“One of the things most concerning to me is not just that we are below where we were in prior seasons for vaccinations, it’s that we are plateauing earlier. If we were still on the upward trajectory for vaccinations, I would feel more confident,” said Dr. Robbie Goldstein, state public health commissioner.
It can take a couple of weeks for a vaccine to be fully effective, so the sooner people get shots, the better, Goldstein said.
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Just 38 percent of children under 5, and less than two-thirds of people 65 to 79, have had their flu shot this season. For COVID, only 10 percent of children under 5, and roughly 45 percent of those over 65 have received vaccinations.
The numbers are also measurably down across all other age groups in Massachusetts and have been trending downward for the past two years. Nationally, flu vaccinations for all children are down significantly this year, the lowest they’ve been since before COVID. Meanwhile, COVID vaccinations for children, 6 months to 17 years old, nationwide are also low — roughly just 10 percent have gotten their shot — but are about what they were last year at this time.
Both COVID and flu shots have been administered to millions of people nationwide and have proven safe and effective in preventing severe illnesses and death over the years, but that message has been drowned out by louder voices, Goldstein said.
“The COVID pandemic introduced doubt about whether that vaccine is safe and effective, and it has transferred over to flu shots and other vaccines as well,” Goldstein said. “I worry about what that means, that very vulnerable individuals may be swayed by misinformation.”
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Dr. Matthew Russell, interim chief of geriatric medicine at Massachusetts General Hospital, said he is increasingly hearing older patients mistakenly say they don’t think they need COVID shots anymore.
“I see people who say, ‘It’s not the COVID of 2020. Do I really need to get the vaccine?’ ” Russell said.
The COVID virus, like other viruses, mutates over time, which means vaccines need to be regularly updated to match and protect against the strains most likely to be circulating.
Another misconception Russell has been hearing comes from family members of older adults who don’t realize they can walk germs through the front door when they visit an older relative.
“They’ll say, ‘No one really sees her except the family and we don’t want to expose her to the potential side effects of the vaccine,’ ” Russell said.
Similarly, he hears from patients who live alone who also don’t think they need flu and COVID shots because they don’t go out much.
“And I say, if you go get food, you get exposed, one way or another,” Russell said.
One 2022 study of older adults found many citing poor health or a fear of COVID vaccine side effects for not getting vaccinated.
Side effects from flu and COVID vaccines are usually mild, such as fatigue, chills and fever, and a sore arm, and are likely to be significantly less onerous than being infected. Russell explains to patients that it’s better to avoid the infections than to need antivirals once infected, which may interfere with their other medications.
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And then there are those over 65 who are in good health and feeling invincible, not realizing that with increasing age comes increasing risks for more serious complications from flu and COVID infection, Russell said.
“I can’t tell you how many times I hear patients say, ‘I can’t believe I am in an older persons clinic,’ and I say, ‘This is all about keeping you at your level of function and our job is to predict the road out or bridge out ahead,’ ” Russell said.
Dr. Wayne Altman, a family physician in Arlington and chair of Family Medicine at Tufts University School of Medicine, said one major reason vaccinations are down significantly for young children comes down to simple math.
“There are not enough primary care physicians to care for all of their patients, and if a 5-year-old comes to see me in October for their physical, I will tell their parents to get them their flu shot,” Altman said. “But if that 5-year-old’s physical is in May, are they going to think to get that flu shot in October?”
One widely quoted 2022 study found that in order for primary care physicians to complete all the duties required of them, they would need 26.7 hours each day.
“So when you have 26.7 hours of responsibility in a 24-hour day, engaging a campaign to get 5-year-olds flu shots may slip through the cracks,” Altman said.
And then there is the rising problem of vaccine hesitancy, especially among parents of young children.
“Even before COVID, vaccine hesitancy by parents of young children was on the rise, and [the medical field] has demonstrated an arrogance, a paternalistic approach of, ‘Just do it because we said do it,’ and in this information age that doesn’t fly with people anymore,” Altman said.
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“It is incumbent on primary care physicians to take a more collaborative approach and listen to people’s concerns,” he said, “instead of shutting them down.”
Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.
