One solution is coadministering more than one of the vaccines at the same visit to the pharmacy. A new study found, however, that U.S. Medicare beneficiaries are not very likely to do that.
The researchers from Brown University School of Public Health noted that while coadministering COVID-19 and influenza vaccines is recommended by the CDC to improve uptake and convenience, not much data is available on uptake.
“Investigations into COVID-19 and influenza vaccine coadministration are needed to describe compliance with newer recommendations and to identify potential gaps in the implementation of coadministration,” the researchers wrote, explaining the impetus for their recent study published in the American Journal of Preventive Medicine.
The descriptive, repeated cross-sectional study was conducted between September 1, 2021, and November 30, 2021 (Period 1), and September 1, 2022, to November 30, 2022 (Period 2). The study included community-dwelling Medicare beneficiaries aged 66 years or older who received an mRNA COVID-19 booster vaccine in Periods 1 and 2. The outcome was an influenza vaccine administered on the same day as the COVID-19 vaccine.
The results indicated that, among beneficiaries who received a COVID-19 vaccine—78.8% in Period 1 (N = 6,292,777) and 89.1% in Period 2 (N = 4,757,501)—received an influenza vaccine at some point during the study period (i.e., before, after, or on the same day as their COVID-19 vaccine), although rates were lower in nonwhite and rural individuals.
The researchers reported that vaccine coadministration increased from 11.1% to 36.5% between periods. “Beneficiaries with dementia (aORPeriod 2 = 1.31; 99% CI, 1.29-1.32) and in rural counties (aORPeriod 2 = 1.19; 99% CI, 1.17-1.20) were more likely to receive coadministered vaccines, while those with cancer (aORPeriod 2 = 0.90; 99% CI, 0.89-0.91) were less likely,” they advised.
The study concluded that, while influenza vaccination was high among Medicare beneficiaries vaccinated against COVID-19, coadministration of the two vaccines was low. “Future work should explore which factors explain variation in the decision to receive coadministered vaccines,” according to the researchers.
Background information in the article noted that COVID-19 and influenza are common viral illnesses associated with substantial morbidity and mortality, especially among older adults. The article cited one study finding that U.S. military veterans aged 65 years and older hospitalized for COVID-19 or influenza had a 30-day risk of mortality of 6.4% and 3.7%, respectively. There is a five- and three-time (respectively) greater risk than those aged younger than 65 years, the report explained.
“Fortunately, vaccines can prevent infection and mitigate the severity of both illnesses, with thousands of influenza-related hospitalizations and millions of COVID-19-related hospitalizations being prevented through vaccination in the U.S. alone,” the researchers wrote.
The authors pointed out that one strategy to increase vaccine uptake and confer immune protection against cocirculating viruses is coadministration of more than one vaccine at a single health visit. “Although initially discouraged in some jurisdictions due to a lack of evidence regarding safety and effectiveness, most public health authorities now recommend coadministering COVID-19 and influenza vaccines following favorable clinical trial evidence.”
The study demonstrated that the prevalence of COVID-19 and influenza vaccine coadministration increased over time—from 11.1% in 2021 to 36.5% in 2022—and varied widely across U.S. counties. “Beneficiaries living in rural areas were generally more likely to receive a COVID-19 and influenza vaccine at the same time compared to those living in urban centers, and older adults with ADRD were also more likely to be co-administered,” the authors pointed out. “In contrast, beneficiaries with cancer or immune disorders who were vaccinated against COVID-19 were less likely to be coadministered. Racial and ethnic and rural/urban disparities in influenza vaccine uptake were also observed.”
The report emphasized the logistical, clinical, and public health benefits to the coadministration of vaccine, including that it is more cost effective. In addition, the study team noted that pairing vaccines also reduces the time to receive protection against cocirculating viruses, as opposed waiting for multiple visits (where attrition may also occur).
The researchers noted that a review of nine studies found that coadministering influenza and pneumococcal vaccines reduced the risk of hospitalization, death, and associated healthcare costs compared with the vaccines being administered alone. “To date, with the exception of a recent study, prior work has suggested coadministering COVID-19, and influenza vaccines is safe and has no to modest impact on SARS-CoV-2 antibody response,” the researchers added. “Although the likelihood of a regularly scheduled COVID-19 vaccine remains uncertain, its coupling with annual influenza vaccines is a natural public health strategy to improve convenience and uptake.”
The authors stated that in their study, racial and ethnic and rural/urban disparities in influenza vaccine receipt were observed, in line with previous research. For example, in Period 2, only 10.2% of white beneficiaries who were vaccinated against COVID-19 were unvaccinated against influenza compared with 20.6% black, 16.2% Hispanic, and 17.2% Native American beneficiaries. Interestingly, the authors wrote, although Native American beneficiaries were less likely to have an influenza vaccine relative to white beneficiaries, “they were more likely to be coadministered, perhaps due to generally more rural residence and/or tailored public health communication regarding coadministration. Interestingly, in the secondary analysis restricting to those who received an influenza vaccine at some point during the study period, Black and Hispanic beneficiaries were slightly more likely to be coadministered compared to white beneficiaries. These findings suggest that racial and ethnic differences in the likelihood of coadministration are more related to access than differences in the acceptance of coadministration.”
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