For years, American health care providers have struggled to improve influenza vaccination rates. A health care provider’s recommendation is the strongest predictor of vaccination—yet despite our advice, only half of Americans get their annual flu shots. With the availability of safe and effective influenza immunizations, why aren’t more patients heeding our call?

To tackle this complex problem, Reliant Medical Group (Worcester, MA), Optum Life Sciences and Sanofi Pasteur joined forces to change the minds of hesitant patients.

Hesitancy and misconceptions

One of the biggest roadblocks to increasing vaccination rates when face-to-face with a patient is patient resistance. In the exam room, we hear a variety of misconceptions that cause vaccine hesitancy: we’re told by patients that they believe they can contract the flu from the shot, or they underestimate the seriousness of a virus that hospitalized between 400,000-800,000 and killed approximately 20,000-60,000 people each year from 2017-2020, based on CDC data. We have even heard concerns that getting a flu shot could affect COVID-19 test results.

To increase influenza vaccination rates, we need to continually educate patients about the realities and seriousness of influenza and combat the misinformation that causes hesitancy and fear. With the increased awareness that the COVID-19 pandemic brings to public health, infectious diseases, and vaccines, we have a unique opportunity to do just that.

Because of the pandemic, more Americans are coming to understand that contracting a potentially deadly virus poses a serious threat: not only to them, but also to their vulnerable loved ones. Protecting others can be a powerful motivator. The idea of passing a dangerous virus on to a family member or friend who may be at greater risk of influenza-related complications (e.g. young children, those with chronic medical conditions, pregnant women, etc.) hits close to home for many people. This sentiment may be one of the missing links to boosting annual flu vaccination rates.

A new approach

Last winter, we collaborated and put this idea to the test. In our search for novel ways to improve seasonal flu vaccination rates, we launched a late-season interventional study designed to shift patient behavior and opinion. Adapting principles from the psychological discipline of behavioral economics and guidance from the CDC’s Flu Communication Resource Center, we employed an innovative household-based patient recall/reminder program.

Behavioral economics studies how people make choices—and, by extension, how to influence those choices and the behaviors people exhibit. Its use in health care is a relatively recent phenomenon, but it offers a lot of potential when combined with the growing precision of health care data. We can now identify and target specific groups of patients with messages about steps they can take to protect and improve their health.

Our joint study sought to leverage the increased awareness surrounding preventive health measures and the importance of protecting others. We brought together Optum’s expertise in data analytics and Sanofi’s experience with the influenza vaccine to identify ways to better serve Reliant’s patient population. In doing so, we explored how the social structure of households and the influence of family members could affect flu vaccination rates.

Using automated patient portal emails and phone calls, we delivered targeted messages about influenza and the flu shot to more than 27,000 households with one or more unvaccinated patients. By messaging all individuals in a household, regardless of vaccination status, we aimed to inspire persuasive conversations between the unvaccinated and vaccinated household members about getting the flu shot.

The full results of our study are forthcoming and will be published later in 2021. We look forward to presenting data demonstrating that evidence-based interventions like patient communication can move people to get their annual influenza jab. As we continue to see an increase in patient portal engagement, more practices should further leverage these platforms to deliver targeted messages. By doing so, we increase the chances that family members can persuade their loved ones at high risk of severe illness, hospitalization, and even death to protect themselves.

We can move the needle on flu vaccinations

Of course, encouraging your patients to get a flu shot is important every year—and this year your recommendation is as critical as ever. As we head into an unprecedented influenza season, with new coronavirus variants appearing and surging across the country, the convergence of these two potentially deadly viruses could devastate communities and overwhelm our health care systems once again.

Many of the preventative measures we took last year against COVID-19 also helped minimize the impact of influenza—but as people return to workplaces, schools, and social functions, we cannot forget that the flu still poses a serious risk. Health care providers must help patients understand and protect against its consequences: an increase in the risk of heart attack and stroke, a decrease in infant immune function, and detriments to the overall quality of life, among many others.

We need to utilize all resources available to our practices—including digital outreach efforts—to communicate the importance of household influenza vaccination to our patients. As doctors and health care professionals, we need to empower our patients to talk to their family members about protecting themselves and others. If we are to succeed in helping to prevent severe influenza-related illness and death, we must not let down our guard now.

Dr. Michael Greenberg, Head of Medical, North America, Sanofi Pasteur

Dr. Lloyd Fisher, Pediatrician, Reliant Medical Group

Dr. Brian Solow, Chief Medical Officer, Optum^® Life Sciences