Understand the Patient Behind the Hesitation to Address Flu Vaccine Concerns

Although influenza vaccination is recommended annually for most individuals, vaccine hesitancy remains common in clinical practice. Pharmacists frequently encounter patients who are uncertain about the benefits of vaccination or question whether it is necessary for their personal health circumstances.

Influenza continues to pose a substantial public health burden in the US. During the 2024 to 2025 influenza season, the CDC estimated approximately 51 million illnesses, 710,000 hospitalizations, and 45,000 deaths attributable to influenza.¹ Despite these outcomes, many patients continue to question the need for annual influenza vaccination due to concerns about safety, uncertainty regarding effectiveness, or a belief that they are unlikely to experience serious illness.

Pharmacists are often among the most frequently encountered health care professionals, placing them in a unique position to address concerns surrounding influenza vaccination. These encounters provide opportunities to identify vaccine hesitancy, correct misconceptions, and deliver personalized recommendations that align with a patient's individual health needs and risk factors. Although public health initiatives help educate the public, vaccine decisions are frequently made after patients have the opportunity to discuss their concerns with a trusted health care professional.

Understanding Patient Hesitation

Patients who are hesitant about influenza vaccination are often seeking reassurance that vaccination is the right choice for their individual circumstances. Understanding those concerns is a critical first step in effective vaccine counseling.

For some patients, hesitancy may stem from concerns about vaccine safety. Pregnant individuals, for example, may question whether influenza vaccination is necessary or worry about its potential impact on their developing child. These discussions provide an opportunity to review the increased risk of severe influenza-related illness during pregnancy and the well-established benefits of maternal immunization for both maternal and infant health. In addition to helping protect pregnant individuals from influenza-related complications, maternal vaccination provides passive antibody protection to infants during the first months of life, before they are eligible for influenza vaccination themselves.²

For other patients, concerns may center on vaccine effectiveness. Individuals receiving immunosuppressive therapies often question whether influenza vaccination will provide meaningful protection. Although immune responses may be attenuated in certain populations, vaccination remains an important strategy for reducing the risk of severe illness, influenza-related complications, and hospitalization.³

Patients with chronic conditions often require a different counseling approach. Individuals living with diabetes, cardiovascular disease, asthma, or chronic obstructive pulmonary disease may not immediately recognize how influenza infection can adversely affect their underlying condition. For instance, influenza infection can trigger disease exacerbations, worsen glycemic control, and increase the risk of cardiovascular events. Framing vaccination as a means of preventing these complications often resonates more strongly than discussing influenza prevention in general terms.

This ability to connect vaccine recommendations to a patient's individual health circumstances is one of the pharmacist's greatest strengths. Although patients may not remember specific effectiveness statistics, they are more likely to remember a recommendation that is relevant to their personal health concerns and goals.

Addressing Questions About Vaccine Effectiveness

Questions about vaccine effectiveness are among the most common concerns pharmacists encounter during influenza season. Patients frequently cite stories of friends, family members, or even their own experiences with breakthrough infections as evidence that influenza vaccination is ineffective.

Part of this perception stems from a misunderstanding of what influenza vaccines are designed to accomplish. Influenza vaccines are reformulated each year to account for changes in circulating viral strains. As a result, vaccine effectiveness can vary from season to season, and commonly reported effectiveness percentages may not fully capture the broader clinical benefits of vaccination.

When discussing effectiveness, it is important to emphasize that influenza vaccination is not solely intended to prevent infection. Vaccination also plays a critical role in reducing disease severity and preventing serious complications when infection occurs. Evidence has consistently demonstrated that vaccinated individuals experience lower rates of hospitalization, intensive care unit admission, and influenza-related mortality compared with those who remain unvaccinated.⁴

This distinction is particularly relevant for patients who view vaccination as an all-or-nothing intervention. Many assume that a breakthrough infection means the vaccine has failed, when, in reality, vaccination may have reduced the severity of illness and lowered the risk of serious outcomes. Helping patients understand this difference can shift the conversation from whether influenza vaccination provides complete protection to how it reduces overall risk.

For older adults, immunocompromised individuals, and patients with chronic medical conditions, this perspective can be especially meaningful. Preventing hospitalization, disease exacerbations, and influenza-related complications may ultimately be more important than preventing every infection. By reframing effectiveness in terms of risk reduction rather than complete prevention, pharmacists can help patients better understand the value of annual influenza vaccination.

The Importance of Proactive Conversations

One of the challenges associated with influenza prevention is that the benefits of vaccination are often not immediately apparent to patients. Unlike treatments that relieve symptoms or improve a measurable condition, successful vaccination prevents an outcome that may never be seen. Proactive conversations create opportunities to reinforce the value of prevention and help patients understand how influenza vaccination can reduce the risk of serious illness before influenza season is underway.

Influenza vaccine hesitancy remains a reality in everyday practice, even among patients who stand to benefit most from vaccination. Concerns regarding safety, effectiveness, and personal risk continue to influence decision-making and can contribute to missed opportunities for prevention. As influenza remains a significant cause of preventable illness each year, helping patients understand both their risk of infection and the potential consequences of influenza-related complications remains an important component of patient care.

About the Author

Anjeza Fero, PharmD, RPh, is a professor at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES

1. 2024-2025 influenza season summary: severity, disease burden, and burden prevented. CDC. March 12, 2026. Accessed June 12, 2026. https://www.cdc.gov/flu-burden/php/data-vis-vac/2024-2025-prevented.html 

2. Nunes MC, Madhi SA. Influenza vaccination during pregnancy for prevention of influenza confirmed illness in the infants: a systematic review and meta-analysis. Hum Vaccin Immunother. 2018;14(3):758-766. doi:10.1080/21645515.2017.1345385

3. Grohskopf LA, Ferdinands JM, Blanton LH, Broder KR, Loehr J. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2024-25 influenza season. MMWR Recomm Rep. 2024;73(5):1-25. doi:10.15585/mmwr.rr7305a1

4. Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis. 2017;65(8):1289-1297. doi:10.1093/cid/cix468