Navigating patient hesitation this flu and RSV season

You've heard it at least once this season: "I saw on the news that the flu shot doesn't work this year. Why should I bother? Isn't the vaccine mismatched?"With headlines about high flu rates in the Southern Hemisphere, unprecedented outbreaks in Japan, the UK bracing for a "cruel winter," and a new H3N2 variant that emerged after this year's vaccine was already locked in, it's not surprising that vaccine confidence may be on shaky ground.As a pharmacist, you’re often the first line of defence against confusing or conflicting information and the trusted voice your patients turn to when they are not certain. Here are a few opportunities for you to guide your patients with honesty, empathy and evidence.Acknowledge concerns As an ally and a trusted health care provider, acknowledge concerns to build confidence and trust. Currently there are three strains of the influenza virus circulating: H1N1, H3N2 and influenza B. The flu vaccine currently available to Canadians is tailored to protect against all three strains. But a new H3N2 variant emerged in June—picking up several new mutations—a few months after vaccine formulations were finalized for this flu season.Many countries are seeing an early start to the flu season with 3-6 times the number of flu cases that they had at this time last year. Here in Canada, cases are climbing and public health officials are warning that we could also be in for an early and tough season. But what is sometimes lost in a headline is that the vaccine is still needed. Real world evidence from the UK is showing that the current vaccine is still 40% effective in preventing hospitalization for adults. Even with a less than perfect match, the vaccine still does its most important job—keeping people out of the hospital.So even if protection against this specific H3N2 variant is not ideal, Canadians are still getting solid coverage against other currently circulating strains. Vaccines don’t just protect against one “kind” or “strain” of influenza, they protect against several. The H3N2 strain does cause more severe disease especially in older adults. And this is what makes vaccination even more important. Because even partial protection against a severe strain is better than no protection at all.Responding to influenza questions you may get this year“I heard the flu shot is a mismatch this year, so the vaccine won’t even work.”You are right, there is a mismatch—a new variant showed up AFTER the vaccine was formulated. But in real time, we are seeing, in countries that are dealing with this exact strain, that vaccinated people are 40% less likely to end up in the hospital. Also, your flu shot will protect against multiple strains, not just this one. The vaccine’s job isn’t to create a force field—it's to keep you out of the hospital. And real-world data is showing us that this year's flu vaccine is doing that! “Other countries are seeing lots of flu anyway, so what is the point in getting the vaccine?“These global trends are warning signs—we have time to protect ourselves before flu season hits hard here. The best move is to get ahead of the flu and its outcomes and get the flu shot. This is even more important for people 65 years and older who tend to experience more complications from the flu. Two out of three people hospitalized with flu last season were not vaccinated. That's not a coincidence—it's a pattern we see year after year.Don’t forget about RSVWhile flu is dominating the headlines lately, don’t overlook RSV; it deserves equal attention in your vaccination conversations. Flu, RSV and Covid all peak around the same time. Just like getting your snow tires, and wearing a seat belt (even though not 100% effective in preventing all accidents) comprehensive protection against seasonal respiratory disease should be part of a winter strategy.When thinking of RSV protection talk to:Pregnant patients (32-36 weeks): Maternal RSV vaccination protects newborns during their most vulnerable first months.Parents of infants: Nirsevimab is 90% effective at preventing RSV hospitalizationAll adults 75+: Should get the RSV vaccine - the burden of disease is much higher in older people. More older people with RSV are hospitalized, are more likely to experience a cardiac event and are at higher risk of death.Adults 60-74 with risk factors: Those with comorbid conditions like diabetes or COPD - many people you see in the pharmacy - can have serious complications from RSV. 0Not all provinces have universal RSV programs yet, so coverage will vary by jurisdiction. Check your provincial guidelines or help patients navigate coverage (public and/or private) and costs. Responding to RSV questions you may get this year: I had RSV when I was in the hospital two weeks ago for COPD. I’m protected.The natural immunity from an RSV infection is very short lived. It's important that once you’ve fully recovered from your recent illness, to get the vaccine right away. I would have to pay out of pocket for my RSV shot—do I need it every year?Studies are showing that the RSV vaccine lasts two seasons and possibly even a third. The virus doesn’t change a lot every year like the flu. We’re not sure yet whether boosters will be needed in the future, but for now, one dose gives you extended coverage. Think of any out-of-pocket cost that you incur as multi-year protection. In some jurisdictions, certain people qualify for free coverage; that will likely continue to expand every year.When engaging in conversations, build trust and vaccine confidence by: Being honest. "Yes, there is a flu mismatch against one of the circulating strains—but here's why you should still get it"Making it local. "We're already seeing flu activity pick up in this local area"Using a presumptive approach. “Today you are due for your flu vaccine”Helping to define the why. “You want to protect your independence and stay out of the hospital.” “You want to spend lots of time with your grandkids this winter.”Modelling vaccine confidence. "I got mine in September. Even knowing about the mismatch, I wouldn't skip it ""My mom got the RSV vaccine last year and is still protected this year without needing another one.”Making it easy. Co-administer vaccines whenever you can. You are a trusted voice cutting through the noise of headlines and social media. Every conversation you have and every question you answer with honesty, evidence and empathy is a chance to build on that trust. Every person who leaves your pharmacy vaccinated—or even just better informed—is one more person protected.

Navigating patient hesitation this flu and RSV season

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