The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study

Abstract

Background: In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination.

Objective: The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people.

Methods: Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination.

Results: Among 6641 respondents, 945 (14.2%) were previously eligible but were not vaccinated; of these, 536 (56.7%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49%) stated they would decline vaccination in 2020-2021.

Conclusions: In this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs.

Keywords: COVID; COVID-19; Health Service; National Health Service; Pandemic; United Kingdom; electronic health record; flu; impact; influenza; intention; observational; public health; uptake; vaccination; vaccine; virus.

Figure 1

Participant inclusion flow diagram based on responses to questionnaires capturing variables required for analysis. CIE: Care Information Exchange.

Figure 2

Study participants (N=1624) from UK-wide responses to web-based questionnaires administered through Care Information Exchange (influenza-related questionnaire sent July 31, 2020); network diagram of free-text responses (n=1453, 89.5%). Responses from previously eligible respondents who had previously not accepted the influenza vaccine but would (A) accept it in 2020-2021 (n=478) or (B) continue to decline it (n=356); responses from newly eligible participants who would (C) accept vaccination (n=432) or (D) decline it (n=187). A connecting line (edge) between nodes implies at least one response in which themes of connected nodes co-occurred; the thickness of the line corresponds to the frequency of co-occurrence. Flu: influenza; NHS: National Health Service.