What Minnesota’s flu vaccine rates can tell us about a COVID-19 vaccine rollout

India Ampah holds her son, Keon Lockhart, 12 months old, as pediatrician Amanda Porro M.D. administers a measles vaccination during a visit to the hospital. Photo by Joe Raedle/Getty Images.

A COVID-19 vaccine may be available in a matter of months — but convincing enough Minnesotans to get the shot might not be easy.

Roughly one-third of Americans said they would not get a COVID-19 vaccine if it were available this month, the majority citing concerns about side effects or that the vaccines were moving too quickly through trials, according to a recent poll

The COVID-19 vaccine is likely arriving during a moment of collapsing confidence in life-saving immunizations due to organized disinformation campaigns on Facebook and other social media. The campaigns have led to a decline in childhood vaccination rates, causing outbreaks across the country — including a measles outbreak in Minnesota in 2017, attributed to anti-vaxxers targeting the Somali community, and a resurgence in whooping cough cases.

Vaccines have also become politically charged, as Republican lawmakers nationwide have in recent years increasingly shared baseless anti-vax claims and sponsored bills undermining immunizations.

Influenza vaccination rates could provide some insight into challenges health officials might encounter during the COVID-19 vaccine rollout and how to address them, experts say. 

“People need to weigh the risks and benefits for themselves. It’s a very personal decision,” said Kumi Smith, a University of Minnesota epidemiology professor. “But the benefits for the public really do rely on a lot of people making this decision in a certain direction, all together, relatively quickly.”

Here are three things to know about Minnesota’s flu vaccination rates, and what that could mean for the rollout of the COVID-19 vaccine.

1. Minnesota has a relatively high influenza vaccination rate

Flu vaccination rates vary widely across the United States, from 44% in Nevada to nearly 61% in Rhode Island. These geographic gaps could be a sign that COVID-19 vaccine coverage will vary across the country as well, according to the Kaiser Family Foundation. These disparities would make it difficult to get the pandemic under control.

More than 56% of Minnesotans received a flu vaccine last year, the 14th-highest rate in the country, according to data from the federal Centers for Disease Control and Prevention.

Minnesota’s robust health care system and low uninsured rate may explain the state’s relatively high flu vaccination rate, although it’s too soon to tell if that will help the state’s COVID-19 vaccination rate. Studies have found that people with health insurance and access to regular medical care are more likely to get a flu vaccine.

Still, Minnesota — and every other state — are far below the target of 70% vaccinated, according to the CDC.

The flu shot is safe and effective, but misconceptions and fears about the vaccine are a major reason people don’t get it, said Dr. Paul Erickson, medical director at north Minneapolis clinic NorthPoint Health and Wellness. Similar concerns could deter people from getting a COVID-19 vaccine.

The clinic has worked for decades to build trust with its diverse community of patients and participates in a state program that provides free vaccines for uninsured people. As a result, NorthPoint’s vaccination rates are higher than the state’s, but doctors still hear from patients who are reluctant to get immunized against the flu because they worry they’ll get sick, Erickson said. 

“There are myths and stories about people getting vaccines and getting sick,” he said. “If you have a trusted health care provider that says, ‘This vaccine is really safe, and there’s no way you can get sick from this,’ I think people are more likely to take it.”

2. Younger people are less likely to get vaccinated

Minnesotans under 50 get flu shots at lower rates than other age groups, according to CDC data. Roughly 45% of people between the ages of 18 and 49 received a flu vaccine last year, compared to nearly 54% of people ages 50-64 and 72.5% of people over 65.

This could be a troubling trend if it’s repeated in COVID-19 vaccination rates. Minnesotans between the ages of 18 and 35 account for more than a third of the state’s confirmed COVID-19 cases, and officials have said the age group is driving the surge in cases statewide. Young people are less likely to get sick or die from the virus, but they can still spread it to people at higher risk of serious illness.

Efforts to convince young people to stay home during the pandemic haven’t been very successful, and motivating that age group to get vaccinated against COVID-19 could be a difficult task as well, Smith said.

“I think we have a far bigger communication challenge, and challenge of how to change behaviors of young people, than we ever would have thought,” she said.

Smith said finding celebrity spokespeople to promote the vaccine could be an effective way to reach 20- and 30-somethings. The strategy was successful during the 20th-century polio epidemic: Teens were resistant to being vaccinated, so health officials recruited Elvis Presley to get the shot. Today, that would be like Beyonce receiving a COVID-19 vaccine, Smith said. 

3. There are wide racial disparities in flu vaccination rates

Minnesota has wide gaps in flu vaccination rates by race. Last year, nearly 58% of white Minnesotans got a flu shot, compared to roughly 48% of Black Minnesotans and nearly 51% of Hispanic Minnesotans.

There are a number of reasons for the racial disparities nationwide, including lower rates of insurance coverage and less access to health care for people of color. Distrust in the medical system and experiences with discrimination also play a role — and could make people of color reluctant to get a COVID-19 vaccine, even as they experience illness and death from COVID-19 at disproportionately high rates, experts say.

Half of Black Americans say they would probably not or definitely not receive a COVID-19 vaccine, compared to 34% of white people, according to a recent survey by the Kaiser Family Foundation. Of the Black survey respondents who said they wouldn’t get a vaccine, about 40% cited concerns about safety, and another 35% cited lack of trust in the health care system. 

They have good reason to be skeptical. The United States has a long history of performing medical experiments on Black people without consent — like the Tuskegee syphilis experiment, in which the government studied hundreds of Black men who had syphilis without informing them of the diagnosis or treating them. This history, as well everyday experiences of discrimination, have created a legacy of mistrust of the medical field.

Repairing that relationship will take time, and long-term engagement strategies will be key, Smith said. Officials can start by clearly communicating the results of COVID-19 vaccine trials and working with individual communities to address their questions and concerns, she said.

Creating partnerships with trusted community groups can also be an effective way for agencies to share public health information, as long as the partnerships are beneficial for everyone involved, Smith said.

“This is an issue that medical and public health communities need to think about beyond just the context of COVID-19 because this has been a longstanding issue,” Smith said. “The onus is on the public health and research and medical communities to fix this.”

Strong data showing the vaccine is safe will be crucial in addressing patients’ concerns, along with good relationships with health care providers, Erickson said. Patients need to be able to decide if getting vaccinated is right for them, and receiving accurate information from a trusted doctor can help them make that decision, he said.

“We really have to demand that we have good science on the safety,” Erickson said. “And if (it’s safe), then I’ll get one, and I’ll tell my patients I got one, and I think that has some weight.”

Rilyn Eischens
Rilyn Eischens is a data reporter with the Reformer. Rilyn is a Minnesota native and has worked in newsrooms in the Twin Cities, Iowa, Texas and most recently Virginia, where she covered education for The Staunton News Leader. She's an alumna of the Dow Jones News Fund data journalism program and the Minnesota Daily. When Rilyn isn't in the newsroom, she likes to read, add to her plant collection and try new recipes.