Reducing Racial and Ethnic Disparities in Influenza Vaccination for the 2024–2025 Flu Season

Reducing Racial and Ethnic Disparities in Influenza Vaccination for the 2024–2025 Flu Season

Inequities in Racial and Ethnic Influenza Vaccination Coverage among Adult Americans: Provider Recommendations to Closing the Coverage Disparity Gap for the 2024–2025 Flu Season in the United States

Summary

Significant public health efforts have been aimed at improving access to vaccination and other forms of care to equitable influenza (flu) outcomes nationally. Such efforts have seen a steady increase in flu vaccinations over each season over the years, with a notable increase in the 2019-2020 and 2020-2021 flu seasons. However, there has been a significant stagnation in the uptake of these vaccines from 2020 through the 2023 flu season. At the same time, racial and ethnic disparities in the coverage of influenza vaccination are still persistent in the United States. The Black, Hispanic, and Native American groups have historically seen lower rates of influenza vaccination coverage compared to Whites, leaving them vulnerable. This report provides evidence-based, tailored recommendations to improve flu vaccination rates among these minority racial/ethnic groups for the 2024–2025 flu season.

Introduction

Influenza is a major public health issue of concern in the United States. The annual influenza viruses, majorly circulating throughout the fall to spring seasons, cause respiratory conditions that may clear without serious complications (Grohskopf et al., 2024). However, influenza virus infections are associated with serious lower respiratory tract infections that increase the risk and rate of hospitalizations, death, and an increased burden of disease (Macias et al., 2021). The Centers for Disease Control and Prevention (CDC) reports that there have been an estimated 9 to 41 million illnesses, 140,000 to 710,000 hospitalizations, and 12,000 to 52,000 influenza-related deaths annually between 2010 and 2020 (Black et al., 2022). The CDC further notes that the 2023-2024 flu season (October 1, 2023, through June 15, 2024) has seen an estimated 35 million illnesses, 16 to 30 million medical visits, 400,000 hospitalizations, and 25,000 deaths (Centers for Disease Control and Prevention, 2024b). The annual influenza vaccination is recommended as the most effective approach to preventing the annual flu and related illnesses, hospitalization, complications, and death (Grohskopf et al., 2024). The World Health Organization (WHO) (2024) recommended trivalent vaccines for use for the 2024-2025 flu season, including egg-based vaccines and cell culture- or recombinant-based vaccines. Despite these recommendations and national efforts to promote vaccination across the U.S., there are evident racial and ethnic disparities in flu vaccination coverage that persist, creating significant health inequities. This report presents influenza vaccination trends, identifying gaps in vaccination coverage across adults from various racial and ethnic backgrounds, and develops evidence-based tailored recommendations to close such gaps and improve flu vaccination rates among adults in these population groups for the 2024–2025 flu season.

Methods

The data reviewed on the flu vaccination coverage by race or ethnicity was drawn from the National Center for Immunization and Respiratory Diseases (NCIRD) accessed via the CDC and previous reports for 2019-2020, 2020-2021, 2021-2022, 2022-2023, and 2023-2024 flu seasons. The quality of evidence from the literature to inform recommendations is assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Flu Vaccination Coverage by Race/Ethnicity

The reviewed data shows a notable increase in the rate of vaccination at the national level across all racial/ethnic groups. For instance, the national vaccination coverage for adults was 48.4% during the 2019-2020 flu season, which rose to 51.8% in the 2020-2021 season (Black et al., 2022). During the same periods, the influenza flu vaccination coverage for various racial/ethnic groups was at 52.6% for non-Hispanic whites, Blacks at 41.8%, and 44.9% and 45.2% for Hispanic and Native American groups during the 2019-2020 season, and 55.2% among non-Hispanic White adults, 44.5% among Blacks, 49.1% among Hispanics, and 50.3%, among Native American adult populations for the 2020-2021 season (Centers for Disease Control and Prevention, 2024a). There were notable improvements in the overall influenza vaccination coverage across all racial/ethnic groups for the 2019 through 2020-2021 seasons. However, the influenza vaccination coverage for Black, Hispanic, and Native American groups was lower as compared to coverage among non-Hispanic Whites.

