Ram Koppaka, M.D., Ph.D.

As a possible flu season looms in the midst of the COVID-19 pandemic, the health and lives of older adults living in long-term care facilities face a potential double threat, making flu vaccination more important than ever. 

Influenza places a heavy burden on long-term care facilities every year, but the COVID-19 pandemic has brought the susceptibility of those who live and work in these institutions into sharp focus. Personnel must balance the demands of caring for sometimes seriously ill people with navigating the disruptions caused by isolation and protecting themselves from infection.

As we wait for safe and effective COVID-19 vaccines to reach us, there is something we can do now to help protect the health of everyone in long-term care facilities: ensure that all — including non-clinical staff from housekeeping to security to volunteers, as well as eligible residents — receive a flu vaccine. This will not only protect residents and staff from the flu, but it can help lay the groundwork as long-term care facilities are a priority population for COVID-19 vaccination. 

Long-term care facilities remain vulnerable to COVID-19. Federal data from 20 states show new weekly cases among residents rose about four-fold from late May to the end of October, and weekly cases among nursing home staff in those states more than quadrupled during that same timespan. The heightened threat from COVID-19 elevates the urgent need to address long-term care facilities’ risk from flu. 

Flu vaccine is widely available, but its use in long-term care facilities remains unacceptably low. In the most recent flu season, the  vaccination rate of healthcare personnel in long-term care facilities was 69%, compared with 93% among healthcare personnel working in hospitals. This difference is concerning, as healthcare personnel in long-term care facilities make up more than one-fifth of the healthcare workforce and care for people who are at high risk of serious flu complications, including those aged 65 and older, and those with certain chronic medical conditions, like heart disease, asthma and diabetes. 

Only 44% of healthcare personnel in long-term care facilities reported that flu vaccination was required at their workplace. While mandates can be effective — 2019-2020 CDC data found coverage was higher (94%) among healthcare personnel required by employers to be vaccinated – there are other proven steps long-term care facilities can take to improve the rate of influenza vaccination in their staff, including:  

·    Promoting on-site flu shots; 

·    Offering low- or no-cost vaccines; and 

·    Extending focus to non-clinical personnel, including housekeeping, clerical, dietary, security, administration and volunteers. 

In addition, implementing these tactics now for flu vaccination may help long-term care facilities be better prepared for when COVID-19 vaccines become available. 

Amid a pandemic that can make people feel helpless, flu vaccination is one way to help healthcare personnel, including non-clinical personnel, at long-term care facilities protect themselves and those they care for against flu – not just in their workplace, but also in their homes and their communities.  

This year, when healthcare personnel are navigating additional challenges due to the COVID-19 pandemic, we must make one thing an easy and actionable priority: protecting healthcare personnel and residents at long-term care facilities with a flu shot.  

Ram Koppaka, M.D., Ph.D., is associate director for adult immunization in the Centers for Disease Control and Prevention’s Immunization Services Division.