Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2023

Discussion

As of December 9, 2023, self-reported coverage with influenza, updated COVID-19, and RSV vaccines among U.S. adults was low, particularly for updated COVID-19 and RSV vaccines. RSV vaccination coverage was low even among persons with chronic conditions who are at highest risk for severe RSV disease and might benefit from vaccination. As of mid-November, influenza vaccination coverage was approximately 2.5 percentage points lower than it was at the same time during the 2022–23 influenza season (6). Approximately 41% of all adults and 53% of adults aged ≥60 years were unvaccinated but reported that they definitely or probably plan to receive or are unsure about receiving updated COVID-19 and RSV vaccines, respectively, suggesting they are open to vaccination. A health care provider recommendation for and offer of vaccination are strongly associated with vaccination (7). A previous report found that unvaccinated adults who were open to receiving a bivalent COVID-19 vaccine had not yet done so mainly because of concerns about side effects, being too busy, or just had not gotten around to getting vaccinated (8). Making vaccination available in provider offices, pharmacies, workplaces, and other convenient locations at convenient times, along with a strong provider recommendation for vaccination, could increase vaccination coverage, particularly for RSV, which is recommended on the basis of shared clinical decision-making between a patient and provider (3).

Despite disparities in vaccination coverage by race and ethnicity, when responses indicating the person is open to vaccination are included, the potential vaccination coverage that could be achieved for Hispanic, Black, and Asian adults is similar to or higher than that for White adults. Programmatic measures that helped reduce disparities in coverage with the primary series of COVID-19 vaccine, such as making vaccines available free of charge, use of trusted messengers, and bringing vaccines into communities through nontraditional settings (e.g., local libraries and local businesses such as barber shops and restaurants)^§§ (4,9), might increase equitable access to vaccination and decrease disparities for these currently recommended vaccines.

CDC is partnering with community-based organizations, health care providers, and other trusted messengers to build vaccine confidence and awareness, including through the Partnering for Vaccine Equity program.^¶¶ CDC is also working to expand COVID-19 vaccine access to all through the Bridge Access Program, which provides COVID-19 vaccines for adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. Public health safety net and pharmacy locations offering influenza and COVID-19 vaccines, including COVID-19 vaccines through the Bridge Access Program, are available at https://www.vaccines.gov. Communication campaigns,*** such as the “Wild to Mild” and “Get My Flu Shot” influenza vaccine campaign and the “Everything” broad respiratory virus communication initiative, include various materials and resources to promote vaccination, including to persons who are disproportionately affected by disease. Finally, CDC has developed health care provider toolkits to empower providers with knowledge to confidently recommend vaccination.^†††

CDC makes vaccination coverage estimates rapidly available during the respiratory virus season.^{§§§,¶¶¶} In addition to data from the NIS-ACM, vaccination data are available from multiple sources and include coverage among children, pregnant persons, Medicare beneficiaries, and national projected vaccination in pharmacies and medical offices. Jurisdiction-level estimates of COVID-19 vaccination coverage and intent stratified by demographic factors, behavioral and social drivers of vaccination, and barriers to vaccination are available.**** CDC’s COVID-19 Vaccination Geographic Information System Mapping Tool, designed with feedback from several local health departments, provides web maps where jurisdiction-level data including demographic characteristics and social determinants of health can be displayed along with vaccine confidence and vaccination coverage.^†††† End-of-season influenza vaccination coverage estimates for children and adults since the 2010–11 influenza season, nationally and by state, are available on FluVaxView.^§§§§

Limitations

The findings in this report are subject to at least three limitations. First, response rates for NIS-ACM were relatively low (<25%). Data were weighted to mitigate possible bias resulting from incomplete sample frame (i.e., exclusion of households with no phone service or only landline telephones) or nonresponse, but some selection bias might persist. Second, all responses were self-reported; vaccination receipt, and month and year of receipt of most recent dose might be subject to recall or social desirability bias. Nonresponse and social desirability bias could result in overestimation of coverage. Third, the survey sampled noninstitutionalized U.S. adults; therefore, adults who were incarcerated or who live in long-term care facilities^¶¶¶¶ might not be represented in the sample.

Implications for Public Health Practice

Although influenza, updated COVID-19, and RSV vaccination has slowed for the 2023–24 respiratory season, vaccination is recommended to continue while viruses are circulating (1–3), and many unvaccinated persons continue to report intent to be vaccinated. Health care provider recommendations for and offers of vaccination are important to increasing vaccination coverage (7). Immunization programs and vaccination partners are encouraged to use CDC developed dashboards and tools, as well as other data sources available to them, such as immunization information systems, to identify undervaccinated populations and better understand vaccination patterns, attitudes and behaviors, and systemic barriers to vaccination in their jurisdiction to help tailor vaccination activities to improve coverage and health equity.