Inequities in Flu Vaccine Uptake — CDC Vital Signs

A CDC Vital Signs report updated October 18, 2022, with data through the 2021–2022 flu season.

At a glance

• Only 1 in 2 Americans got a flu vaccine in the 2021–2022 season.
• Less than 43% of Black, Hispanic and American Indian/Alaska Native (AI/AN) adults were vaccinated.
• From 2009 to 2022, flu hospitalization rates were nearly 80% higher among Black adults than White adults.

The problem

Flu can be serious, leading to hospitalization or death, and vaccination is the best protection. Between 140,000 and 710,000 people were hospitalized with flu each year in 2010–2020. People from some racial and ethnic minority groups are more likely to be among them. Compared with White adults, flu hospitalization rates are:

• nearly 80% higher among Black adults;
• 30% higher among AI/AN adults;
• 20% higher among Hispanic adults.

(These are rate ratios from 2009–2022, excluding 2020–21: 1.8, 1.3 and 1.2 times the White rate.)

The 2020–21 season is left out because case counts were too low to calculate rates by race and ethnicity.

Vaccination does not always prevent infection, but it can make illness milder and lower the risk of hospitalization. Yet since 2010, coverage has consistently been lower among Black, Hispanic and AI/AN adults.

Differences in vaccination are not the whole story — other factors likely contribute to worse outcomes for some groups too.

Why the gap

• Access. People in some racial and ethnic minority groups face barriers to health care in general and to vaccination in particular. Last season, adults with insurance, a regular provider and a checkup in the past year were more likely to be vaccinated. Hispanic adults were less likely to be insured; Hispanic, AI/AN and adults of other races were less likely to have a provider or a recent checkup. Many also lack access to culturally competent providers.
• Missed opportunities. Even among adults with a recent checkup, coverage was lower for Black, Hispanic, AI/AN and other or multiracial adults than for White adults — providers are missing chances to vaccinate during routine visits.
• Mistrust and misinformation. Underestimating how serious flu can be and false claims about vaccine safety have held vaccination back for years, and systemic racism and historical events have deepened distrust. Racism and prejudice are known to worsen inequalities.

What works

Closing the gap means tackling all the reasons people go unvaccinated. Four measures work best together: community-based vaccination, culturally responsive messages, trusted messengers, and emphasising flu vaccination.

COVID-19 vaccination showed that partnerships with community organisations and trusted messengers raise vaccination rates. CDC's Partnering for Vaccine Equity (P4VE) programme aims to reduce adult vaccination disparities by building trust, improving access and countering misinformation — through town halls, pop-up clinics and other outreach with community groups, and work with health care providers and local media.

National campaigns help too. The Ad Council, the American Medical Association and CDC have backed campaigns tailored to Black and Hispanic audiences, using culturally responsive content on channels they use and trust. After two years, worries about flu vaccine risks or side effects fell from 43% to 33% among Black adults and from 41% to 32% among Hispanic adults.

What each can do

Health care providers

• Strongly recommend flu vaccination to every patient 6 months and older.
• Check vaccination status at every visit.
• Work with health systems to offer vaccines where people live and work.
• Give culturally appropriate recommendations and answer every question.
• Refer patients elsewhere if vaccine is out of stock.
• Vaccinate all clinic staff and teach them how to talk about vaccination.

State and local governments

• Help community and faith-based organisations build trust and vaccine confidence.
• Find the barriers to vaccination and work with community groups to remove them.
• Hold clinics where people work and spend their time.
• Develop culturally responsive outreach, led by influencers, with accurate messages.
• Partner with media that reach racial and ethnic minority communities.
• Help local businesses make vaccination easy — several on-site clinics, clinics open to employees' families, paid time off or incentives.

Everyone

• Get vaccinated. A yearly flu vaccine is the best protection for you and your family against severe flu.
• Encourage others to get vaccinated and share facts about flu vaccines.

Sources

• Centers for Disease Control and Prevention, Vital Signs, Inequities in Flu Vaccine Uptake, and the MMWR report behind it, Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity—United States, 2009–10 Through 2021–22 Influenza Seasons. The page's partner-credited campaign images and photo collage are left out.