourage vaccinations among their staff.
Some systems such as UCLA and Sentara require all employees to get the flu shot and social distancing protocols add an extra layer of complexity to vaccinate a workforce with tens of thousands of people. "That's our biggest challenge, rethinking how we are going to get (35,000) staff members vaccinated," said Mary Morin, Sentara's vice president of clinical effectiveness.
The health system is addressing that by offering drive thru vaccines as well as deploying buses to Senatara parking lots to administer flu shots before and after employee shifts.
Health systems that don't require employees to get vaccinated, like Baptist Health, are trying to increase vaccination rates by improving convenience. Typically, Baptist Health would offer the flu shot in the cafeteria. Now that more people are working from home and mingling less during lunch, the health system plans on establishing a drive thru where staff can get the flu shot. Dr. Jack Ziffer, executive chief clinical officer of Baptist, said he expects employee vaccination rates, which were already at 97%, to be even higher this year regardless given the stressed importance of getting vaccinated. "Our employees are so attuned to wanting to do the right thing," he said.
