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International Health

June 26, 2020

Recommendations on Dealing with the Dual Epidemics of COVID-19 and Influenza, New JAMA Viewpoint


In a new Viewpoint in JAMA, Daniel Salmon of the Johns Hopkins Bloomberg School of Public Health and Lawrence Gostin of Georgetown University make recommendations for the U.S. to deal with the likely co-epidemics of COVID-19 and influenza this fall and winter. They urge the nation to take steps now to attain a high influenza vaccine coverage. With an effective COVID-19 vaccine unlikely until 2021, it will be especially critical to reduce the number of hospitalizations caused by influenza to preserve health system capacity. Even though seasonal influenza vaccines have variable year-to-year effectiveness, they can significantly reduce morbidity and mortality, especially with high coverage. 

The authors lay out multiple strategies required to expand vaccine coverage. They also discuss issues around creating new mandates for vaccination, which they argue should be a last resort. To address growing levels of vaccine hesitancy, they urge all levels of governments to develop evidence-based immunization plans, which can appeal to individuals’ ethical responsibilities to protect themselves, health care workers, family members, and vulnerable populations.

Recommendations include

  • Incentivizing Vaccine Production
    The federal government should plan now to incentivize influenza vaccine production, while also ensuring that cost is not a barrier to access. Because demand for the influenza vaccine remains uncertain, the federal government should absorb the risk vaccine manufacturers would face if they increased the supply of the vaccine.
  • Increasing Demand
    The federal government should fund an evidence-based mass communication campaign, focusing on the public benefit and personal obligation of vaccination. Dispelling misconceptions will be vital, including that vaccines cause influenza.
  • Ensuring Safe Access
    As a major driver of influenza circulation, children should be a vaccine priority. Childhood immunization rates, however, have declined during the COVID-19 pandemic. Individuals must feel safe when seeking influenza vaccination. Thus, rigorous infection control in clinics, pharmacies, workplaces, and schools that deliver vaccines will be essential. These kinds of “safe” immunization sites could also be used for COVID-19 vaccine delivery.

The complete Viewpoint is available for free at JAMA.

The Dual Epidemics of COVID-19 and Influenza – Vaccine Acceptance, Coverage, and Mandates was written by Lawrence O. Gostin, JD, of the O’Neill Institute for National and Global Health Law at Georgetown University and Daniel Salmon, PhD ’03, MPH, a professor in the Department of International Health at the Bloomberg School.