Fighting Flu Fatigue

New Report Finds H1N1 Hospitalization Rates Higher But Vaccination Rates Lower for Minorities

H1N1 flu hospitalization rates for African-Americans, Hispanics, and American Indian/Alaska Natives were nearly two to one higher than rates for Whites during the 2009-2010 flu season, according to a new report, Fighting Flu Fatigue,from the Trust for America’s Health (TFAH). At the same time, both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than for Whites.

During the 2009-2010 flu season:

• African American hospitalization rates were 29.7 per 100,000 people compared to White hospitalization rates of 16.3 per 100,000 people. Hispanic hospitalization rates were 30.7 percent per 100,000 people;
• H1N1 vaccination rates were 9.8 percent lower for African-American adults and 4.2 percent lower for African-American children than for Whites;
• Seasonal flu vaccination rates were 16.5 percent lower for African-American adults and 5.6 percent lower for African-American children than for Whites;
• H1N1 vaccination rates were 11.5 percent lower for Hispanic adults than for Whites, although rates were 5.5 percent higher for Hispanic children; and
• Seasonal flu vaccination rates were 21.7 percent lower for Hispanic adults and 2.6 percent lower for Hispanic children than for Whites.

The flu is preventable with a vaccine – yet, each year, between 3,000 and 49,000 Americans die from flu-related illnesses (based on a review of deaths from 1976 to 2007) and the flu contributes to more than $10 billion in lost productivity and direct medical expenses and $16 billion in lost potential earnings each year in the United States.Fighting Flu Fatigue examines lessons from the H1N1 pandemic to inform future flu policies and prevention in the United States.

“Following the H1N1 pandemic, we could take two different paths,” said Jeffrey Levi, PhD, Executive Director of TFAH. “We could go back to a national complacency around the flu or we could build on the momentum of the pandemic response efforts to help spare millions of Americans from suffering yearly from the flu. Building on the work we’ve done would also better prepare the country for future disease outbreaks we may face.”

Last flu season, during the pandemic, flu vaccination rates reached historical highs. Around 44 percent of children ages six months to 17 years received the seasonal flu vaccination and around 40 percent of children received the H1N1 vaccine in 2009-2010. In prior years, childhood flu vaccination rates had been around 24 percent. In 2009-2010, approximately 40 percent of adults were vaccinated against the seasonal flu, compared to past years where vaccination rates had been around 30 percent. The adult H1N1 vaccination rates were approximately 27 percent, but these rates were deflated because of the limited availability of vaccine in the beginning of the outbreak.

This year, for the first time, the U.S. Centers for Disease Control and Prevention (CDC) has recommended that all Americans older than six months should get vaccination against the flu. To further combat the flu, increase vaccination rates and build on the momentum from the H1N1 response, the report recommends creating a major campaign that provides:

• Education about the need for flu shots, focused on why everyone should get immunized and the safety of the shots;
• Special, concerted outreach to minority groups. It is particularly important to use targeted, culturally-appropriate messages and messengers that encourage vaccinations and address negative beliefs and misinformation;
• Increased easy access to flu shots, even to people who are uninsured or do not receive regular medical care; and
• Incentives for health care workers to be vaccinated. Last season, only 62 percent of health care workers were vaccinated against the seasonal flu and only 37 percent received an H1N1 flu shot by January 2010.

Recommendations for Preparing for a Possible Future Pandemic and Other Health Emergencies

While the H1N1 pandemic was considered to be moderate, it had a serious impact on the country, – infecting around 20 percent of Americans (approximately 60 million individuals) and resulting in approximately 274,000 hospitalizations and 12,000 deaths. In addition, the H1N1 pandemic required a rapid and unprecedented large-scale nationwide public health response, including surveillance, laboratory testing, public and practitioner education, medical countermeasure management, and distribution and launch of a national vaccination campaign.

The Fighting Flu Fatigue report examined a range of after-action assessments and found that the response to the H1N1 outbreak showed that investments made to support emergency health preparedness meant the country was much better prepared to respond to a pandemic than it would have been just a few years ago. However, the outbreak also revealed ongoing issues for public health preparedness – including some real-world lessons and long-standing infrastructure gaps.

One key factor that hampered the H1N1 response was that, even in the middle of the outbreak, budget cuts resulted in the loss of more than 23,000 jobs in local health departments, mandatory furloughs, and shortened work weeks for 13,000 local health department employees.

The report also highlighted several lessons learned from the H1N1 outbreak, most notably that:

• Emergency funds are essential – but not sufficient for backfilling the long-standing public health infrastructure issues;
• Pandemic and emergency response plans must be adaptable and science-driven;
• Establishing trust with the public through clear and honest communication is imperative – and the highest-risk groups often have the lowest levels of trust;
• Recommendations for sick leave, school closings, and limiting community gatherings have major ramifications that must be taken into account;
• Coordination across communities, states, and countries is extremely complicated, but must be a high priority; and
• Competing emergency declarations and laws must be better coordinated to avoid confusion and provide protection to volunteers.

In addition, the report found key areas that must be at-the-ready for potential emergencies and to respond to the seasonal flu, but are often deficient due to lack of resources, including:

• Up-to-date and available pharmaceuticals, vaccines, and medical equipment;
• Surge capacity to provide mass care to patients; and
• Core public health infrastructure, such as surveillance, laboratory capacity, and workforce.

The report was supported by a grant from the Robert Wood Johnson Foundation.