Bold truth: vaccination rates for respiratory diseases are dropping, and that could put more people at risk this season. But here’s where it gets controversial: trust in public health is eroding, complicating efforts to protect communities.
A new study reveals that adults in the United States are increasingly unvaccinated against respiratory illnesses. The National Foundation for Infectious Diseases (NFID) released online data showing that, among 1,015 adults surveyed, fewer than half have received vaccines for any respiratory virus. Specific figures include 34% having a flu shot, 25% having a COVID-19 vaccine, 8% for pneumococcal disease (which can lead to pneumonia, meningitis, and sepsis), and 6% for respiratory syncytial virus (RSV).
IQVIA’s health statistics corroborate these declines over the past year. Retail pharmacies report notable drops in vaccinations for three major viruses: RSV (-34%), COVID-19 (-27%), and flu (-6%). Pneumococcal vaccination is the notable exception, rising 27%, likely driven by the CDC’s update to lower the eligible age from 65 to 50 and the NFID’s note on this shift in its medical director’s commentary.
The NFID survey, conducted online from November 10–12, also explored why people avoid vaccination. Among those who didn’t get a flu shot, 16% cited safety concerns and 13% said they “never get sick.” For COVID-19, 20% worried about side effects, and 12% said no healthcare professional had recommended vaccination.
The data also reveal how information sources differ by age and political affiliation. About 44% of respondents trust their healthcare provider most for vaccine information, while only 13% name the CDC as their top source. Younger adults are more likely to rely on digital sources; 15% of Gen Z (ages 18–28) rank social media as their second-most-trusted vaccine information source.
Political divides also emerge. Democrats show higher vaccination rates for updated flu and COVID-19 shots than Republicans or Independents: 41% vs. 35% vs. 22% for flu, and 34% vs. 20% vs. 19% for COVID-19, respectively.
Tom Frieden, MD, MPH, former CDC director and founder of Resolve to Save Lives, warned that historic levels of distrust in public health could be deadly. At a December 3 NFID webinar, Frieden described the challenge of countering a flood of misinformation from anti-vaccine advocates and urged public health bodies to harness social media and trusted messengers to share accurate information. He emphasized humility: science does not confer certainty, but it can offer clear guidance about what is known and unknown.
Rochelle Walensky, MD, MPH, also a former CDC director, attributed much of the trust erosion to political interference and misinformation propagated by the previous administration, while noting that mainstream healthcare providers and medical societies have maintained a consistent, unified stance on vaccine safety. She contrasted this with perceived governmental messaging differences.
The shifting guidance around vaccines has added to confusion. For example, the CDC now recommends that people discuss COVID-19 vaccination with their healthcare provider rather than a universal mandate for everyone over six months old. In September, guidance on the MMRV vaccine (measles, mumps, rubella, and varicella) was updated to separate the varicella component into a separate chickenpox shot, with separate MMR vaccination for measles, mumps, and rubella.
Amid these changes, 44% of NFID respondents felt current guidance on respiratory vaccines was unclear or only partially clear. A Pew Research Center poll around the same time found that many Americans either were unaware of guideline changes or believed those changes had little effect on their behavior. Yet in another Pew survey, about two-thirds expressed strong or high confidence in vaccine effectiveness, while roughly half trusted the safety testing and scheduling.
NFID’s recommendations to reduce respiratory illness risk are as follows:
- Annual flu vaccination for everyone aged 6 months and older.
- COVID-19 vaccination for individuals at high risk (including young children, pregnant people, older adults, and those with chronic conditions), and for anyone aged 6 months and older who wishes to be vaccinated.
- RSV vaccination for pregnant people or RSV monoclonal antibody protection for infants whose mothers did not receive an RSV vaccine during pregnancy; RSV vaccination for certain adults aged 50–74 and all adults 75 and older.
- Pneumococcal vaccination for children under 5 years, all adults 50 and older, and people with chronic health conditions or other risk factors.
The overarching message is clear: vaccines save lives, but trust, access, and clear communication are equally crucial for broad uptake. What’s your take on the balance between evolving scientific guidance and public confidence? Do you think public health institutions should adjust how they communicate risk and uncertainty to different communities, and if so, how?
