Thwarting The Next Surge: A Tactical Plan to Improve Covid-19 Vaccination Uptake

It’s been over four years since the first reported case of Covid-19, and although it is no longer the public health emergency it once was, it remains the leading respiratory infectious disease responsible for hospitalizations and deaths. And, while Covid-19 may no longer define most of our daily lives, it still does for many – nearly 20% of U.S. adults continue to suffer for months or even years from long-term symptoms, known as Long Covid.

Vaccines changed the trajectory of the pandemic, preventing an estimated 18 million Covid-19-related hospitalizations and millions of deaths. But, it’s clear that the perceived value of vaccination we saw during that time has declined over time.

Fall 2023 was a turning point for our management of Covid-19. Despite a steadfast recommendation for vaccination from the CDC’s Advisory Community on Immunization Practices (ACIP), only 22% of eligible adults and 14% of children were vaccinated. At the same time, the enduring health threat of Covid-19 was increasingly evident – at its peak in the 2023/2024 season, there were up to 2,500 deaths and 30,000 people hospitalized due to Covid-19 each week. This juxtaposition begs the question: what is preventing widespread vaccination? 

In the face of new variants and lower public acceptance of vaccination, it’s imperative that we take stock of lessons learned from previous seasons and examine key barriers to uptake as we prepare for this fall and winter – from adjusting approval timelines at the federal level, to implementing programs to address vaccine complacency, convenience and confidence. 

Align the approval process for Covid-19 with influenza vaccines 

As of March of this year, uptake of the 2023/2024 influenza vaccine far outpaced that of the updated Covid-19 vaccine across all ages. For example, among U.S. adults between 50-64 years, 51.2% have received the influenza vaccine while only 25.3% have received the Covid-19 vaccine. And yet, Covid-19 hospitalizations were higher than influenza across the board, but especially among older adults, where the number of Covid-19 related hospitalizations were more than double. One way to close this gap is to better align Covid-19 approval timelines with that of the flu to encourage co-administration.

Last year, the Covid-19 vaccines were not available until approximately 6-8 weeks after flu vaccines. However, this year, public health agencies have proposed steps that would help make both vaccines available at the same time. The FDA advisory board responsible for evaluating vaccine safety is expected to meet earlier to review the updated Covid-19 vaccine, while the CDC is expected to release its recommendations three months earlier than last year. These changes in the approval process should not only help to simplify the manufacturing and distribution of vaccines, but also help streamline communication to better align Covid-19 with influenza vaccine recommendations.

Integrate Covid-19 vaccine delivery into routine healthcare and engage providers

There are key differences in where and by whom patients receive Covid-19 vaccines and influenza vaccines. Pharmacies have administered nearly every adult dose (92.7%) of the updated Covid-19 vaccine, whereas administration of last year’s flu vaccine is more evenly split between pharmacies (59.5%) and medical offices (40.5%). This disparity underscores the need to engage more healthcare providers beyond the pharmacy to take a more active role in Covid-19 vaccine administration. 

Fortunately, the CDC’s updated timeline for approvals may bridge this divide. Having clear and early recommendations will allow healthcare systems and providers to have the appropriate supply and simplify communication with patients to match that of influenza, relaying the benefits and convenience of co-administration. The gap between the number of people receiving influenza and Covid-19 vaccines, along with the stark differences in the location in which they’re typically administered, suggests that if providers discuss the Covid-19 vaccine and its shared risk factors with influenza with patients at the point of care, they could play a key role in increasing vaccine uptake. 

Mobilize community partners to improve equitable access 

While vaccine uptake has decreased across the board over the past couple of years, this decline is most pronounced among minority communities and high-risk patient populations. For example, as of April this year, Hispanic Americans have received the updated Covid-19 vaccine at a significantly lower rate (15.7%) than non-Hispanic White Americans (25.7%).

Improving access for everyone, but especially high-risk and marginalized communities, is essential to combat complacency and enhance Covid-19 protection. To reach high-risk populations, we need to mobilize trusted messengers who can help increase awareness and explain the benefits of vaccination.

Those conversations shouldn’t only take place in doctor’s offices, but also in community settings. Civic groups and other community-based organizations can all play a role in providing straightforward, trusted information to their neighbors. By enlisting new partners to support public health in their communities, we can enhance equitable access to the Covid-19 vaccine.

Simplify the message 

Achieving broad vaccine uptake depends on clear and compelling narratives about how vaccines protect individuals, their families, and their communities. Individual doctors are most effective at delivering this narrative, with 93% of the public expressing a great deal or a fair amount of trust in their doctor’s recommendations. 

Healthcare providers should consistently communicate with their patients about the best ways to stay safe from Covid-19, and in particular, reinforce the importance of staying up-to-date with the most recent vaccine given that the virus mutates rapidly. Moreover, doctors can use patient visits to clearly explain the threat of Long Covid and the role vaccination can play in reducing one’s risk – the debilitating physical and psychological symptoms Long Covid poses for people of all ages are in many ways a “great equalizer” that all patients can relate to.

Studies have shown that using presumptive language in vaccine discussions can increase uptake and reduce hesitancy. For instance, they could say, “You mentioned you haven’t received the latest Covid-19 vaccine – let’s get that shot in today so you are up to date.” That framing simplifies the process and underscores that vaccination is a routine and effective tool to protect oneself against Covid-19. 

Be proactive 

The heavy disease burden Covid-19 continues to bring each year warrants a sense of urgency that has seemingly receded for the majority of Americans. All of these interventions have the potential to overcome this complacency and avert the distressing surge in hospitalizations and deaths we witnessed last fall and winter. But, we shouldn’t wait until the next surge before taking action. The government and public health community should use the time we have now to lay the groundwork for an effective vaccination campaign. Covid-19 is here to stay – but its impact largely depends on how we plan and respond.

Photo: Geber86, Getty Images

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