Influenza Vaccination Rates Among Children Have Not Recovered Since COVID-19 Pandemic, Study Shows

Influenza vaccination coverage among children and adolescents rose steadily in the years leading up to the COVID-19 pandemic, but that progress has since reversed, according to a new retrospective cohort study published in JAMA Network Open. Researchers from the City University of New York Graduate School of Public Health and Health Policy, working with Montefiore Medical Group (MMG), found that overall coverage rose from 49.1% in the 2017-2018 season to a peak of 56.5% in 2019-2020, before declining to 43.6% by the 2022-2023 season—a drop of 12.9 percentage points from the pandemic-era high.^1-4

The findings add to a growing body of evidence that pediatric vaccination broadly has yet to recover from pandemic-related disruptions and, in some respects, continues to worsen.^1-4

Study Design and Key Findings

The study included 138,500 children aged 2 months to 18 years across more than 1.4 million total visits to MMG primary care and family medicine clinics between 2017 and 2023. Investigators used New York State Immunization Information System data, defining seasonal coverage as receipt of at least 1 influenza vaccine dose among patients with at least 1 clinic visit that season. Modified Poisson regression models were used to calculate risk ratios (RRs) across demographic subgroups.¹

Declines were most pronounced among older children. Compared with the 2017-2018 season, coverage in 2022-2023 fell 16% among children aged 10 to 14 years (RR, 0.84; 95% CI, 0.82-0.86) and 15% among those aged 5 to 9 years (RR, 0.85; 95% CI, 0.83-0.87), versus a more modest 2% decline among children aged 0 to 4 years (RR, 0.98; 95% CI, 0.97-0.99). Insurance status also mattered, as children on self-pay insurance saw coverage fall 20% (RR, 0.80; 95% CI, 0.70-0.92), and those with public insurance saw a 12% decline (RR, 0.88; 95% CI, 0.87-0.89), with an adjusted model showing steeper drops among children on Medicaid (aRR, 0.91; 95% CI, 0.86-0.97) and self-pay (aRR, 0.84; 95% CI, 0.73-0.97) than among privately insured children. Declines also varied by race and ethnicity, with the steepest drop—13.5 percentage points—among American Indian, Alaska Native, and Native Hawaiian or Other Pacific Islander children.¹

A National Pattern, Not an Isolated Trend

Although the Bronx cohort reflects a single, largely publicly insured urban population, its findings align with national surveillance data. CDC's FluVaxView estimates that only about 46% of children received a flu vaccine during the 2024-2025 season, down from nearly 64% five years earlier. That same season produced the highest number of pediatric influenza deaths since national reporting began in 2004, apart from the 2009-2010 H1N1 pandemic: 280 deaths, a rate of 3.8 per million children, with 89% of medically eligible children not fully vaccinated.^2-5

Separately, CDC's National Immunization Survey-Child data show broader declines in routine childhood vaccination coverage among children born in 2020 and 2021 compared with earlier cohorts, with persistent disparities by insurance status and geography. A 2025 analysis from the Johns Hopkins Bloomberg School of Public Health's International Vaccine Access Center further found that non-medical vaccine exemptions among kindergartners reached an all-time high of 3.4% in the 2024-2025 school year.^2-5

Implications for Pharmacists and Primary Care

The study authors point to vaccine hesitancy and misinformation as likely contributors to the post-pandemic plateau. They recommend 2 practical levers for reversing it, including stronger, more consistent vaccine recommendations from primary care clinicians and expanded access through alternative vaccination sites, such as school-based health centers. Community and clinical pharmacists are increasingly positioned to fill both roles—offering walk-in flu vaccination for eligible children where state law permits, reinforcing vaccine confidence during routine interactions with parents, and helping identify children who have fallen behind on recommended immunizations. These efforts can be particularly impactful among school-aged children, adolescents, and those with public insurance or no coverage at all.¹

REFERENCES

1. Rane MS, Gopalan G, Nahmias J, Rinke ML, Teasdale CA. Influenza vaccination trends among children and adolescents, 2017-2023. JAMA Netw Open. 2026;9(6):e2617332. doi:10.1001/jamanetworkopen.2026.17332

2. Influenza vaccination coverage, children 6 months through 17 years, United States. FluVaxView. Centers for Disease Control and Prevention. Updated December 3, 2025. Accessed August 4, 2026. https://www.cdc.gov/fluvaxview/dashboard/children-vaccination-coverage.html

3. Reinhart K, Huang S, Kniss K, Reed C, Budd A. Influenza-associated pediatric deaths—United States, 2024-25 influenza season. MMWR Morb Mortal Wkly Rep. 2025;74(36):565-570. doi:10.15585/mmwr.mm7436a2

4. Hill HA, Yankey D, Elam-Evans LD, Mu Y, Chen M, Peacock G, Singleton JA. Decline in vaccination coverage by age 24 months and vaccination inequities among children born in 2020 and 2021—National Immunization Survey-Child, United States, 2021-2023. MMWR Morb Mortal Wkly Rep. 2024;73(38):844-850. doi:10.15585/mmwr.mm7338a3

5. Across the U.S., childhood vaccination rates continue to decline. International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health. Published August 20, 2025. Accessed August 4, 2026. https://publichealth.jhu.edu/ivac/2025/across-the-us-childhood-vaccination-rates-continue-to-decline