The period during and after the COVID-19 pandemic has seen the greatest reluctance in vaccine uptake, including the uptake of influenza vaccination. The 2021-2022, 2022-2023, and 2023-2024 seasons have seen a decline in influenza vaccination coverage among adults from racial/ethnic minority groups as compared to non-Hispanic Whites. For instance, the 2021-2022 flu season saw the rise in vaccination coverage for non-Hispanic White adults to 54.3%, while for Black, Hispanic, and Native Americans dropped to 42%, 38%, and 41%, respectively compared to previous years (Centers for Disease Control and Prevention, 2024a).

In the period from 2022 to the current 2023 flu seasons, the trends in influenza vaccination coverage have continued to rise across all racial/ethnic groups, with non-Hispanic White adults having a higher coverage rate of 55.7% as compared to previous seasons, while the coverage among adults from Black, Hispanic, and Native American adults rose to 46.2%, 47.9%, and 50.1%, respectively. These trends are promising and indicate success over the nationwide efforts to overcome vaccine reluctance. However, a comparison of the coverage trends from 2019 through to 2024 seasons shows major vaccination disparities that still persist among Black, Hispanic, and Native American adults, as compared to their White adults. Such disparities exist due to overlapping factors that have an impact on the ability and willingness to take influenza vaccines, such as socioeconomic barriers, misinformation about vaccines, concerns over vaccine safety, and lack of a culturally sensitive approach to vaccine dissemination. Hence, there is a need for tailored strategies to overcome such barriers and close the vaccination coverage gaps across racial/ethnic groups.

Recommendations for Improving the Vaccination Coverage for the 2024-2025 Flu Season

Recommendations for Addressing Socioeconomic Barriers

Socioeconomic barriers remain the leading factor in lower vaccination uptake among adults from ethnic/racial minority population groups. Income disparities in the U.S. determine the ability and willingness of individuals to access healthcare services, including vaccination services. Statistically, White adults tend to have higher levels of income as compared to other racial minority groups, including Blacks and Hispanics. For instance, although the U.S. labor markets have experienced a growth in the levels of income nationally, with income among Asian households having the highest rise from $88,774 to $98,174, Whites following with a rise from $71,922 to $76,057 while Blacks and Hispanic households had a rise of $42,447 to $46,073 and $52,382 to $56,113, respectively (Wilson, 2019), there are notable income disparities that still exist. Such racial disparities in income have further contributed to the disparities in the purchase of insurance in the U.S. (Lee et al., 2021). This is a major concern as it has led to the perception that vaccination is expensive for low-income households. Therefore, the following actions are recommended: i) focus on federal, state, and local-backed coverage for influenza vaccination costs for low-income households for adults from Black, Hispanic, and Native American racial and ethnic groups, and ii) collaborate with local governance and social authorities, and local pharmacy outlets to improve the coverage for vaccination services in terms of availability and accessibility at the local levels.

Recommendations for Combating Vaccine Misinformation and Concerns over Vaccine Safety

The periods during and after COVID-19 have seen the highest levels of vaccine misinformation, especially over the safety of vaccines. Rumors about using vaccines as race and ethnic-targeted bioweapons still persist (Sharma et al., 2022). Mostly targeted by such misinformation are minority ethnic and racial groups creating mistrust over the safety of vaccines, including the annual influenza vaccines. To cure such vaccine misinformation and build influenza vaccine trust among adult Blacks, Hispanics, and Native Americans, the following are recommended i) create local partnerships with local community leaders, social health workers, and other healthcare providers to educate individuals on the need for the influenza vaccination including a focus on possible complications; ii) provide data evidence on the safety of the recommended vaccines, including the processes of certifying the safety of vaccines both by the FDA and the CDC; iii) strive to address existing historical concerns and mistrust in the healthcare system over unethical vaccination and health studies. Besides, a majority of racial/ethnic minority groups, such as the Blacks, have existing mistrust in the healthcare system due to previous experiences in the healthcare system, including targeted diseases studies within those groups; iv) combat social media misinformation as it emerges regarding influenza vaccination through targeted health campaigns, providing accurate information on vaccine safety, efficacy, and other concerns; v) improve media literacy and trust in medical or healthcare experts by providing education on influenza vaccines and transparent communication on vaccines and vaccination objectives. Notably, improved media communication and the transparency of experts in the communication of vaccines have been previously associated with the intention to take flu and COVID-19 vaccines (Austin et al., 2023); and vi) provide an open and 24/7 available system for reporting of adverse events that community can report to and ask vaccine safety-related questions.

