February 6, 2013
How to Respond to Common Excuses for Not Getting an Influenza Vaccine

Nashville, TN—Pharmacists are on the front line for encouraging Americans to be vaccinated against influenza—which also puts them in the sometimes uncomfortable position of having to respond to a volley of excuses for not getting immunized.
With an especially bad flu season this year, a report published recently in the Journal of the American Medical Association offers some very practical advice on how to answer.

Authors from Vanderbilt University School of Medicine point out that vaccination rates for high-risk individuals with comorbid conditions as well as the health care providers (HCP) who have contact with them remains “unacceptably low.” They point out that as recently as the 2008-2009 influenza season, only 28.2% of all adults aged 18 to 64 years and 41.4% of those with a high-risk condition received an influenza vaccine.

Furthermore, despite an increase in facilities mandating vaccination as a condition of employment and credentials, one-third of HCPs were not vaccinated last year, potentially increasing the risk of transmission to their patients, coworkers, families, and the general public.

“Assessments of why people refuse influenza vaccination often reveal similar themes. We provide perspectives to some of the reasons,” they note.

Here are a few common objections and their suggested responses:

“The vaccine does not work.” The vaccine’s effectiveness this season is 62% and, because it matches many of the circulating viruses, can mitigate morbidity. A better influenza vaccine may be needed, but that is no reason to shun the current vaccine, according to the article.

“The vaccine causes the flu.” Neither of the widely used influenza vaccines, LAIV or the inactivated vaccine, can cause infection with the flu—either because they have a temperature-sensitive adaption that will not allow replication of the virus at human core body temperature or because they contain a killed virus in the first place. Illness that occurs coincidently around the time of the vaccination could be from an influenza exposure before immunization or a noninfluenza virus. Later illness could be because the vaccine is not 100% effective.

“I cannot get the vaccine because I am pregnant or have an underlying medical condition or because I live with an immunocompromised person.” Those are all reasons to have a flu vaccine, not refuse one, the authors say. For years, these groups have been specifically recommended for influenza vaccination. Emphasize that the vaccine is safe in these persons and can prevent serious morbidity and mortality.

“I never get the flu/I am healthy.” Even if healthy adults don’t themselves get a severe case of influenza, they still can transmit the virus to others. Remind them of the potential risk to close contacts, especially those who cannot get vaccinated or who cannot mount a strong immune response to the vaccine and, therefore, must rely on herd immunity for protection, the authors suggest.

“Misperceptions about influenza vaccine are common and often deeply rooted; for the protection of patients, colleagues, and loved ones, these perceptions must continue to be addressed, and the approach should be to immunize, immunize, immunize!” the authors conclude.

U.S. Pharmacist Social Connect