Remember when that Scottish rock band Simple Minds sang “Don’t You Forget About Me?” Well, the concern right now is that all of this Covid-19 stuff may have helped too many Americans forget about the flu and how bad it can be. A survey of 1,005 adults in the U.S. conducted in mid-August and commissioned by the National Foundation for Infectious Diseases (NFID) found that only 49% planned on actually getting the vaccine this Fall. And 20% of those not planning on getting vaccinated actually did not even think of influenza as a serious illness, which is kind of like believing that cinder blocks falling from the sky is not a serious problem. That’s why a key recurring message from Centers for Disease Control and Prevention (CDC) and NFID experts at Tuesday’s 2022 Annual Influenza and Pneumococcal Disease News Conference held by the NFID at Bethesda, Maryland, was to not forget about the flu, to take the flu seriously, and to get vaccinated against the flu.

During the conference, U.S. Centers for Disease Control and Prevention (CDC) Director Rochelle P. Walensky, MD, MPH, indicated that, “Over the past two years, we’ve seen some worrisome drops in flu vaccination coverage, especially in some groups of people who are at the highest risk of developing serious flu illness,” as you can see in the following video:

What’s a worrisome drop? A CDC FluVaxView webpage report shows that flu vaccination coverage among adults 18 years and older in the U.S. during the 2020-2021 flu season was estimated to be 50.2%. Such a coverage level would already be well below the herd immunity thresholds needed to really stop transmission of the flu virus in a population. Well, the estimated vaccination coverage got even worse the following 2021-2022 flu season, dropping to 45.5%, according to the CDC Weekly Flu Vaccination Dashboard. And unlike golf scores and the number of times a ferret hits you in the groin with a golf club, a lower vaccination coverage number is clearly not better.

Why might this vaccination coverage have dropped? A big part of the reason may have been the relatively low influenza activity over the past two Winters. Each year, from 2010 to 2020, influenza resulted in an estimated nine million to 41 million illnesses, 140,000 to 710,000 hospitalizations, and 12,000 to 52,000 deaths in the U.S. alone. The CDC didn’t even have such estimates for the 2020-2021 flu season due to what they called “minimal influenza activity.” And for the 2021-2022 flu season, such estimated climbed to nine million illnesses, 100,000 hospitalizations, and 5,000, still way below the ranges for the previous decade.

In the words of Walensky, “the timing and severity of the past two flu seasons have been different than our typical flu seasons before the Covid-19 pandemic, and this is likely due to the Covid mitigation measures and other changes in circulating respiratory viruses.” In other words, Covid-19 precautions such as social distancing and face mask use probably helped prevent transmission of not only the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but also the flu virus as well.

Obviously, lower flu activity is better. No human should say, “it would be better to have more flu cases,” unless that human were serving as a lobbyist for the influenza virus. However, such low flu activity may have created a false sense of security. Another panelist at the conference, William Schaffner, M.D., Medical Director of the NFID and Professor of Medicine at at the Vanderbilt University School of Medicine, told me after the meeting that “for many people, in recent memory, flu is not a concern.” This, in turn, may lead to people being less concerned about getting the flu vaccine. Schaffner also mentioned the fatigue problem: “My concern is because of Covid fatigue and Covid vaccine fatigue, you almost have to remind people about the flu and other respiratory diseases.”

The NFID survey, conducted from August 11 to 15, 2022, did ask the people who indicated that they were not planning to get vaccinated this coming season their rationale for not doing so. Well, 41% of the not-going-to-get-vaccinated believed that flu vaccines don’t work very well, even though numerous studies have shown that flu vaccines can reduce your risk of flu-related hospitalization and death. Although the effectiveness of the flu vaccine may vary from year to year depending on how well the virus strains in the vaccine match the circulating strains, Schaffner did emphasize that every year the vaccine should offer at least some protection against more severe flu outcomes and potentially transmission of the virus. He also added that so far, “the H3N2 virus in this season’s vaccine appears to be a good match.”

The NFID survey also showed that 39% of the not-going-to-get-vaccinated were worried about potential side effects, despite flu vaccines having a very good safety record over the past five decades. Nearly a quarter (24%) were concerned about getting flu from the vaccine, which can’t really happen because the virus in the vaccine is either completely inactivated or too weak to infect you. Then there were the 28% who asserted that they never get the flu and the 20% who did not think of flu as a serious illness, despite all the aforementioned statistics showing how many people get the flu, get hospitalized with the flu, and die as a result. So clearly there’s a disconnect between perception of the flu and the flu vaccine and scientific facts.

Again the major concern right now is that the U.S. may be headed into a bad flu season. This year many people have been ditching Covid-19 precautions such as social distancing and face mask wearing like they were three-day old cheesecake. This could leave the American population like a guy in a thong mankini, a lot more exposed. In fact, what happened in the 2021-2022 flu season compared to the 2020-2021 flu season showed what happened after Covid-19 precautions like face mask requirements were relaxed in 2021. “Last year’s flu season was relatively mild,” Walensky explained. “However, there was more activity during the 2021-2022 flu season than during the prior season. Flu activity last season began to increase in November and remined elevated until mid-June, making it the latest season on record.” Yes, after having virtually no flu season from 2020 to 2021, the 2020-2021 flu season lasted over half a year. Still think that face mask wearing makes no difference in the transmission of respiratory viruses like the Covid-19 coronavirus and the influenza virus?

Speaking of face mask wearing, 58% of respondents to the NFID survey did indicate that they will wear a mask at least sometimes during flu season with 40% saying that they will do so if flu and/or Covid-19 activity gets high in their community and 35% when they are around crowds and large groups of people. Schaffner indicated that he’s “encouraged by face mask results. This is learned behavior with people having internalized the effectiveness of face mask wearing and how easy it is to do so.”

Since the flu season tends to ramp up in November or the ensuing months, it is a good idea to get vaccinated against the flu before the end of October. Remember that getting vaccinated is not like putting on a pair of pants. The immune protection doesn’t come immediately but instead takes about two weeks to fully kick in after vaccination. With so much going on around you, it can be easy to forget out getting the flu vaccine. But even if you forget about the flu, the virus is not likely to forget how to infect you.