Talking about flu shots during a pandemic

By Kate Land, MD

It may feel hard to believe after the past many months of the COVID-19 crisis, but it’s time to talk with our patients again about the flu vaccine.

Our flu clinics are opening, and we are already having conversations with patients aimed at convincing them to get vaccinated. Because of the SARS-CoV-2 pandemic, these conversations matter more than ever.

It is crucial to maximize flu vaccination rates in order to minimize the impact of flu on the expected surge of COVID-19 this winter. We need our patients to understand the following key points:

• It is not yet understood how the combination of circulating COVID-19 and influenza will affect our population. Our patients may become very ill if they get COVID and influenza at the same time or one after the other.
• Influenza is a serious illness and having it may weaken the immune system’s response to COVID-19. Let them know that having the flu may make them more likely to get COVID.
• While social distancing will help decrease the rates of infection for both viruses, it is still important to get the flu vaccine. You can explain, “Staying away from people who may be sick and washing hands frequently helps, but a flu vaccine brings added protection!”
• Children may be vectors for the influenza virus to their elderly or at-risk relatives. As schools consider even partial reopening, we need to vaccinate children to protect the population at large and prevent them from bringing flu home to their families.

Avoiding confusion between COVID and flu

Decreasing the rate of influenza cases has many benefits in the fight against SARS-CoV-2.

These 2 illnesses present in a similar fashion, making them potentially confusing to diagnose. If fewer of our patients have influenza, we will preserve our COVID testing and treating capabilities. Fewer tests, therapies, and hospital beds will be taken up by patients with influenza. Fewer doctors and support staff will miss work due to illness. The Centers for Disease Control and Prevention explains further:

Influenza vaccination of persons aged greater than 6 months can reduce prevalence of illness caused by influenza and can also reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system.

On top of these messages we need our patients to know that it is safe to come in to get a flu vaccine. We are paying close attention to social distancing and hygiene at our flu clinics. Many sites are even offering drive-through flu shot clinics to allow patients to get vaccinated from their own cars — a shot done safely (but without the shake and side of fries!).

Talking about flu shots

To help you have the most effective conversations with your patients, here is a recap of advice I shared last fall:

• Start strong. Your clear, confident recommendation to vaccinate is important. Rather than asking if the person wants the flu vaccine, assume that they will be getting vaccinated. Use a statement rather than a question: “You are due for your flu shot today, and we should take care of that before you leave.” You may be surprised how often this works.
• Don’t argue. Answer questions with confident, short answers. Be careful to not fall into the trap of lecturing, debating, or arguing. Many people have long-standing opinions about the flu vaccine. You will not change their minds by citing evidence. Surprisingly, we have learned that when patients are confronted with research and data, they can become more resistant to vaccination. Try to break the habit of correcting people’s mistaken beliefs about the flu shot.
• Focus on common ground. Instead of correcting mistaken beliefs or lecturing, focus on the reason you want them protected. Emphasize your common goals with the patient or family: “What we both want is to see you have a smooth winter with your asthma.” “We both want your kids protected in as many ways as possible.”
• Use positive terms. “Protection,” “safe,” and “healthy” are far more convincing than negative terms like “side effect,” “illness,” or “danger.” Frame your conversation with positive terms, rather than spending time discussing or debating the perceived negatives of the vaccine: “Getting the flu shot today is the most important thing you can do to have a safe and healthy winter.”

This fall let’s master our persuasive conversations about the flu vaccine. These conversations can be difficult, but the concurrent pandemic makes them more important than ever. These conversations, if done well, can save the lives of our patients, colleagues, family, and friends.

Kate Land, MD, is a pediatrician with The Permanente Medical Group, which provides care to Kaiser Permanente members in Northern California. She serves as chief of Health Education and Promotion for Kaiser Permanente’s Napa-Solano area and writes for the Thriving Families blog. Follow her on Twitter at @KPkiddoc.