October 14, 2021

With the 2021-2022 flu season approaching, and again converging with COVID-19, now is the time to focus on effective promotion and implementation of strategic flu vaccination programs and redeploy the learnings from last year’s successful campaign.

Seasonal Influenza Impact in Numbers

Flu is a seasonal disease, impacting millions each year and putting a strain on health care resources. In a typical flu season, the health and socioeconomic impacts can be significant. The World Health Organization (WHO) estimates that seasonal influenza may result in 290,000-650,000 deaths globally each year due to respiratory diseases alone.²

According to the Centers for Disease Control and Prevention (CDC), during the (pre-pandemic) 2019-2020 flu season, estimates of its impact in the United States were:

• 39 million to 56 million illnesses;
• 410,000 to 740,000 hospitalizations; and
• 24,000 to 62,000 total deaths.³

Each year, the seasonal flu costs employers billions in both medical/direct costs - such as emergency and/or outpatient visits, hospitalizations and in indirect costs like loss of projected earnings. Employer cost estimates for earnings lost during the 2019-2020 flu season was roughly $13 billion.⁴ It is estimated that U.S. employees miss up to 111 million workdays annually because of the flu.⁵

Higher vaccination rates save lives and alleviate pressure on the health care system. Taking the U.S. as an example, vaccination rates reached 49% during the 2018-2019 flu season. The CDC estimates that those vaccinations prevented 4.4 million flu illnesses, 3,500 deaths and 58,000 hospitalizations.⁶

During the 2020-21 flu season, Americans experienced significantly fewer flu cases and deaths than ever before. This can be attributed to lockdowns and widespread masking, as well as a record number of flu vaccines administered. In the U.S., of the 1.3 million specimens tested, only 2,136 positive cases and 748 deaths were associated with influenza (note that not all deaths are reported, so, in any year, this number can vary/fluctuate).⁷

Looking Ahead to the 2021-22 Season

The increase in U.S. flu vaccine uptake during the 2020-21 flu season may be explained, in part, by increased awareness of infection risks and concerns about public health during the peak of the pandemic, in the fall and winter of 2020. In a recent news conference discussing the importance of staying current with all vaccinations, especially during flu season and the ongoing COVID-19 pandemic, health officials stated that “flu seasons are unpredictable,” and even though U.S. 2021-22 flu vaccination rates are on track with last year’s, they are still taking a cautious approach and preparing for a worse flu season this year. Health officials’ concerns are based on troubling results from surveys on health behaviors and attitudes, which underscore the importance of fostering awareness and tackling misconceptions about all vaccines, as well as the need for health care professionals to strongly recommend vaccines for their patients.^10,11

For example, findings from the recent National Foundation for Infectious Diseases (NFID) survey found that even though most adults in the U.S. believe annual vaccinations are the best protection against flu, many do not plan to get the vaccine during the 2021-2022 flu season.¹¹ Moreover, U.S. adults are more likely to worry about getting COVID-19 than getting the flu.¹¹ The survey insights also highlight the need to address health disparities and better educate populations at increased risk, especially older adults and individuals with chronic health conditions (e.g., diabetes, lung disease and heart disease), as they have a higher risk for complications from flu, pneumococcal disease and COVID-19 as well.

What Will Be Different During the 2021-2022 Flu Season?

Two Viruses with Similar Symptoms: Symptoms of the flu and COVID-19 (and even more so with the COVID-19 Delta variant) present in similar ways. Determining which virus an individual has will require effective and quick testing—now much more readily available since the start of the pandemic.

Seeking Preventive Care: With reduced numbers of in-person preventive visits and an increase in the number of people seeking non-urgent care, there is concern that adherence to the recommended preventive services that need to be delivered in person, such as vaccinations, may decrease in 2021-22. However, the availability of vaccines at local pharmacies and convenient access to both flu and COVID-19 vaccines may help keep uptake high.

The Role of Employer Vaccination Programs: These programs have always been key to successful seasonal vaccination campaigns in the U.S., and there is a significant opportunity for on-site clinics to continue to expand their role and provide vital preventive care and testing/screening services to employees (including administering vaccines and testing for COVID-19 and/or for the seasonal flu). For example, many employers are being innovative in their on-site/near-site care model by offering care via drive-through vaccine clinics and moving services to a virtual model when possible (e.g., remote screening/testing). The Business Group’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey confirmed this perception and reported that on-site clinic staff helped conduct COVID-19 testing, screenings and vaccinations during the pandemic, along with delivering virtual health services. In 2021, 72% of large employers with on-site clinics will offer COVID-19 vaccinations in at least some of their clinics, while 97% will offer flu vaccinations in at least one of their on-site clinics (74% will offer flu vaccines to employees at all on-site clinic locations).

