NFID Survey Finds Respiratory Vaccine Gap Driven by Lack of Clarity, Not Hesitancy

In recent weeks, the National Foundation for Infectious Diseases (NFID) held its Annual Respiratory Season Kick-Off. They also released the findings of their 2026 National Survey on Respiratory Diseases. Of the findings, an overwhelming majority of Americans appreciate the value of vaccines, but not everyone is acting on this information. In fact 77% of US adults agree vaccines are among the most effective ways to prevent serious infectious disease.¹ Yet only 48% tried to get a flu, COVID-19, respiratory syncytial virus (RSV), or pneumococcal vaccine in the past year.¹ NFID framed the gap as a problem of clarity rather than hesitancy, with many adults unsure which recommendations apply to them.²

The briefing, held September 24, 2026, in Washington, DC, was moderated by NFID Medical Director Robert H. Hopkins Jr, MD, and featured speakers from AAFP, ACEP, AHIP, and Families Fighting Flu.³ NFID also launched the National Respiratory Communications Initiative (NRCI), a coalition of immunization, infectious disease, patient advocacy, and public health organizations focused on consistent, evidence-based prevention guidance.² Hopkins said the event is timed to the seasonal rise in influenza, RSV, and winter COVID-19 activity, along with secondary pneumococcal pneumonia.

NFID’s nationally representative survey, conducted by NORC at the University of Chicago, included 1,206 adults interviewed August 13 to 17, 2026, with a margin of sampling error of ±3.6 percentage points.¹ Reported vaccination attempts were highest for flu vaccine (44%), followed by COVID-19 (23%), pneumococcal (10%), and RSV (9%) vaccines.¹ Support for access remained high, with 89% agreeing anyone who wants a vaccine should be able to get one.¹

Uncertainty about personal eligibility was common. Overall, 28% of adults said flu vaccination was not recommended for someone like them or did not know, and the figure rose to 49% for COVID-19 vaccination.¹ Healthcare professionals remained the most trusted source, with 55% naming a doctor, nurse, or pharmacist as their first stop for vaccine information, compared with 46% reporting high trust in the CDC.¹

“I think the biggest driver of this challenge is we don’t do a very good job as individuals of understanding our risk,” Hopkins said. He added many people view vaccine recommendations as applying to others, while varied messaging creates uncertainty and inaction. Busy holiday schedules also push vaccination down the priority list, he noted.

Why RSV and Pneumococcal Vaccines Face the Greatest Access Barriers

Among adults who tried to obtain at least one respiratory vaccine, 22% reported a problem, such as out-of-stock vaccine, being told to return later, or being sent between a pharmacy and a physician’s office.¹ Problems were most frequent among those seeking pneumococcal (27%) or RSV (23%) vaccination, compared with 15% for flu vaccine, though estimates for RSV and pneumococcal attempts relied on small samples.¹ Pharmacies were the first access point for roughly half of adults seeking each vaccine, followed by physician offices or clinics.¹

Hopkins attributed much of the difficulty to risk-based eligibility. RSV vaccination is recommended once for adults 75 years and older, for younger adults at increased risk of severe disease, such as those with heart or lung disease, and during pregnancy. Pneumococcal vaccination is recommended for all adults 50 years and older, while eligibility for younger adults depends on individual risk.

“Selective recommendations, I think, are harder for people to understand. They’re harder for people to apply,” Hopkins said. “Frankly, it’s harder for our healthcare professional community to understand and use.”

Respondents also underestimated disease burden. Only 11% selected a range close to the CDC estimate of approximately 710,000 flu-related hospitalizations during the 2024-2025 season, and half estimated fewer than 400,000.¹ Only 47% correctly identified RSV as the leading cause of hospitalization among US infants.¹

Hopkins encouraged clinicians to tailor risk conversations, using data for patients who respond to numbers and simple high, medium, or low framing for others. Clinicians and pharmacists can reduce barriers by posting current recommendations, answering patient questions, and keeping colleagues current on risk-based eligibility. NRCI resources for patients and healthcare professionals are available at TameIt.org.²

REFERENCES

1. 2026 National Survey on Respiratory Diseases. National Foundation for Infectious Diseases. Published September 24, 2026. Accessed October 12, 2026. https://www.nfid.org/resource/2026-national-survey-on-respiratory-diseases/

2. New survey: most US adults support vaccines, but many remain unclear about respiratory vaccine recommendations. News release. National Foundation for Infectious Diseases. September 24, 2026. Accessed October 12, 2026. https://www.nfid.org/new-survey-most-us-adults-support-vaccines-but-many-remain-unclear-about-respiratory-vaccine-recommendations/

3. 2026 NFID Annual Respiratory Season Kick-Off. National Foundation for Infectious Diseases. Accessed October 12, 2026. https://www.nfid.org/news-updates/media-resources/news-conferences/2026-nfid-annual-respiratory-season-kick-off/