Past Low Flu Vaccination Rates and Gaps in Flu Policies Contribute to Vaccine Shortages and Other Problems in Preparedness

A new review of flu vaccination trends and policies issued by the Trust for America’s Health (TFAH) found fewer than half of Americans ages 6 months and older were vaccinated against the flu in the last two flu season (2010-11 and 2011-12).  For the first time during the 2010-11 flu season, CDC recommended that all Americans ages 6 months and older receive the flu vaccine.  The historically low demand for seasonal flu vaccinations has contributed to limiting the supply of vaccine manufactured each year.

“The flu is an annual threat.  Some years, like this one, the threat is more severe than others.  The problem is we let our guard down during mild seasons and then we aren’t ready when a harder season hits,” said Jeffrey Levi, PhD, executive director of TFAH.  “We need to maintain a steady defense and make annual flu vaccinations – and the manufacture of sufficient supply — a much higher priority every year.”

Every year, around 20 percent of Americans get the flu.  Between 3,000 and 49,000 Americans die from flu-related illnesses and an average of 226,000 are hospitalized.  The flu leads to economic losses of more than $10 billion in direct medical expenses and more than $16 billion in lost earnings.

TFAH identified some additional actions that could be taken to fill persistent gaps in flu preparedness and policy including to:

• Reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) to address and update ongoing challenges in the ability of the public health system to respond to health threats and ensure targeted investment in flu-related medicines and technologies;
• Ensure all healthcare personnel receive the annual seasonal flu vaccine every year;
• Educate the public, especially at-risk groups, front-line workers, and clinicians, about the seriousness of the flu, need to be vaccinated and the safety of the vaccine;
• Continue investments in expanded domestic flu vaccine manufacturing capacity with government guarantees to industry to assure an adequate supply during bad flu seasons;
• Improve diagnostics to ensure accurate surveillance and proper treatment of influenza-like illness;
• Expand the use of nurse triage lines and other pre-hospital systems to reduce the number of healthy people seeking medical care;
• Cover flu vaccines under public and private insurance without cost-sharing.  For instance, currently, 12 states and Washington, D.C. do not require Medicaid to cover flu shots with no co-payment requirements for beneficiaries under the age of 65;
• Invest in research for a universal flu vaccine to replace the annual shot;
• Sustain investments – such as the Prevention Fund investments that have been used to improve the Immunization Information Systems and other information technologies – in immunization programs, adult immunization programs and vaccination capacity in schools;
• Better integrate electronic health records and public health surveillance systems to improve surveillance of flu outbreaks and improve two-way communication between clinicians and public health experts;
• Allow workers in businesses with 15 or more employees to earn up to seven job-protected paid sick days each year to be used to recover from their own illnesses, access preventive care or provide care to a sick family member. Currently, around 38 percent of private workers do not have any sick leave coverage (around 40 million Americans); Maintain the Strategic National Stockpile with emergency medical equipment and vaccines and medicines not only to respond to new pandemics but to help respond to shortages;
• Improve disaster surge capacity so hospitals and health care providers are better able to respond to major increases in numbers of patients, including through regional coordination, strengthened health care coalitions and planning for discharging non-emergency patients; and
• Sustain federal, state and local funding for core public health capabilities, to ensure there are adequate resources and staff to maintain ongoing functions and respond to emergency needs when they arise.  Since 2008, state and local health departments have cut more than 45,700 jobs across the country.

As of November 2012, this season’s flu vaccination rates were similar to those in 2011 (36.5 percent of Americans ages 6 months and older were vaccinated by November 2012 compared to 36.5 percent by November 2011), according to data collected from http://www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2012.htm.

Last Flu Season’s (2011-12) Vaccination Rates Data

According to data from the U.S. Centers for Disease Control and Prevention (CDC), vaccination rates have varied widely by state.  During last year’s flu season (Fall 2011 to May 2012), vaccination rates of individuals ages 6 months and older ranged from a high of 51.1 percent in South Dakota to a low of 32.6 percent in Nevada.  Twelve states had rates below 40 percent.