 Recommendations for Providing a Culturally Sensitive Vaccination Drive

The mistrust in the safety and efficacy of influenza vaccines among racial/ethnic minority groups, as noted above, is due to negative experiences in the past and a lack of culturally sensitive vaccination practices. It is, therefore, important that the CDC and other vaccine-related committees adopt a culturally sensitive approach in the dissemination of influenza vaccines, including the communication related to vaccines. To achieve a culturally sensitive influenza vaccination drive, it is recommended that: i) The CDC and other vaccine-related committees and stakeholders should adopt community-specific vaccination communication approaches that address racial/ethnic-specific concerns and tailor communication to specific racial/ethnic cultures; and ii) Address specific racial/ethnic concerns and barriers to uptake of the influenza vaccines, including mistrust among Blacks due to previous experiences with vaccines and vaccinations, language barriers that may hinder vaccine communication, and traditional health practices and medicines that may be considered safe and effective for preventing and managing annual influenza outbreaks.

Conclusion and Considerations for Implementing Recommendations

The above recommendations can potentially address concerns over vaccine affordability and safety, tackle misinformation, and improve trust in vaccines among minority racial groups. However, the recommendations must be further tailored to meet other inter-group and regional issues that lead to reduced influenza vaccination coverage at the individual and local community levels, regardless of race and ethnicity, existing health conditions, medications, and geography.

References

Austin, E. W., Austin, B. W., Borah, P., Domgaard, S., & McPherson, S. M. (2023). How media literacy, trust of experts and flu vaccine behaviors associated with COVID-19 vaccine intentions. American Journal of Health Promotion, 37(4), 464–470. https://doi.org/10.1177/08901171221132750/ASSET/IMAGES/LARGE/10.1177_08901171221132750-FIG2.JPEG

Black, C. L., O’Halloran, A., Hung, M.-C., Srivastav, A., Lu, P., Garg, S., Jhung, M., Fry, A., Jatlaoui, T. C., Davenport, E., Burns, E., Reingold, A., Alden, N. B., Yousey-Hindes, K., Anderson, E. J., Ryan, P. A., Kim, S., McMahon, M., Bleecker, M., … Cummings, C. (2022). Vital signs: Influenza hospitalizations and vaccination coverage by race and ethnicity—United States, 2009–10 Through 2021–22 Influenza Seasons. MMWR. Morbidity and Mortality Weekly Report, 71(43), 1366–1373. https://doi.org/10.15585/MMWR.MM7143E1

Centers for Disease Control and Prevention. (2024a, April 12). Influenza vaccination coverage, adults.

Centers for Disease Control and Prevention. (2024b, September). Weekly U.S. influenza surveillhttps://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-adult-coverage.htmlance report. https://www.cdc.gov/flu/weekly/index.htm

Grohskopf, L. A., Blanton, L. H., Ferdinands, J. M., Chung, J. R., Broder, K. R., & Talbot, H. K. (2024). Prevention and control of seasonal influenza with vaccines: Recommendations of the advisory committee on immunization practices — United States, 2023–24 influenza season. MMWR Recommendations and Reports, 72(2). https://doi.org/10.15585/MMWR.RR7202A1

Lee, D. C., Liang, H., & Shi, L. (2021). The convergence of racial and income disparities in health insurance coverage in the United States. International Journal for Equity in Health, 20(1), 1–8. https://doi.org/10.1186/S12939-021-01436-Z/TABLES/3

Macias, A. E., McElhaney, J. E., Chaves, S. S., Nealon, J., Nunes, M. C., Samson, S. I., Seet, B. T., Weinke, T., & Yu, H. (2021). The disease burden of influenza beyond respiratory illness. Vaccine, 39, A6–A14. https://doi.org/10.1016/J.VACCINE.2020.09.048

Sharma, K., Zhang, Y., & Liu, Y. (2022). COVID-19 vaccine misinformation campaigns and social media narratives. Proceedings of the International AAAI Conference on Web and Social Media, 16, 920–931. https://doi.org/10.1609/ICWSM.V16I1.19346

Wilson, V. (2019, September 16). Racial disparities in income and poverty remain largely unchanged amid strong income growth in 2019. Economic Policy Institute; Bulgaria. https://coilink.org/20.500.12592/g7rpjr

World Health Organization (WHO). (2024, February 23). Recommendations announced for influenza vaccine composition for the 2024-2025 northern hemisphere influenza season. https://www.who.int/news/item/23-02-2024-recommendations-announced-for-influenza-vaccine-composition-for-the-2024-2025-northern-hemisphere-influenza-season

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Reducing Racial and Ethnic Disparities in Influenza Vaccination

Introduction to Assignment:

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