Messaging for Two Annual Vaccines: COVID-19 and Influenza

John W. Harrington, MD
Director, Division of General Academic Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA

Harrington JW. Messaging for two annual vaccines: COVID-19 and influenza. Consultant360. Published online January 17, 2022.


As a pediatrician and advocate for vaccines, I am always trying to improve how I message future information to parents since they usually need time to digest the recommendations that our decision-making bodies such as the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) eventually decide each year. I have always provided parents/guardians the CDC vaccine information sheets at the 1-month visit to allow them the chance to tell me their hesitancy level at that time for the routine 2-month vaccines, as well as get a handle on how I will need to talk with them about the importance of vaccines. Therefore, I think it will be important to start asking parents about the COVID-19 vaccine for their children soon to be aged 6 months to 5 years. Assessing a parent’s current knowledge of COVID-19 and the likelihood of vaccination against COVID-19 will at least be a starting point. Next, we will have to imagine how we will message offering 2 vaccines (COVID-19 and influenza) during summer/fall 2022 to this younger age group. This has already been a bit difficult for patients aged 5 to 11 years, since the approval of the COVID-19 vaccine on November 2, 2021, was at a time when we were also pushing for influenza vaccination. This set up the perfect foil for parents preferring to select 1 vaccine over the other and not follow through on both.

Firstly, let us look at how we might consider messaging the COVID-19 vaccine to our youngest group of patients aged 6 months to 5 years. Although the length of time the vaccines have been available for the different age groups varies, we may be seeing a distribution of vaccination rates lower for younger children.1 As of January 5, 2022, the rate of 1 immunization completed for people aged 12 to 17 years is 62%, and the rate for children aged 5 to 11 years is 25% (Table).1 Obviously, vaccination rates vary from state to state, but the distribution to younger children will likely have some hurdles that we will need to navigate. This may especially be true based on when the vaccine is approved for this younger age group and what the pandemic looks like in 6 to 12 months. COVID-19 vaccine messaging has been difficult since parents/guardians get their information from a multitude of media outlets that can transmit erroneous or false information even inadvertently. For example, when reliable sources are trying to be transparent in terms of transient mild cardiac inflammation after COVID-19 vaccination, the lay media and parents/guardians confuse this with the more concerning multisystem inflammatory syndrome in children (MIS-C) that can create a more critical illness.2

Table. Percentage of Individuals Vaccinated for 1 Dose and Completed Dose of COVID-19 Vaccine by Age Bracket

Even if we are able to convince the parent/guardian that a young child/infant needs a COVID-19 vaccination, since their child will be vaccine naïve, we would discuss a 2-dose regimen. However, because of the patient’s age and interrupted care during the pandemic, it is likely that they may also be vaccine naïve for influenza, and therefore, we would try to negotiate 4 vaccines in a 1-month period. The 2- to 4-vaccine dilemma during the summer/fall of 2022 will exist, and it may appear to the parents/guardians that they will have to choose; however, we need to message early and often that both vaccines are needed to be given to provide maximal protection. We usually discuss that influenza vaccination is particularly important for children in the age category of 6 months to 2 years, because of an increased risk of pneumonia, hospitalization, and death.3,4 Unfortunately, the message that this age group has a milder reaction to COVID-19 infection may decrease the urgency of parents to immunize when the vaccine is available, but we should still message that they can develop MIS-C.5 Additionally, the physicians practicing at pharmacies and pop-up clinics in many areas have been less comfortable with providing immunizations to and testing for COVID-19 in the younger pediatric age groups, so our primary care facilities will need to consider extended hours and more available to make sure we are able to get these younger patients vaccinated when it becomes available.

Overall, the same issues for helping parents make good choices for their children is to educate early and often with evidenced-based information and transparency about adverse effects, establish trust, meet them where they are in their vaccine hesitancy, and be able to keep the lines of communication open while still maintaining a firm recommendation about the importance of vaccination.6 The challenges that lie ahead—so that we can finally get things back to normal—will require a final push from primary care physicians and, who knows, maybe a combination vaccine in the future that will alleviate extra vaccination doses.       

  1. COVID-19 vaccination and case trends by age group, United States. Centers for Disease Control and Prevention. Updated January 13, 2022. Accessed January 14, 2022.
  2. Chelala L, Jeudy J, Hossain R, Rosenthal G, Pietris N, White C. Cardiac MRI findings of myocarditis after COVID-19 mRNA vaccination in adolescents. AJR AM J Roentgenol. October 2021.
  3. Disease burden of flu. Centers for Disease Control and Prevention. January 7, 2022. Accessed January 14, 2022.
  4. Flu & pneumonia. Centers for Disease Control and Prevention. August 14, 2019. Accessed Jan 14, 2022.  
  5. Woodruff RC, Campbell AP, Taylor CA, et al. Risk factors for severe COVID-19 in children. Pediatrics. 2021:e2021053418.
  6. Jarrett C, Wilson R, O'Leary M, Eckersberger E, Larson HJ; SAGE Working Group on Vaccine Hesitancy. Strategies for addressing vaccine hesitancy - a systematic review. Vaccine. 2015;33(34):4180-90.