Changing Mood About Vaccines: It is possible that the 2020-21 flu season saw an increased uptake in seasonal flu vaccinations because there was no COVID-19 vaccine available/approved at that time. Since then, however, the environment has changed. Conflicting reporting, variant surges, misinformation and misconceptions in data/science, lifting of restrictions, vaccine hesitancy and overall increased fatigue/burnout/stress associated with the pandemic precautions could result in lower uptake of the seasonal flu vaccines for the 2021-2022 compared to the 2020-2021 flu season.¹²

With many people not getting the COVID-19 vaccine even though it is readily available to anyone who wants it in the U.S., it is possible that flu vaccines will follow a similar course. Some might choose to forgo routine flu vaccinations due to misconceptions regarding immunity and/or the role of flu vaccines. Also, the timing may still be unclear to some. Initially, out of an abundance of caution, COVID-19 vaccines, were not recommended to be given at the same time as seasonal flu vaccines.¹³ Since then, the Advisory Committee on Immunization Practices (ACIP) has amended their recommendations (see quote below).^{13, 14}

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“COVID-19 vaccines may be administered without regard to timing of other vaccines. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day. […] When deciding whether to [simultaneously] administer an(other) vaccine(s) with a COVID-19 vaccine, vaccination providers should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines”

Centers for Disease Control and Prevention

The Role of the Employer

Employers have a substantial role to play in ensuring that employees get their flu vaccines. They can provide education, coverage, access, vaccination programs (e.g., mobile, on-site/near-site and virtual), sound workplace hygiene practices, paid leave and sick policies. By having these programs and services available, employers can keep employees with symptoms of respiratory illness, potential exposure to COVID-19, and/or unvaccinated for COVID-19, and thus more at risk for serious illness/disease, from entering the workplace and spreading disease.

According to the updated guidelines from the CDC, all Americans are encouraged to sign up for a flu shot and a COVID-19 vaccine (if they haven’t already) this fall. Nonetheless, CDC officials and news outlets still suggest that if you or someone you know are more likely to experience adverse side effects from the annual flu shot, it is fine to consider spacing out the inoculations. In addition, if an individual has a mild illness or COVID-19, they should postpone getting the flu vaccine to avoid exposing health care personnel and other patients to COVID-19 or another virus. When scheduling or confirming appointments for vaccination, patients should be instructed to notify the provider’s office or clinic in advance if they currently have or develop any symptoms of COVID-19.

Vaccine Promotion

Not all companies and company locations can provide access to on-site vaccination programs. However, employers can still promote the importance of annual flu shots to employees and their families. Communicate early and often about the benefits of flu vaccines, especially during the COVID-19 pandemic.

Consider taking the following steps:

• Explain coverage to ease any concerns related to out-of-pocket costs.
• Connect employees to health care providers, pharmacies and clinics that can provide the vaccine.
• Extend time off for the COVID-19 vaccine to also cover flu vaccine appointments.
• Offer coupons for employees and/or their dependents not on the health plan to cover the cost of the flu shot.
• Combine COVID-19 vaccination communications with those for flu.
• Leverage local programs and resources. Government leaders of many countries are urging as many people as possible to obtain a flu vaccine in addition to a COVID-19 vaccine and/or booster shot wherever recommended.
• Consider the needs of employees working in geographies outside the U.S. who have limited access to the flu vaccine this year. In India, one employer is helping secure access to COVID-19 vaccines to its workers when the government was unable to do so.
• Use reliable resources to make the case for the benefit of flu vaccines. Such resources may include:
• The World Health Organization: https://www.who.int/influenza/en/;
• Centers for Disease Control and Prevention: https://www.cdc.gov/flu/, and https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm, https://www.cdc.gov/flu/prevent/vaccine-benefits.htm; and
• State/regional and employer specific resources such as: https://www.cdc.gov/flu/weekly/usmap.htm, https://www.cdc.gov/flu/business/promoting-vaccines-workplace.htm, and https://www.health.ny.gov/diseases/communicable/influenza/seasonal/.

Hygiene

Handwashing and Hand Sanitizer: Employees should be encouraged to wash their hands often with soap and warm water. If handwashing is not available, employees should have access to alcohol-based hand sanitizer.

Sick Policy

Sick Employees Should Stay Home: When employees are beginning to experience early symptoms of any illness, especially respiratory illnesses like the flu, they should stay home for as long as they are symptomatic (especially if unvaccinated for COVID-19). If the illness is confirmed to be the flu through a positive test result, employees should remain home for at least 24 hours after their fever has subsided without the use of fever-reducing medications or after symptoms have improved (at least 4-5 days after flu symptoms started).¹⁶ Individuals should also seek advice from health professionals about whether a COVID-19 test is needed.

Conclusion

This year, getting a flu vaccine is more important than ever. While it’s not possible to predict how challenging the upcoming flu season may be and what impact the changes in behavior and attitudes toward infectious disease protection will have on the rate of spread, we can be almost certain that flu viruses and the virus that causes COVID-19 will both be spreading this fall. By keeping in mind lessons learned from the 2020-21 flu season and taking advantage of available vaccines, we can significantly reduce the burden of these diseases. The CDC recommends that all people 6 months and older get a yearly flu vaccine, excluding some rare exceptions.¹⁴

In addition, COVID-19 vaccines are available for all in the U.S. over age 12, and vaccine approval for younger children is expected this winter. Employers have a significant role to play in ensuring that vaccinations take place. The time to prepare for the flu season is now.

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