Flu vaccine hesitancy: Four key cultural factors
Winter is approaching, and with it comes the annual peak of flu season, generally starting in April and peaking in June1.
Influenza is a contagious respiratory illness caused by influenza viruses, with the most common symptoms including fever, aches, chills, chest discomfort, cough, and headache. While most people infected with the flu will recover, some will develop complications, especially those in higher risk groups which includes pregnant women, young children, the elderly, and individuals with chronic medical conditions2.
Getting vaccinated is the best way to reduce illness and death from seasonal flu2. In fact, The World Health Organization (WHO) estimates that flu vaccinations globally between 2019 and 2020 may have prevented as many as 7.5 million influenza infections, 3.7 million influenza-related medical appointments, 10 000 influenza-related hospitalisations and 6 300 influenza-related deaths3.
Yet, back in 2019, WHO also referred to vaccine hesitancy as one of the top ten threats to global health, highlighting the risk it posed to the progress made in controlling vaccine-preventable diseases3.
Vaccine hesitancy is the unwillingness or delay in getting vaccinated, with individuals who are hesitant experiencing varying degrees of uncertainty. Some might accept all vaccines but still have concerns, while others may delay or refuse certain or even all vaccines4. Negative media messages and word of mouth, especially among younger adults, also plays a part in spreading fears and misinformation about vaccine safety5.
Over the past 20 years, extensive research and studies have identified several reasons for vaccine hesitancy, with four key themes emerging, namely cultural factors, a perceived lack of need for vaccination, concerns about vaccine safety, and a general mistrust3. With the COVID-19 pandemic, concerns about the vaccine development process, including its safety and reliability and the speed of development and testing, contributed to hesitancy6.
Of course, in the case of the COVID-19 vaccine, the mRNA technology behind these new vaccines had been in development for almost two decades, which enabled the vaccine development process to begin early in the pandemic7.
The 1918 influenza pandemic is believed to have infected 500 million people globally, causing between 20 and 50 million deaths. The death toll was so severe that life expectancy worldwide decreased by several years, and it is estimated that more people died from the flu pandemic than during the entire First World War8. Researchers in the United States and Europe raced to find an effective vaccine against influenza during these pandemic years, and their efforts produced hundreds of thousands of doses, but it was only in 1933 that researchers at London’s National Institute for Medical Research (NIMR) made a breakthrough when they isolated and identified the influenza virus8.
Since the 1940s, the flu vaccine itself has evolved alongside advancements in medicine9. As it continues to improve, all vaccine ingredients undergo thorough safety testing before production, ensuring that each vaccine is very safe9. Each year, the WHO, the Centers for Disease Control (CDC), and other public health experts work together to gather and analyse global data to identify the flu viruses most likely to cause widespread illness in the upcoming flu season10.
This year, the trivalent vaccine has been recommended to protect against the three strains expected to be most common during the 2025 flu season in the Southern Hemisphere11. The 2025 quadrivalent influenza vaccine will also be available, including the Influenza B (Yamagata lineage), despite this strain not being detected in South Africa last year12.
Vaccines are one of the most effective health tools, saving millions of lives each year.
They protect people from preventable diseases and improve community health. In addition to health benefits, vaccines help boost the economy by lowering healthcare costs, improving productivity, and reducing the societal impact of illness6.
Every flu season is different, yet flu usually affects millions of people, causing hundreds of thousands of hospitalisations and thousands of deaths globally13. Flu can cause mild illness or lead to serious complications including pneumonia, ear infections, and worsening chronic conditions such as heart failure, asthma, or diabetes13.
Locally, the flu kills between 6 000 to 11 000 South Africans every year, with approximately 50% of those deaths being among the elderly, and about 30% in HIV-infected people14.
Getting an annual flu vaccine is the best way to reduce the risk of flu and its complications13.
In South Africa, flu vaccinations will be available at most healthcare providers, pharmacies and clinics from March. For more information, go to https://prevent-flu.co.za/.
References:
1. National Institute for Communicable Diseases. Influenza Surveillance in South Africa: 2024 (2024) at https://www.nicd.ac.za/wp-content/uploads/2024/09/Influenza-Surveillance-in-South-Africa_10-September-2024.pdf (website accessed on 2 February 2025)
2. Trombetta, C.M. et al. Vaccines. Influenza Viruses and Vaccines: The Role of Vaccine Effectiveness Studies for Evaluation of the Benefits of Influenza Vaccines (2022) at https://pmc.ncbi.nlm.nih.gov/articles/PMC9143275/ (website accessed on 2 February 2025)
3. Kumar, S; Shah, Z and Garfield, S. Vaccines. Causes of Vaccine Hesitancy in Adults for the Influenza and COVID-19 Vaccines: A Systematic Literature Review (2022) at https://pubmed.ncbi.nlm.nih.gov/36146596/ (website accessed on 2 February 2025)
4. European Centre for Disease Prevention and Control (ECDC). Let’s talk about vaccine hesitancy (2016) at https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/lets-talk-about-hesitancy-vaccination-guide.pdf (website accessed on 2 February 2025)
5. Leonardelli, M et al. Vaccines. The Effects of the COVID-19 Pandemic on Vaccination Hesitancy: A Viewpoint (2023) at https://pubmed.ncbi.nlm.nih.gov/37515007/ (website accessed on 2 February 2025)
6. Cleveland Clinic Journal of Medicine. Meeting the challenge of vaccine hesitancy (2024) at https://www.ccjm.org/content/91/9_suppl_1/S50 (website accessed on 2 February 2025)
7. John Hopkins Medicine. COVID-19 Vaccines: Myth Versus Fact (2022) at https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-19-%20vaccines-myth-versus-fact# (website accessed on 2 February 2025)
8. World Health Organization. History of the Influenza Vaccination (2024) at https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination (website accessed on 19 February 2024)
9. Families Fighting Flu. The History of the Flu Vaccine (2025) at https://familiesfightingflu.org/the-history-of-the-flu-vaccine/ (website accessed on 2 February 2025)
10. FDA US Food and Drug Administration. It’s a Good Time to Get Your Flu Vaccine (2025) at https://www.fda.gov/consumers/consumer-updates/its-good-time-get-your-flu-vaccine (website accessed on 2 February 2025)
11. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2025 southern hemisphere influenza season. 27 September 2024. As supplied
12. World Health Organization. Recommendations announced for influenza vaccine composition for the 2025 southern hemisphere influenza season (2024) at https://www.who.int/news/item/27-09-2024-recommendations-announced-for-influenza-vaccine-composition-for-the-2025-southern-hemisphere-influenza-season (website accessed on 13 January 2025)
13. Centers for Diseases Control and Prevention (CDC). Key Facts About Seasonal Flu Vaccine (2024) at https://www.cdc.gov/flu/vaccines/keyfacts.html (website accessed on 13 January 2025)
14. University of Cape Town Lung Institute. Thousands die from flu every year in SA – how does the common flu virus compare to the new coronavirus? (2020) at https://lunginstitute.co.za/2020/03/04/thousands-die-from-flu-every-year-in-sa/ (website accessed on 2 February 2025)
This post and content is sponsored, written and produced by Influvac.
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