In addition:

• Child (ages 6 months to 18 years) vaccination rates: ranged from a high of 73.8 percent in Rhode Island to a low of 38.8 percent in Alaska.  Twenty states had rates below 50 percent.  Hispanic children were the most likely to be vaccinated at 59.5 percent compared to 53.7 percent of Black children and 47.6 percent of white children;
• Seniors (ages 65 and older) vaccination rates: Ranged from a high of 75.9 percent in Iowa to a low of 49.5 percent in Alaska; and
• Health care worker vaccination rates:  66.9 percent of health care workers were vaccinated.

Last Season’s Flu Vaccination Rates State-by-State (for 2011-12)

State-by-state flu vaccination rates come from CDC.  CDC analyzed NIS and BRFSS data collected September 2011 through June 2012 from all 50 states and the District of Columbia to estimate national and state level influenza vaccination coverage for the 2011–12 influenza season. These findings were compared to 2010-11 influenza season estimates.  http://www.cdc.gov/flu/professionals/vaccination/coverage_1112estimates.htm#data.

Ranking for total percent of all individuals (children and adults) ages 6 months and older vaccinated, including adults and children:

1. South Dakota (51.1%); 2. Massachusetts (50.1%); 3. Hawaii (49.9%); 4. Rhode Island (49.8%); 5. Iowa (47.9%); 6. West Virginia (47.5%); 7. Maryland (47.4%); 8. Tennessee (47.3%); 9. Minnesota (47.2%); 10. TIE Arkansas (46.6%); and District of Columbia (46.6%); 12. North Carolina (46.5%); 13. Connecticut (46.4%); 14. Delaware (46.1%); 15. Virginia (46.0%); 16. Maine (45.7%); 17. TIE Oklahoma (45.5%); and Vermont (45.5%); 19. Nebraska (45.2%); 20. Kansas (44.8%); 21. New Mexico (44.6%); 22. North Dakota (44.5%); 23. Louisiana (44.4%); 24. Colorado (44.3%); 25. New Hampshire (43.8%); 26. Ohio (43.7%); 27. Pennsylvania (43.5%); 28. TIE New Jersey (42.8%); and Utah (42.8%); 30. Kentucky (42.7%); 31. South Carolina (42.1%); 32. Missouri (41.8%); 33. Washington (41.7%); 34. Alabama (41.6%); 35. Texas (41.4%); 36. New York (41.4%); 37. Wisconsin (40.8%); 38. California (40.5%); 39. Indiana (40.0%); 40. Mississippi (39.6%); 41. Michigan (38.8%). 42. Georgia (38.5%); 43. Arizona (38.2%); 44. Oregon (38.0%); 45. Illinois (37.3%); 46. Wyoming (37.1%); 47. Florida (36.9%); 48. Montana (36.8%); 49. Alaska (34.7%); 50. Idaho (34.3%); 51. Nevada (32.6%).

Rankings for adults ages 18 and older vaccinated:

1. South Dakota (48.9%); 2. Iowa (47.3%); 3. West Virginia (47.0%); 4. Massachusetts (46.5%); 5. Tennessee (46.3%); 6. Minnesota (45.6%); 7. Hawaii (45.4%); 8. Virginia (44.7%); 9. Kansas (43.8%); 10. North Carolina (43.7%); 11. Delaware (43.5%); 12. Nebraska (43.4%); 13. Rhode Island (43.3%); 14. Oklahoma (43.0%); 15. Vermont (42.8%); 16. Maine (42.5%); 17. TIE District of Columbia (42.4%); and Maryland (42.4%); 19. Connecticut (42.4%); 20. North Dakota (42.0%); 21. Colorado (41.8%); 22. Ohio (41.5%); 23. Arkansas (41.4%); 24. New Hampshire (41.1%); 25. Kentucky (40.9%); 26. Missouri (40.8%); 27 TIE Louisiana (40.4%); and Pennsylvania (40.4%); 29. Washington (40.1%); 30. Utah (39.7%); 31. South Carolina (39.6%); 32. TIE Alabama (39.3%); and New Mexico (39.3%); 34. Mississippi (38.6%); 35. TIE Indiana (37.7%); and Wisconsin (37.7%); 37. Texas (37.3%); 38. TIE New Jersey (37.2 %); New York (37.2%); 40. Michigan (36.7%); 41. Georgia (36.4%); 42. California (36.2%); 43. Oregon (36.1%); 44. Montana (35.3%); 45. Florida (35.0%); 46. Illinois (34.8%); 47. Arizona (34.7%); 48. Wyoming (34.6%); 49. Alaska (33.3%); 50. Idaho (31.4%); 51. Nevada (28.3%).

