In the first half of 2023, COVID-19 killed 42,670 people in the United States, while the flu killed about half that amount. Yet half as many people received the updated COVID booster as those who got the flu shot — even though COVID is twice as deadly as influenza.

In all, around 22% of people have received the new COVID booster, while 47% of people have had a flu vaccine. Experts said much of that COVID-shot resistance is due to the continued polarizing nature of the pandemic and of the COVID vaccine, which has been shown to reduce the risk for long COVID as well as serious acute viral infections and deaths.

“COVID shots are controversial and polarizing, whereas flu shots (for the most part) are not. The decision to get or not get a flu shot is made calmly,” said Peter M. Sandman, PhD, an expert in risk communication who writes about COVID risks and our responses to them.

It is also true that the likelihood of vaccination depends on your political leanings. An August 2023 study published in the journal Cureus found that even after controlling for alternative explanations to vaccine hesitancy, “there was a statistically significant relationship between the percentage of Republican supporters and rates of vaccine hesitancy.” It’s made vaccination against COVID much harder than for other vaccinations.

The Role of Complacency

Complacency is also a factor, said Cameron R. Wolfe, MD, an infectious disease specialist and professor of medicine at Duke University of School of Medicine, in Durham, North Carolina. While COVID is still quite deadly, killing 42,670 Americans in the first 6 months of 2023, it’s one fifth what it was in 2021 when the infection killed 219,222 people in the first half of the year.

Many young and middle-aged adults have experienced mild cases of COVID and aren’t as fearful as they should be of the mortality numbers, said Wolfe. What’s more, COVID deaths aren’t being reported or highlighted in the media as often as they were in the first 2 years of the pandemic because the number of cases declined, and restrictions were lifted.

“Much of the mortality is happening out of sight these days compared to what was going on in 2020 and 2021,” Wolfe said. “During that time, nearly everyone was directly impacted or knew someone who was impacted by COVID.”

Pandemic fatigue has also played a role in our complacency. “There was this collective trauma around the death, disease, and lockdowns,” said Ziyad Al-Aly, MD, a global expert on long COVID and chief of research and development at the VA Saint Louis Health Care System. “It was a devastating experience that people just want to forget.”

‘[COVID] Vaccines Have a Better Safety Profile Than Almost Any Others’

Public health messaging is also to blame for the lower-than-normal COVID vaccine rates, said Al-Aly. Patients need to better understand that the role of the vaccine isn’t to completely prevent COVID but to reduce the likelihood of hospitalization and death, similar to that of a flu shot. By reducing the risk for severe disease, the vaccine also reduces the risk for long COVID, a debilitating condition that’s still poorly understood, has no cure, and has already caused thousands of American deaths, he said.

Botched public health messaging also allowed for misinformation to run rampant. Rare adverse events associated with the COVID vaccine have been severely overplayed and spread like wildfire on social media.

“Patients need to know that like any vaccine, vaccine injury does occur, but these vaccines have a better safety profile than almost any others,” Al-Aly said. “The rewards of getting the vaccine far outweigh the risks, and patients need to understand that.”

Normalizing COVID vaccination in the same way that health specialists and doctors have done with the flu shot will do a lot to increase vaccine numbers.

“[With the flu vaccine you] aren’t hearing a lot of expert disagreement or nonexpert rumors about the vaccine or about the disease. The messaging every year is pretty consistent,” Sandman said.

Reshaping beliefs will likely fall on physicians who are often much more trusted by their patients than the Centers for Disease Control and Prevention and other public health authorities. When physicians take the time to talk with their patients about the benefits of getting the vaccine, they can start to change minds, said Shivanjali Shankaran, MD, an infectious disease specialist at RUSH University Medical Center in Chicago.

“It might not happen in one 3-minute conversation, but over time, we need to help patients understand that the safety profile of these vaccines is really good, and even for those who don’t fear acute COVID, the vaccine reduces the likelihood of chronic illness,” Shankaran said.

The hope is that in time, people will accept the COVID vaccine as they do the flu shot and understand that it’s really not a booster but a shot taken periodically or even annually to protect them against a disease that can still do a lot of damage, said Shankaran.

“The COVID vaccine needs to be discussed as part of our preventative healthcare routine like getting a flu shot or a colonoscopy,” Shankaran said.