January 22, 2020 03:44 pm David Mitchell – According to CDC estimates, at least 13 million influenza-related illnesses, 120,000 hospitalizations and 6,600 deaths from flu had occurred as of Jan. 11 in the United States during the 2019-2020 flu season. Despite those staggering numbers, more than half of Americans haven't received a flu shot this season, and nearly a third of adults don't plan to get one, according to results of a survey the AAFP commissioned last year.
The survey, conducted by Wakefield Research between Nov. 27 and Dec. 9, investigated the impact of myths and misconceptions about the flu among adults ages 25 to 73. When provided with a series of facts about influenza, more than 80% of adults overall got at least one fact wrong, and 28% got all of them wrong.
Moreover, the results found that certain groups, including millennials and African Americans, are more susceptible to antivaccination rhetoric, while men are more likely than women to forgo vaccination -- both for themselves and their children.
Millennials were the least likely age group to have been vaccinated, the survey revealed, with 55% reporting that they had not received a flu shot this season. Of those, one-third said they did not plan to get vaccinated.
When asked about the health risks of influenza, millennials also were the least-informed group, with 86% of respondents getting at least one fact wrong, and 31% getting all of them wrong. More than 60% of millennials who were familiar with the antivaccination movement said they agree with some antivaccination beliefs, compared to 52% of all adults surveyed and 42% of baby boomers.
As far as reasons given for not being vaccinated, millennials were almost twice as likely to say they forgot to get the vaccination compared with older generations. They also were twice as likely to say they didn't have time to get a flu shot compared with Generation X respondents and three times more likely than baby boomers to use that excuse.
African Americans had the lowest vaccination rate compared with other ethnic groups, with 55% of respondents saying they had not yet received a flu shot, and 34% saying they did not plan to receive one. When asked about the flu, nearly 90% of African Americans got at least one flu fact wrong, and more than one-third got all of the facts wrong.
Finally, men were more likely to underestimate the dangers of the flu compared with women. More than 20% of men reported forgoing a flu shot because they didn't deem the disease serious compared with just 5% of women. Similarly, 19% of men reported not vaccinating their children for that same reason compared with only 2% of women.
More than 20% of parents overall were concerned that their children would get sick as a result of vaccination, 13% thought their children didn't need the shot, and 10% didn't consider flu to be a serious health risk.
Margot Savoy, M.D., M.P.H., a graduate of the AAFP Vaccine Science Fellowship program and a former Academy liaison to the CDC's Advisory Committee on Immunization Practices, recently offered tips for immunizing hesitant patients against the flu in the AAFP's Leader Voices Blog. AAFP News followed up with Savoy, who also is a member of the AAFP Board of Directors, to get her thoughts on the survey.
Q: Is there anything in the survey results that surprised you?
A: I didn't find the results surprising, but they did confirm what I sensed was happening in my practice. My millennial patients really struggle to come in for preventive care in general, so if they don't get sick or need a required physical for work, there is a good chance I won't have an opportunity to talk to them about influenza vaccine. There are a lot of reasons for that, including lack of paid sick time, rising deductibles and cost-sharing with high-deductible plans.
My patient panel is about 80% African American, and it didn't surprise me that they are less likely to be vaccinated, either. There continues to be widespread mistrust of the medical and pharmaceutical industry for using African Americans as experimental subjects without their consent, and that shows up as deep mistrust and fear around vaccines, invasive procedures, new medications and research protocols.
Q: Should practices be targeting groups that are more resistant to vaccination?
A: I think we should continue to offer vaccine to everyone at each opportunity and find ways to reduce barriers wherever possible (no appointment needed, no copay, offering pain minimizing techniques, etc.). It is always great to use diverse images in marketing campaigns, but I would not approach how I recommend influenza vaccine differently based on age, race or cultural background.
Q: How, then, might primary care physicians reach those specific groups and change their attitudes?
A: I think it makes a difference when people have a family physician they know well and trust. (I don't think it hurts to have access to doctors who share your background or have similar cultural beliefs.) Patients who will decline the vaccine initially will reconsider in future years when they come to know me better and appreciate that I don't recommend things to them that I wouldn't also recommend for myself or my own family. And I won't abandon them even if I disagree with their decision not to be vaccinated today; I also won't give up trying to change their mind because I care about their health.
Q: Education is obviously important, but how do you go about providing that? How do you get the message to people that they should be vaccinated?
A: In my office, we use the team-based approach -- from our front desk through the medical assistant, to the medical student, to me -- with each person asking again if the patient declines vaccination and answering any questions or concerns they may have. We start telling patients in the summer that we will be giving their flu shot at the next visit (adult anticipatory guidance). We minimize barriers by providing information in more than one language. Patients don't need a physician visit to be vaccinated; they can be vaccinated using a standing order, and we continue to recommend and offer vaccine at every visit during flu season.
I believe in transparency with patients, so I openly share with them a story about the time I didn't get vaccinated and managed to get the flu in medical school. I also share with them that I make sure my family gets vaccinated every year (including my needle-averse sister). I validate their fears and concerns, and we talk about which ones are based on real potential side effects and which are myths.
I don't know how to address the abundance of false information on social media. Some recommend flooding our own accounts with positive and accurate facts. Others encourage us to challenge the false claims, but that appears to lend credibility to the people spreading false claims. Personally, I have open conversations with my patients about social media and how I judge what to believe or not. It's slow going to have to influence a population one person at a time, but it is better than doing nothing. I also privately reach out to my friends who post false information to educate them and help them access more useful information so they can make informed decisions about their health.
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