Rankings for children ages 6 months to 18 years old vaccinated:

1. Rhode Island (73.8%); 2. Hawaii (66.6%); 3. District of Columbia (65.1%); 4. Maryland (64.0%); 5. Massachusetts (63.4%); 6. Arkansas (63.3%); 7. New Jersey (61.5%); 8. TIE Connecticut (60.8%); and New Mexico (60.8%); 10. Maine (58.6%); 11. South Dakota (58.2%); 12. Louisiana (56.6%); 13. Vermont (56.5%); 14. North Carolina (55.7%); 15. Delaware (55.1%); 16. TIE New York (54.8%); and Pennsylvania (54.8%); 18. North Dakota (53.7%): 19. New Hampshire (53.6%); 20. California (53.4%); 21. Oklahoma (53.2%); 22. Minnesota (52.6%); 23. Texas (52.5%); 24. Colorado (52.4%); 25. Wisconsin (51.6%); 26. Ohio (50.9%); 27. Nebraska (50.7%); 28. TIE South Carolina (50.6%); and Virginia (50.6%); 30. Tennessee (50.4%); 31. Iowa (50.1%); 32. Utah (49.9%); 33. Alabama (49.4%); 34. West Virginia (49.3%); 35. Kentucky (48.9%); 36. Arizona (48.2%); 37. Kansas (47.8%); 38. Indiana (47.4%); 39. Washington (46.9%); 40. TIE Michigan (45.5%); and Nevada (45.5%); 42. Wyoming (45.2%); 43. Illinois (45.1%); 44. Missouri (44.9%); 45. TIE Georgia (44.4%); and Oregon (44.4%): 47. Florida (43.9%); 48. Mississippi (42.6%); 49. TIE Idaho (42.4%); and Montana (42.4%); 51. Alaska (38.8%).

Rankings for seniors ages 65 and older vaccinated:

1. Iowa (75.9%); 2. Tennessee (74.6%); 3. West Virginia (72.5%); 4. Louisiana (72.3%); 5. North Carolina (71.6%); 6. Oklahoma (71.3%); 7. South Dakota (71.0%); 8. Kansas (70.9%); 9. Missouri (70.8%); 10. Hawaii (70.6%); 11. Vermont (70.1%); 12. Massachusetts (70.0%); 13. Minnesota (69.8%); 14. Colorado (69.5%); 15. Maryland (69.4%); 16. Delaware (69.1%); 17. Mississippi (68.8%); 18. Georgia (68.6%); 19. Ohio (68.1%); 20. TIE Pennsylvania (67.6%); and Washington (67.6%); 22. Nebraska (67.1%); 23. TIE Alabama (67.0%); and Kentucky (67.0%); 25. Maine (66.8%); 26. Connecticut (66.4%); 27. South Carolina (65.7%); 28. Texas (65.1%); 29. North Dakota (65.0%); 30. Arkansas (64.1%); 31. TIE Utah (63.6%); and Virginia (63.6%); 33. New jersey (63.5%); 34. New Hampshire (62.9%); 35. New York (62.5%); 36. Florida (62.3%); 37. Indiana (62.1%); 38. New Mexico (62.0%); 39. TIE District of Columbia (61.6%); and Michigan (61.6%); 41. California (60.7%); 42. Rhode Island (60.3%); 43. Montana (59.8%); 44. Illinois (59.1%); 45. Wyoming (58.7%); 46. Arizona (58.1%); 47. Oregon (58.0%); 48. Idaho (57.7%); 49. Wisconsin (54.9%); 50. Nevada (52.2%); 51. Alaska (49.5%).

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

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