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Vaccination Rates Are Falling. How Will That Affect Flu Season?
More Americans are skipping routine shots, and public health experts worry that could mean more people get sick this winter
6-minute read
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Flu season is just around the corner, and a troubling trend could affect how hard it hits this year. Declining flu and COVID vaccine rates could leave more people vulnerable to illness.
In the years leading up to the COVID pandemic and through the season after it began, flu vaccination rates were rising. In the 2020-2021 season, 50.2 percent of Americans age 18 and older rolled up their sleeves for the annual shot. But since that time, rates have steadily fallen. In the 2024-2025 season — the most recent year the Centers for Disease Control and Prevention (CDC) has reported — 41.9 percent of adults were vaccinated against the flu, the lowest rate in seven seasons.
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Meanwhile, during that same season, 710,000 Americans were hospitalized for flu, and 45,000 died from it — and older adults shouldered the greatest burden.
COVID vaccines have also been on the decline: The latest CDC data for the 2025-2026 season showed just 22.6 percent of Medicare users age 65 and older had been vaccinated, compared to just shy of 30 percent at the same point in 2024.
Misinformation plays a role
Public health experts cite several potential reasons for the drop. While issues such as a lack of access, forgetfulness and a perceived lack of need are part of the story, doctors agree that vaccine hesitancy and misinformation play a major role.
Health policy research organization KFF polled just under 2,500 Americans to ask their beliefs on four common vaccine myths: whether or not they believe that measles, mumps and rubella (MMR) vaccines have been proven to cause autism in children; that more people have died from the COVID-19 vaccines than the virus; that mRNA vaccines can alter DNA; and that measles vaccines are more dangerous than measles itself.
They found that relatively few people (around 8 percent) strongly believed all four myths, but a much larger percentage weren’t sure. At least half of all respondents fell into what researchers called the “malleable middle”: They didn’t agree that these myths were definitely false or definitely true.
Uncertainty in changing vaccine recommendations may also play a role. A new survey from the National Foundation for Infectious Diseases found that many U.S. adults aren’t sure which vaccines they need and when. At the same time, many Americans underestimate the severity of common respiratory illnesses, such as the flu, the poll found.
“It’s not just a cold,” Dr. Ryan A. Stanton, president-elect of the American College of Emergency Physicians, said in a news briefing. “There is just a cold out there. I still don’t want to have that one either. But a lot of these [respiratory viruses] are much, much more serious.”
Do the vaccines really help?
One of the reasons many people cite for not getting vaccinated is low effectiveness. It’s true that neither flu nor COVID vaccines offer perfect protection, and that effectiveness varies quite a bit from year to year. The CDC estimates that vaccines reduced the risk of flu-related hospitalization in older Americans by 31 percent last season.
Dr. Uzma Syed, chief of infectious diseases and director of the Antimicrobial Stewardship Center of Excellence at Good Samaritan University Hospital in New York, says she understands why the sometimes-low statistics can make people think, “What’s the point?”
But, she says, “What they’re not really taking into account is that even if it’s 30 or 40 percent effective against the circulating strain, that’s 40 percent more protection than you had without being vaccinated, and it still prevents a worse outcome.”
Dr. Amy Kressel, medical director for infection prevention at Parkview Health in Indiana, compares vaccines to seat belts and airbags in cars, saying that each safety measure stacks up and provides more protection from serious injury and death.
“We know that sometimes people die in motor vehicle accidents, and we are not going to prevent everything, even though we have very effective interventions. And vaccines are the same way: They will not prevent every single case of influenza, but they will prevent, to a large extent, death from influenza,” she says.
Vaccines don’t just protect an individual; they can also have a broader impact by reducing transmission in the community. If fewer people get vaccinated, viruses can spread more easily and cause more people to get sick.
Reasons to vaccinate beyond the short-term protection
Another strong case for getting vaccinated is that the risks associated with both flu and COVID don’t end when the immediate illness ends.
“We know that people who get influenza, even if you do fine and you think you’re better, the following year your risk of either a heart attack or stroke is increased,” Kressel says.
Long COVID is still the subject of significant research, but it’s widely acknowledged that repeat infections raise the risk of new or lingering symptoms that may include extreme fatigue, heart disease, allergies, cognitive dysfunction, pain, digestive symptoms and a host of other lasting effects. Getting vaccinated reduces your risk not only of the immediate effects of the viruses but the aftereffects too.
Of particular note to older Americans, recent studies of both flu and shingles vaccines show they’re associated with a reduced risk for dementia.
A new study in the journal Neurology shows that high-dose flu vaccines (recommended for those 65 and older) were linked to an even bigger benefit: Individuals who received the high-dose vaccine showed a reduction in new Alzheimer’s disease diagnoses by 55 percent, compared to a 40 percent reduction from the standard dose, for the first 25 months afterward, with protection waning after that.
The newer shingles vaccine, Shingrix, was associated with a 20 percent reduction in new dementia cases over the following seven years, according to a study published in the journal Nature.
In all cases, it’s not yet certain what’s causing this reduction, but Kressel says it could be as simple as this: “Infectious diseases cause inflammation and probably cause some vascular damage. Vascular damage probably plays a role in dementia.”
Other theories include the idea that vaccines may trigger the immune system to break up plaques in the brain, or the converse: They may calm the immune system in the brain and prevent it from triggering inflammation.
When should you get the vaccines this year?
Fall is the ideal time to get vaccinated to protect yourself for the season, and Syed suggests it’s smart to prepare this year, as it’s likely to be a bad respiratory illness season with vaccination rates continuing to fall. As soon as the weather gets chillier, and people spend more time indoors together, respiratory illnesses spread more easily — not because of the cold, but because of shared spaces.
A healthy lifestyle that can help people avoid serious illness includes a “good diet, exercise and sleep habits, but also maintaining all their chronic medical conditions and being up to date with all their immunizations,” Syed says. “That’s how they’re going to make sure that they are heading into this fall and winter season in optimal health.”
The good news: You don’t need to make multiple appointments to get your flu and COVID vaccines — even the RSV vaccine. You can get them all at the same time, though it’s really a matter of personal preference, Kressel says.
“People have to be honest with themselves and know whether or not they’re really going to go back to get those vaccines, or whether they just want to get it over with.”
The CDC reports that there’s no need for a waiting period between the flu and COVID vaccines and that getting them done together only slightly increases the risk of mild side effects, the most common of which include soreness at the injection site, fever, muscle aches and fatigue. Serious adverse events are rare, but can include severe allergic reactions (anaphylaxis) and, with the COVID-19 vaccine, myocarditis or pericarditis, which is inflammation in the heart muscle and lining.
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