Effective and efficient communication in office-based settings about the benefits, risks, and logistics of vaccination will be vital to the success of this effort. Using nationally representative survey data, we observed strong associations between the intention to be vaccinated against seasonal influenza at midseason and actual vaccination status at the end of the season, reasons for not being vaccinated, and openness to provider recommendations.
The validity of our findings rests on the independence of our two samples. To explore this issue we tested whether participation in the mid-season survey and being asked questions about the intention to be vaccinated served to influence late season vaccine uptake. We found no evidence that the mid-season survey influenced overall uptake or late season uptake in models with and without socio-demographic covariates. We suspect the lack of measurable intervention effect reflects the time and effort required to be vaccinated outside of a regularly scheduled office visit.
The associations among intentions, uptake, and attitudes demonstrate the potential value of asking patients simple questions about their intentions to be vaccinated and using responses to target and formulate vaccine-related discussions. Our finding that the majority of those who intended to be vaccinated appeared amenable to provider recommendations suggests that it may be reasonable to consider this group “low hanging fruit” in developing strategies to expand uptake. Making vaccination convenient to those who intend to be vaccinated by administering influenza vaccines available onsite (as part of routine practice or by partnering with a community vaccinator) or by offering practical advice about where and when to be vaccinated might be effective in helping millions of additional adults to be vaccinated who would not otherwise be.
Persuading the two in five adults recommended for seasonal influenza vaccine who were not inclined to be vaccinated is likely to pose a substantially greater challenge. Our results suggest that at midseason, only 2% of those who do not intend to be vaccinated were vaccinated by the end of the season and that a lack of perceived benefit and need may play a key role in explaining low uptake. Moreover, less than half of those who did not intend to be vaccinated indicated willingness to do so based on a strong provider recommendation. Thus, persuading those disinclined to be vaccinated will likely require changing patients’ fundamental beliefs about the benefits and risks of both types of vaccine. Advice and assurance from one’s own healthcare provider that is echoed by public health authorities, such as the U.S. Surgeon General, may likely be required.
In summary, our findings suggest that asking simple questions about patients’ intentions to be vaccinated may help to quickly identify which patients are least and most inclined to be vaccinated and to rapidly focus conversations on patients’ specific concerns and to target efforts in ways that are most likely to result in uptake of influenza vaccines.