How should the annual seasonal influenza campaign be addressed in times of COVID-19 in healthcare and other settings?

Increasing the rates of influenza immunization in all sectors will be extremely important for health and managing logistics of employees with Influenza Like Illness (ILI) during this season while COVID-19 is still realizing significant rates of transmission throughout the US.  The CDC has recommended that vaccine programs should begin early (September and October) and focus on increasing overall immunization rates.  To this end, CDC has worked with vaccine manufacturers to increase the number of vaccines that will be available this season.

The large economic burden of influenza and the benefits of providing influenza vaccine in the workplace are well documented (Molinari,2007, Zimmerman,2012).  While health care settings have required or at least strongly recommended seasonal flu vaccine, other sectors have had less robust uptake in seasonal influenza vaccination, with less than 50% of adults of working age receiving influenza vaccination most years (Bekkat-Berkani, 2018).  In most years, a persuasive argument for influenza vaccination revolves around the benefits of disease attenuation such as reduced mortality, hospitalization, absenteeism and disruption to daily life (Bekkat-Berkani,2018). However, in the midst of a pandemic, the public may be more swayed by immunization reducing the confusion and concern around discerning whether symptoms are due to COVID-19 or influenza.  For this reason, workplace and community settings of vaccine distribution should seek to enhance the ease of obtaining an immunization since other barriers may be lower. Patient reminder and recall systems have been shown to increase vaccine uptake (Jacobsen, 2018).  In addition, the immunization of young children has been shown to reduce overall community morbidity and mortality due to the reduction of community transmission of influenza (Rajaram,2017). Immunization programs for teachers and childcare providers may have particular benefits  for reducing community influenza spread for this reason.

A primary consideration for vaccination programs in the 2020-21 season is delivering high volumes of vaccine while maintaining the social distancing and universal masking necessary for COVID-19 precautions. This means that mass vaccination programs need to be reconfigured to allow increased spacing between patients and assurance of universal masking, which will reduce throughput. Mass vaccination sites should consider expanding space, staff, and hours of operation to allow for these safety measures. Drive through vaccination events are one means of accomplishing social distancing, and could be more feasible this season given lessons learned from drive through COVID-19 testing centers.

Occupational vaccination programs delivered in healthcare and other practices may wish to deliver more vaccine to the worksite through mobile carts to reduce crowding at centralized vaccination stations this season. Employers can also spread out vaccination campaigns to give employees more opportunities to get vaccine over a longer timeframe (e.g. several weeks rather than a few days of vaccine availability on site.) 
Retail pharmacy chains have largely incorporated routine safety procedures including the use of masks and face shields by pharmacists, masking of patients, routine disinfection of surfaces, and encouraging pre registration  online to reduce wait time in the store (Bomey, 2020). 

For vaccination delivered in the outpatient clinical setting, practices can adopt additional strategies to increase influenza vaccination rates without increasing patient crowding at facility entrances and waiting areas. Examples include standing orders for influenza vaccine so that patients having clinic visits for other reasons are routinely offered vaccine, establishing dedicated vaccination stations near or outside healthcare facility entrances, and sharing information with patients and community members about local vaccination sites and off-peak hours.


  • US interactive website to locate vaccine distribution sites:
  • Checklist for best practices for immunization clinics:
  • Bekkat-Berkani R, Romano-Mazzotti L. Understanding the unique characteristics of seasonal influenza illness to improve vaccine uptake in the US. Vaccine. 2018;36(48):7276-7285. doi:10.1016/j.vaccine.2018.10.027
  • Bomey, Nathan. Walgreens, CVS pharmacists to check for coronavirus symptoms, wear face shields during flu shots. USA Today. 8/17/2020.
  • Jacobson Vann JC, Jacobson RM, Coyne-Beasley T, Asafu-Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev. 2018;1(1):CD003941. Published 2018 Jan 18. doi:10.1002/14651858.CD003941.pub3
  • Molinari, Noelle-Angelique M et al. “The Annual Impact of Seasonal Influenza in the US: Measuring Disease Burden and Costs.” Vaccine. 25.27 (2007): 5086–5096. 
  • Rajaram S, Wiecek W, Lawson R, et al. Impact of increased influenza vaccination in 2-3-year-old children on disease burden within the general population: A Bayesian model-based approach. PLoS One. 2017;12(12):e0186739. Published 2017 Dec 15. doi:10.1371/journal.pone.0186739
  • Zimmerman RK, Wiringa AE, Nowalk MP, et al. The comparative value of various employer-sponsored influenza vaccination clinics. J Occup Environ Med. 2012;54(9):1107-1117. doi:10.1097/JOM.0b013e3182677d34

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