Majority of Americans Don’t Get Flu Vaccine, but No Significant Dips Seen in States With COVID-19 Vaccine Doubts

Amid the race for the first COVID-19 vaccine in the U.S., ValuePenguin analyzed Centers for Disease Control and Prevention (CDC) data to try to understand where people are most and least likely to get inoculated.

One in five respondents in two southern regions told ValuePenguin in July that they wouldn’t accept a COVID-19 vaccine once one is released. But in many of those states, the rate at which people get the influenza vaccine is higher than the national average.

From 2010-11 to 2018-19, only 45% of Americans on average were vaccinated against the seasonal flu, well below the federal government’s target threshold of 70%.

Key findings

Despite CDC recommendations, 55% of Americans don't get vaccinated against the seasonal flu

Many Americans aren't required to get the flu vaccine. The percentage of the population that's been vaccinated against the flu has risen this decade, from 43% in 2010-11 to 49% in 2018-19. During this time span, 45% of Americans on average have been getting vaccinated yearly.

In the 2018-19 flu season, the CDC estimated that Nevada had the lowest vaccination rate among U.S. states. Only 37.8% of people in Nevada got a flu vaccine, making it the only state with a vaccination rate below 40%. Of note, just 20.7% of people ages 18 to 49 in the state were vaccinated against the flu, also the lowest.

After Nevada, a number of the lowest vaccination rates appear in the South. In fact, four of the 10 least-vaccinated states were in the South, including Florida, Louisiana, Mississippi and Georgia. In Mississippi — which had the lowest percentage of vaccine exemptions — only 42% of people voluntarily got flu shots in 2018, the fourth-lowest rate.

On the reverse side, Rhode Island — at 60.4% — had the largest share of its population vaccinated against seasonal flu. New England was well-represented in the most-vaccinated states, as Massachusetts followed Rhode Island with a rate of 58.9%, and Connecticut was close behind at 56.8%.

The youngest and oldest Americans are the most likely to get vaccinated against the flu. The CDC reported that about 68% of people 65 and older and nearly 63% of people 17 and younger were vaccinated against the flu in 2018-19. Conversely, 18- to 49-year-olds were the least likely to get inoculated. Even among high-risk individuals ages 18 to 49 with asthma, diabetes, heart disease, cancer and other potentially complicating preexisting conditions, the vaccination rate was only 40%.

People are generally receptive to getting vaccinated where COVID-19 has been the most transmissible

The opinions that Americans have regarding getting vaccinated could provide clues about how the public would receive a COVID-19 vaccine. In a survey conducted this summer, ValuePenguin found that 36% of people said they were going to get the coronavirus vaccine when it came out, no matter what. However, about 14% said they wouldn't get vaccinated under any circumstances. Almost 10% said they wouldn't vaccinate their kids.

The pushback against a COVID-19 vaccine was highest in two southern regions, one of which was the group of states consisting of Alabama, Kentucky, Mississippi and Tennessee. Here, one in five said they wouldn't get vaccinated against COVID-19, while 19% wouldn't inoculate their kids.

Furthermore, in the region consisting of Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia, an average of 49.6% of people were vaccinated against the flu during the 2018-19 season. This is nearly equal to the percentage of people the CDC estimated were vaccinated nationwide during the same time: 49%. Even where there's a degree of skepticism about vaccines, the percentage of people getting vaccinated voluntarily in these states isn't an outlier compared to the rest of the country.

These states had the highest average rates of transmission for COVID-19 from March to August

Additionally, inoculation rates have remained in alignment with national expectations in the states where COVID-19 has been the most transmissive. From March to September, Indiana, Texas, Florida, Kentucky and Illinois had the highest average rates of transmission, according to Rt.live, a model that quantifies how quickly the virus spreads. In these states, though, more than 46% of people in 2018-19 were vaccinated for the flu.

Though, the percentage of people who get the flu vaccine voluntarily, especially compared to those who get mandatory shots, is nowhere near the 70% threshold the federal government targets for reducing the transmission of vaccine-preventable diseases. In Rhode Island, which comes closest to this mark, only 60.4% of residents were vaccinated in 2018-19. Once there is a COVID-19 vaccine, it may take a long time to immunize the public against the disease unless the vaccination rate rises.

Schoolchildren vaccine exemptions have increased since 2014-15, but so have measures combating nonmedical opt-outs

Since the 2014-15 school year, the percentage of exemptions among kindergarteners has increased each year. The CDC reported that 1.8% of the estimated population of 3.7 million kindergarteners were exempted in 2014 for medical and nonmedical reasons. This number rose to 2.6% of 4 million in 2018.

In the majority of states, schoolchildren are required to get vaccinated against a score of diseases, such as:

A complete vaccination record is a precondition for attending public school or day care in many states. However, compliance isn't universal.

In more than half of all states, children can attend school with a grace period, often set at 30 days. For example, the CDC estimated that in the 2017-18 school year, about 2% of kids entered school under a grace period. School staff and nurses are tasked with following up with parents or guardians of unvaccinated children to ensure compliance with the requirements. In other cases, there are a number of exemptions that parents can invoke to avoid getting their children vaccinated.

Children with preexisting conditions that don't allow them to get a vaccine safely may be eligible for medical exemptions. Parents may also gain nonmedical exemptions. Forty-five states and the District of Columbia allow for religious exemptions from vaccines, while 15 allow parents to claim philosophical exemptions from vaccines in public schools.

Idaho and Oregon had the highest percentage of exemptions among kindergarteners, with both states recording opt-outs at 7.7%. A significant portion of the states where exemptions were high — seven of 10 — are in the West.

Conversely, Mississippi (0.1%) had the lowest percentage of opt-outs in the 2018-19 school year. Many Southern states — including Alabama (0.8%), West Virginia (0.8%), Louisiana (1.2%), Kentucky (1.4%) and Tennessee (1.9%) — posted low exemption rates. These states averaged an exemption rate of only 1.22% — more than one percentage point lower than the national median.

Methodology