Attitudes Towards Vaccines Demonstrate More Hesitancy for COVID-19 vs Influenza Immunizations


In a new survey, respondents said both vaccines were efficacious, but a higher share said influenza vaccines were very safe compared to COVID-19 vaccines. This demonstrates a public health concern considering the higher incidence rates and hospitalizations of COVID-19 over the flu, and the possibility of low vaccine intakes.

photo credit: Karolina Grabowska, Pexels

photo credit: Karolina Grabowska, Pexels

As we start 2024, it’s hard not to look back and consider our actions and responses to the public health COVID-19 crisis we’ve lived through over the last few years. Of the many things we continue to face in public health is how to improve vaccine uptake and attitudes towards these critical tools. To begin, consider influenza and COVID-19 incidence rates in the United States this past year. There have been 7.1-14 million influenza illnesses, 3.2-6.5 million flu medical visits, 73,000-150,000 flu hospitalizations, and 4500-13,000 deaths.1

According to the Centers for Disease Control and Prevention (CDC), test positivity in the United States is 12.7%, and 2.5% of emergency department visits are diagnosed as COVID-19.

In the week prior to Christmas, there were over 29,000 hospitalizations due to COVID-19, underscoring the increase in disease transmission and severity.2 The CDC also reported there were 7090 hospital admissions for influenza for the week that ended December 9, up from 5816 admissions the week ending December 2.

These statistics are concerning in that both respiratory viruses are seeing an increase in incidence rates. And according to a new survey, safety beliefs about COVID-19 vaccines may lead to lower immunization uptake, potentially exacerbating the problem.

What You Need to Know

The study highlights that attitudes towards COVID-19 and influenza vaccines differ among adults. While nearly equal shares believe both vaccines are very effective at protecting against serious illness or hospitalization, a higher percentage considers influenza vaccines very safe compared to COVID-19 vaccines.

The study emphasizes that hesitancy is more pronounced for the COVID-19 vaccine. Hesitant individuals cited concerns such as the need for more research, worries about safety and efficacy, and the belief in existing individual immunity. Interestingly, distrust in government agencies and vaccine development companies was reported specifically for the COVID-19 vaccines.

The findings underscore the need for targeted education efforts to address vaccine hesitancy. Understanding the reasons behind hesitancy, including concerns about safety and efficacy, individual immunity, and distrust in institutions, can inform communication strategies.

Specifically, the survey was developed into a new research study published in JAMA, which assessed vaccine attitudes towards the COVID-19 vaccine versus influenza vaccine.3 The authors take care to note that in the post-emergency pandemic state of COVID-19, attitudes have shifted and that ensuring adults continue to get vaccinated requires understanding various pieces, such as perception of annual vaccine schedules, co-administration, and communication.

Utilizing data from a national survey of adults administered July 7-16, 2023, researchers were able to better understand attitudes towards these two vaccines. This survey looked at adult vaccine attitudes but also differentiated in those 50 years and older, as such individuals may have a higher risk for severe disease. The survey ultimately reached and returned results for 1430 adults (a 44% return rate), and attitudes included effectiveness and safety, vaccination intentions, and dug into hesitancy.

The authors of the study reported that respondents claimed that “nearly equal shares said that COVID-19 vaccines (42%) and influenza vaccines (40%) are very effective at protecting against serious illness or hospitalization (all percentages are weighted). Views diverged on vaccine safety, where a higher share said influenza vaccines are very safe compared with COVID-19 vaccines (55% vs 41%). Similarly, intentions differed: 49% said they are very likely to get an influenza vaccine this season, compared with 36% saying the same for an updated COVID-19 vaccine. Patterns were similar among adults aged 50 years and older. Among more hesitant adults (those not very likely to get vaccinated), concerns about updated COVID-19 and influenza vaccines differed.”4

In terms of hesitancy, this surrounded the COVID-19 vaccine more, with responses citing a need for more research, worries about safety and efficacy, and that there was already substantial individual immunity from previous infections or vaccination. Interestingly, individuals reported a distrust of government agencies and vaccine development companies for the COVID-19 vaccines, despite the same being used to also promote flu shots.

Ultimately, there were many reasons for hesitancy and this cross-sectional study did share some important and interesting, self-reported findings, that can be used to drive more focused education. As we move further away from the COVID-19 emergency state, it will be important to address hesitancy and rebuild trust in science, policy, and response.


1. 2023-2024 U.S. Flu Season: Preliminary In-Season Burden Estimates. CDC. December 29, 2023.

2. COVID Data Tracker. CDC. December 23, 2023.

3. Steelfisher GK, Findling MG, Caporello HL, McGowan E, Espino L, Sutton J. Divergent Attitudes Toward COVID-19 Vaccine vs Influenza Vaccine. JAMA Netw Open. 2023;6(12):e2349881. doi:10.1001/jamanetworkopen.2023.49881

4. Ibid.

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