Flu shot fatigue: influenza vaccination rates in R.I. continue to fall post-pandemic

Chalk it up to shot sickness, or maybe just an inflated sense of immunity.

Either way, fewer Rhode Island adults rolled up their sleeves for a flu shot this year, though the state remains a national leader in its influenza vaccination rate, Rhode Island Department of Health Deputy Director Seema Dixit told state lawmakers during a budget presentation Tuesday night.

Just over one-third of Rhode Island adults ages 20 and older got a flu shot during the 2023-2024 season, which began in mid-September, according to RIDOH data. By comparison, 64% of Rhode Island adults got flu shots during both the 2020-2021 and 2021-2022 seasons, according to data with the Centers for Disease Control and Prevention.

That’s higher than the national rate, which ranged from 37.1% in the 2017-2018 season to a peak of 50.2% during the 2020-2021 flu season.

Two months ago, a commentary published in the scientific journal Vaccine named Rhode Island as a model in flu vaccination. The February piece by a pair of Virginia-based researchers touted Rhode Island’s ranking as the state with the highest flu vaccine rate from 2017 through 2022. During that five-year period, state officials helped boost adoption of flu shots through Medicaid expansion, a 2020 mandate requiring health care facilities to offer flu shots to employees, and the state’s Health Equity Zone program, which made flu shots more readily available to underserved neighborhoods through school and community-based clinics, according to the article. 

Those measures remain in place with higher vaccination rates among health care workers and older adults than the average population. Indeed, residents 65 and older were the only demographic whose flu shot rate increased slightly in the last year, up to 55% for this season, according to RIDOH data. Three-quarters of health care workers across all facilities were vaccinated during the 2022-2023 season; more recent data on this group was not available.

Dixit appeared unfazed by the drop in vaccine uptake, explaining to lawmakers Tuesday that Rhode Island continues to see higher vaccination rates, with fewer flu-related doctor’s visits and deaths compared with the region and nation.

“There is a vaccine fatigue we have noted,” Dixit said. “Could we do more? Possibly, yes. I can’t really pinpoint what we didn’t end up doing.”

Dr. Michael Fine, former state health director who now serves as board chair and president for a national advocacy group called Primary Care for All Americans, agreed with Dixit’s assessment.

“We don’t know if our actions lead to boosting vaccination rates,” Fine said in an interview on Wednesday.

Not that it wasn’t worth trying to improve. Fine specifically named outreach by primary care physicians as an effective way to gain public trust and participation in vaccines, including the flu shot.

Nationally, the CDC has reported fewer flu vaccines given out in medical offices and pharmacies; the 60 million doses distributed as of Jan. 13 represents an 11% drop over the 2019-2020 flu season, considered a benchmark because it was the last year before the COVID-19 pandemic. State-specific data through the end of the 2023-2024 flu season was not available.

Primary or urgent care offices and pharmacies were the most popular options for Rhode Islanders to get their flu shot this year, chosen by roughly 45% apiece. White, non-Hispanic residents also had a higher flu vaccination rate, just over 40%, compared with 29% of Black residents and 27% of Hispanic or Latino residents.

The latest COVID-19 booster was given to 17% of Rhode Island adults as of April 23, while 15% of residents 60 and older have received the RSV vaccine this year.