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The race is on to develop a COVID-19 vaccine, but even when one becomes available a large challenge will still exist: getting enough people vaccinated.

In the 2018-2019 influenza season the U.S. Centers for Disease Control and Prevention reported that 45.3 percent of adults and 62.6 percent of children in the United States received an . In order to create herd immunity, the COVID-19 vaccination rates must be much higher.

Misinformation and fear are two of the main causes of low vaccination numbers, according to Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy in the Blavatnik Institute at Harvard Medical School, and Chris Worsham, HMS clinical and research fellow at Massachusetts General Hospital, who wrote about this problem in July in the The Washington Post and STAT.

But other challenges like lack of access and also act as barriers.

In a study published in the New England Journal of Medicine in July, Jena and Worsham found that children born in November are 13 percent more likely to receive influenza vaccines than children born in July. Those with fall birthdays receive vaccines at their annual checkups, while children born at other times of year must return to the pediatrician's office for an additional office visit to get a . Just needing a second visit seemed to be enough to deter many families from getting this important preventive care, the researchers said.

Vaccination rates took another hit during the first wave of the pandemic this past spring, when rates of routine childhood vaccination fell dramatically in the U.S., according to the CDC.

Many states had issued stay-at-home advisories and urged people not go to their doctor's office unless it was absolutely necessary. Vaccinations fell in spite of efforts by the CDC, physician groups and medical practices to urge parents to bring their children in to be vaccinated, something that can be done safely during the pandemic. Vaccination rates have since then rebounded.

Fighting COVID-19 and influenza together

Preventing the spread of influenza is itself an important part of fighting the coronavirus, physicians and public health officials say. The flu experts at the CDC state that in the coming months "it's likely that flu viruses and the virus that causes COVID-19 will both be spreading. In this context, getting a flu will be more important than ever."

Hospitalizations for the flu can quickly overwhelm a hospital in a normal year, and many suspect that coronavirus cases will increase this winter, both because of the weather and because of secondary schools and colleges reopening, Jena said.

"This makes it important to reduce the number of flu cases and hospitalizations," he said. "Also, we haven't seen many cases of flu and COVID-19 combined, but in flu season that's a possibility that could be particularly harmful because we don't have great treatments for either infectious disease."

Jena also noted that many workers, students and people in high-risk categories will need to get tested whenever they develop flu-like symptoms. Although these symptoms are most common in non-flu viruses, reducing the likelihood of these symptoms developing because of the flu will still be helpful, he said.

Creative solutions

With all of these barriers, how can the U.S. ensure that enough people receive the to protect hospital capacity? How can we make sure children receive their crucial, routine vaccinations during the ongoing COVID-19 emergency? And how can we reach high-enough levels of vaccination with a potential coronavirus vaccine to create herd immunity?

Bringing the vaccinations to the people through programs such as home visits by trained medical personnel could help, Jena and Worsham said, adding that public messaging and planning, such as creating "national vaccine days," could be key in raising vaccination numbers. Vaccines should be available at no cost, to ensure that no one is denied a vaccine because of they can't afford one, they said.

"We need creative solutions to make sure that people do not miss out on this crucial preventive care," Jena said.

More information: Christopher Worsham et al. Birth Month and Influenza Vaccination in Children, New England Journal of Medicine (2020). DOI: 10.1056/NEJMc2005928

Journal information: New England Journal of Medicine