With vaccine confusion, fears grow of bad flu and Covid seasons

With another school year underway and growing vaccine hesitancy and confusion, healthcare leaders are bracing for difficult months ahead.

The peak months for the flu and COVID-19 are approaching, and fears are mounting that there will be more cases as fewer people get vaccines. They warn that a spike in flu cases and Covid infections would put more pressure on hospitals and health systems.

The federal government has revised its guidance for COVID-19 vaccines, recommending them for all seniors but saying they aren’t advised for younger adults who are healthy. Medical groups criticized the guidance, along with a host of recent changes in vaccine policy under Health & Human Services Secretary Robert F. Kennedy Jr.

Jennifer Mensik Kennedy, president of the American Nurses Association, told Chief Healthcare Executive in an interview this month that she fears the fall and winter could be rough. Mensik Kennedy hopes that barriers to COVID-19 vaccines are removed and urges the health department to provide stronger messaging about the importance of vaccines.

“I am worried though, if we don't clarify that, then we will have bad flu, bad Covid seasons,” Mensik Kennedy said. “And I want to remind people that at the peak of Covid, when hospitals were full of Covid patients and people with Covid, that does have a downstream barrier to people who have heart attacks or having strokes. Because there are just less people available to take care of you if you have other health care concerns.”

“So yes, maybe you won't get Covid, but if you or your loved one has a heart emergency, a cardiac issue, a stroke, you don't want the hospital to be overrun and over capacity with Covid patients. So having people vaccinated, decreasing the number of people with Covid and flu actually makes it a lot safer for everyone,” she added.

Dr. Bobby Mukkamala, president of the American Medical Association, told Chief Healthcare Executive that he's worried lower vaccination rates could lead to "an uptick of dependence on hospitals and physicians" in the next few months.

"These are things that we should try to avoid," he said.

(The presidents of the AMA and the ANA talk about vaccines in this video. The story continues below.)

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‘Taken that choice away’

The health secretary told senators this month that anyone who wants Covid shots will be able to get them, but pharmacy chains in some states say individuals will need a prescription to get the vaccine. Earlier this year, the health department said it is no longer advising pregnant women and healthy children to get the coronavirus vaccine.

Dr. Wendy Armstrong, vice president of the Infectious Disease Society of America, said in a web briefing this month that the shifting Covid vaccine guidance will limit availability.

“Make no mistake, Secretary Kennedy has taken that choice away from millions of people, including the most vulnerable patients like expectant moms and babies,” Armstrong says. “I'm a physician and I don't qualify for the vaccine today. How do I protect my elderly parents, and my patients who are ill in the hospital?”

Sen. Bill Cassidy, a Louisiana Republican and a physician who serves as chairman of the Senate health committee, told Kennedy at a hearing this month that he’s concerned about the impact of revised guidance for COVID-19 shots. “Effectively, we're denying people vaccine,” Cassidy said.

Mensik Kennedy, who has six children, said the COVID-19 vaccine guidance makes it more difficult for parents in some states who want to get the shots for their kids.

“I am very concerned this is creating confusion and creating barriers for people who want to have choice in what they do,” she says.

For areas where pharmacies are going to require prescriptions for healthy adults to get Covid shots, Mensik Kennedy says family doctors are going to be inundated with requests.

“We're going to overwhelm the primary care system with people trying to get prescriptions and trying to get orders from their physicians,” she says. “We already have a shortage of primary care providers. Why did we just create an additional burden on top of everything else?”

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‘Going backwards’

While some parents who want vaccines may face more obstacles, more Americans are showing hesitancy or skepticism regarding flu vaccines and shots for other diseases. And healthcare leaders worry that will raise the risk of more outbreaks.

A Washington Post/KFF poll released this week shows that roughly 1 in 6 parents have delayed some vaccines for their child, excluding flu and Covid shots. One in eleven (9%) say they skipped measles, mumps and rubella (MMR) shots, with 7% skipping the polio vaccine.

Mukkamala, the AMA's president, told Chief Healthcare Executive that he’s very concerned about the shifting and confusing guidance from the federal government on vaccines.

“To me, this is going backwards in the health care of our country,” Mukkamala said. “To celebrate the independence that we have to decide if we want a vaccine, and totally ignore the fact that more people are going to get sick, more people are going to die. It's just a very odd development in our country, and not a good one.”

Mukkamala, who is based in Flint, Michigan, says he’s gravely troubled by the measles outbreak over the past several months and the dropping rate of vaccination. Through Sept. 10, there have been more than 1,400 measles cases confirmed, representing the highest number in more than 30 years, according to the CDC. Most cases are concentrated in Texas, but there are cases reported in most states.

“The city of Flint, we have a vaccination rate in our city that's one of the lowest in the country,” Mukkamala says. “I hear about the measles outbreak in Texas, and I look at their rate of vaccinations, and then I look at ours, and we're a couple percent below that, and we're not even in the news. And that's happening in Flint, Michigan. It's happening everywhere, and that's a concern.”

When it comes to flu and Covid shots, Mensik Kennedy says an important element of vaccination is getting lost in the changing federal guidance. Healthier people should get flu shots and vaccine shots to protect those who could suffer more serious complications from infections.

The changing guidance may make it more difficult for healthy adults to get vaccines, which is problematic for those living with and caring for loved ones who have health complications.

“I hope we can fix the messaging related to the Covid shots,” Mensik Kennedy said. “We can help educate people on why it is still important … We're protecting those who are vulnerable around us. You're protecting your grandmother, you're protecting your grandfather and other elderly and other immune-compromised individuals.”

Florida gained national attention for its plan to end vaccine mandates, including those for school attendance. Medical groups have warned that would undermine generations of progress in preventing diseases and deaths.

Some institutions are stepping up. The University of Minnesota’s Center for Infectious Disease Research and Policy launched the Vaccine Integrity Project, which is aiming to combat misinformation about vaccines.

The American Academy of Pediatrics is also issuing recommendations on COVID-19 vaccines. The academy advises that all children 6-23 months get the COVID-19 vaccine, along with kids between 2 and 18 years with certain risk factors. The group says all parents and guardians who want their children to have the COVID-19 vaccine should have access to it.

Earlier this month, Mukkamala said he was heartened to see two older patients getting Covid vaccinations.

“I was so happy,” he says. “I was so excited for the winter they're going to have in Michigan because of this protection. And it just made my day.”

Dr. Brandon Smith, the associate medical director of the Harriet Lane Clinic at Johns Hopkins Children’s Center, said he’s worried about more Covid cases and flu cases in the coming months. Smith said it’s important for providers encountering parents who are worried about vaccines to listen to their concerns without judgment.

“It is in understanding and not diminishing the stories that families will share and tell us … but trying to navigate that conversation with the facts that we know,” Smith said. “I think it's the best that we can do, and that's why those conversations take time and ideally with trusted providers that families are comfortable with and know.”

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