Vaccine safety

Why these DOs say getting the flu vaccine is ‘a moral and social imperative’

Physicians share advice on encouraging patients to get their flu vaccine, which they say is more important than ever as the pandemic continues to strain the health care system.

With COVID-19 the primary public health objective this year, some patients may not be aware of the importance of getting their annual flu vaccine.

AOA President Thomas Ely, DO, a family physician based in Clarksville, Tennessee, has been outspoken in his mission to ensure that vaccination rates increase as a unique, potentially challenging flu season takes shape.

“Everyone must get the flu vaccine this fall,” Dr. Ely said in an interview with Health Leaders Media. “We must encourage families to continue the routine care and immunizations that protect them from disease. When there is a vaccine ready for COVID-19, we need everyone to get that, too.”

Peter Bidey, DO, a family physician and vice chair of the Department of Family Medicine at Philadelphia College of Osteopathic Medicine, says patients who are considering not getting vaccinated have given him a wide variety of reasons for their hesitancy. Some, he says, have applied their skepticism about the relative safety of a future COVID-19 vaccine to that of the flu vaccines already in circulation.

“If there is a year that I have been alive when I would push to get the vaccine more than ever, it would be this year,” Dr. Bidey said. “I’ve been assuring patients that we’ve been using the flu vaccine for many, many years. These vaccines do not get put on the market on a whim. They go through rigorous testing, they get tested with other vaccines, and get analyzed for age group effectiveness and side effects. They are vetted.”

With many DOs across the country having similar conversations with their patient populations, The DO asked three osteopathic physicians to give answers to common patient questions about the flu and the vaccine. They also provided advice for encouraging patients to get vaccinated.

What are the most important reasons physicians should give patients for getting their flu vaccine, this year in particular?

“The flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year. According to the CDC, during the 2018-2019 season, flu vaccination prevented an estimated 4.4 million influenza illnesses, 2.3 million influenza-associated medical visits, 58,000 influenza-associated hospitalizations and 3,500 influenza-associated deaths.

Dr. Ely: “This flu season, our health care systems are more likely to be overwhelmed by the dual threats of flu and COVID-19. Increasing the number of patients who are vaccinated will improve public health and conserve resources.”

Dr. Bidey: “There are a couple reasons this year matters more than ever. First, there’s nothing that says you can’t get both COVID and flu at the same time. Second, if there is an increase in flu numbers corresponding with an increase in COVID infections, the hospitals could become even more inundated than they were when the pandemic first started, with a need for ventilators and beds. So by not getting vaccinated, you’re putting yourself and your loved ones at an undue risk.”

One idea that’s been floating around social media is that if you get your flu shot, it’s easier to rule out flu if you are experiencing upper respiratory symptoms. Does that line of reasoning carry weight?

“Knowing someone has had the flu shot is not a good diagnostic test for COVID-19; it would have very poor specificity and sensitivity. The more scientific approach would be to receive the vaccination, then know that you’ve largely prevented that influenza strain from contacting you and limited your ability to spread the flu to others who may be more vulnerable. We can test for colds and other viral illnesses like influenza, too. So there are lots of good reasons to get your flu shot, but this one, in particular, doesn’t make for a good rational decision tree.” —Robert Hostoffer, DO, allergist-immunologist based in Cleveland, Ohio

Some experts have discussed the possibility of a less severe flu season due to COVID precautions continuing into the winter. How would you respond if a patient told you they were considering skipping the vaccine this year because they believe flu season will be less of a risk?

Dr. Bidey: “It’s not a bad thing that people think along the lines of, to a certain extent, if I’m taking COVID precautions, it will also protect me from the flu. When we look at flu data, we look to the southern hemisphere, who has a flu season opposite of ours. This year, they were doing social distancing, wearing masks and washing their hands, all the things we tell people to do every flu season minus the mask-wearing. As a whole, they had decreased flu numbers. That’s good.

“But I would counter that with, if I’m already decreasing my chances of getting the flu by wearing my mask, socially distancing and washing my hands, why not decrease my chances even further by getting the vaccine?”

Dr. Ely: “I would say send me your crystal balls. No one knows for sure what is in front of us. As physicians, we have to prepare for every scenario. You do not want to have two simultaneous viral illnesses, both of which can be fatal. If you get one, that could make the risk that you catch the second very high. It’s the twindemic philosophy. Why take the risk? Our patients should remember that the flu vaccine is proven to be safe and relatively effective.”

What would you tell patients who are still hesitant to visit doctors’ offices or pharmacies due to COVID-related concerns, and as a result might be considering not getting vaccinated?

Dr. Hostoffer: “I’ve heard that concern from my patients. I would reassure them that any facility that distributes flu shots maintains social distancing and that everyone there wears appropriate PPE. So I feel that their fears are generally unwarranted. The flu shot is a moral and social imperative. We must be immunized, and we can go to our doctor’s office or local clinic and receive an immunization safely.”

Dr. Ely: “I would say, at this point, we know physician practices and pharmacies are safe places to be. They have implemented protocols to keep their patients healthy and limit the spread of germs.

“But if you have concerns, you can always call ahead to determine if there is a quieter time to visit. Many pharmacies are in grocery stores, some of which offer select hours for seniors.”

Dr. Bidey: “I wouldn’t invite patients in if I didn’t feel they would be safe here with the protocols we’re taking. But I don’t care where you get the flu shot, I just want you to get the flu shot. Ultimately, if it’s easier for you to get it somewhere else, that’s fine. Go where you’re most comfortable.”

What would your final argument be to vaccine skeptics this year?

Dr. Ely: “I would like to make a baseball analogy. In these uncertain times, getting vaccinated is one of the few ways to ensure better health for yourself, your family and your community. So this fall, cover your bases and get vaccinated.

“And if you’re a practicing physician, definitely get your flu shot. Protect yourself so you can protect your patients. We should shoot for everyone to get their flu shot, this year especially.”

Related reading:

Father-daughter DO team at Cleveland Clinic research COVID-19 inflammation and immunology

‘Tremendous fear and uncertainty:’ Geriatric care in the time of COVID-19

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