key: cord-0860745-ciqqpqct
authors: Sherman, S. M.; Sim, J.; Amlot, R.; Cutts, M.; Dasch, H.; Rubin, G. J.; Sevdalis, N.; Smith, L. E.
title: Intention to have the seasonal influenza vaccination during the COVID-19 pandemic among eligible adults in the UK
date: 2020-10-27
journal: nan
DOI: 10.1101/2020.10.26.20219592
sha: 212a90fb0b7f2ee230a9dd03582a04aa9613f839
doc_id: 860745
cord_uid: ciqqpqct

We investigated likelihood of having the seasonal influenza vaccination in 645 participants who were eligible for the vaccination in the UK. 55.8% indicated they were likely to have the vaccination. Previous research suggests that increasing uptake of the influenza vaccination may help contain a COVID-19 outbreak, so steps need to be taken to convert intention into behaviour and to reach the 23.9% who were unlikely to have the vaccination and the 20.3% who were unsure.

report findings from a survey conducted in July 2020, which explored participants' likelihood of having the seasonal influenza vaccination this winter (2020/21).

The COVID-19 pandemic was declared on March 11 th , 2020. While the first wave of the pandemic missed most of the influenza season in Europe and the US, a second wave is likely to overlap with the 2020-2021 season 1 . Healthcare systems already come under considerable strain during a typical influenza season, which would be compounded if there is an increase in COVID-19 cases this year. Recent research has modelled the impact of mass influenza vaccination on the spread of COVID-19 should such an overlap occur, and the findings suggest that increasing uptake of the influenza vaccination would facilitate efforts to contain a COVID-19 outbreak 2 . However, increasing, or even maintaining, levels of influenza vaccination may be problematic if reduced uptake patterns seen already in other vaccines also hold for the influenza vaccine. For example, the uptake of the measles-mumps-rubella (MMR) vaccine in England became 19.8% lower in the 3 weeks after full physical distancing measures were introduced in March than in 2019 3 .

The influenza season in the UK runs from December until March each year and the national vaccination programme starts from September. The vaccination is available free through the NHS to children aged two to eleven, adults over 65, pregnant women, healthcare workers and individuals aged 6 months to 65 years who are in clinical at-risk groups (many of which . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted October 27, 2020. ; https://doi.org/10.1101/2020.10.26.20219592 doi: medRxiv preprint coincide with the COVID-19 at-risk groups). The vaccination is also available privately through primary care and pharmacies. Despite the wide availability of a free vaccine for eligible individuals, uptake varies across the different categories of eligibility; for example, 72.4% of 65+ adults in England were vaccinated in the 2019-2020 season compared to 44.9% of individuals aged 6 months to 65 in clinical at-risk groups 4 .

In order to protect people as we approach the next influenza season, it is helpful to understand the impact that the COVID-19 pandemic may have had on intention to have a seasonal influenza vaccination. To this end, we explored participants' likelihood of having the seasonal influenza vaccination as part of a larger cross-sectional study investigating attitudes towards a potential COVID-19 vaccination 5 . reported not having it (denominators for these percentages range from 511 to 514, due to missing values). We subsequently investigated variables associated with intention to receive a seasonal influenza vaccine in 2020/21 using logistic regression analyses, and included predictors informed by previous research: 6,7 sociodemographic variables; uptake of influenza vaccine last winter; and beliefs about vaccination (value of vaccination in general; not afraid of needles; see Table 1 ).

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 27, 2020. However, the strongest predictor by far, as indicated by the large odds ratio, was previous influenza vaccination behaviour.

These findings strongly suggest that individuals who had the influenza vaccine last year are likely to intend to have it again this year, and this is consistent with findings from the H1N1 influenza pandemic 6 . However, there are still key issues to address. Vaccination intention across all those individuals in our sample who were eligible for the vaccine (55.8%) was higher than the reported uptake from last year (32.3%). However, it is likely that actual . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted October 27, 2020. ; https://doi.org/10.1101/2020.10.26.20219592 doi: medRxiv preprint 5 uptake will be lower than intention as a result of the intention-behaviour gap 8 , making it important that efforts are made to convert positive intentions into uptake. This might be achieved through appropriate messaging and special arrangements for vaccine delivery, particularly for those who might be shielding or at higher risk from COVID-19 and reluctant to attend their GP surgery. Both approaches are also likely to be needed to motivate those individuals who have not previously had the influenza vaccine and those individuals who are eligible for free vaccination but who were among the 44.2% of our sample that indicated they definitely did not intend to be vaccinated (23.9%) or were unsure (20.3%).

The NHS is often overwhelmed during the influenza season, needing, for example, to cancel routine operations. During the first wave of the COVID-19 pandemic in the UK, which occurred outside the influenza season, there was sufficient concern about the NHS's ability to cope that 10 new 'Nightingale' hospitals were built. Increasing uptake of the seasonal influenza vaccine in a timely fashion will relieve pressure on the service. If this is to be successful, strategies to achieve this increase need to be implemented now.

. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted October 27, 2020. ; https://doi.org/10.1101/2020.10.26.20219592 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted October 27, 2020. ; https://doi.org/10.1101/2020.10.26.20219592 doi: medRxiv preprint

Influenza immunization and COVID-19

Modeling the impact of mass influenza vaccination and public health interventions on COVID-19 epidemics with limited detection capability

Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England

Surveillance of influenza and other respiratory viruses in the UK: Winter

COVID-19 vaccination intention in the UK: Results from the COVID-19 Vaccination Acceptability Study (CoVAccS), a nationally representative cross-sectional survey

Factors associated with uptake of vaccination against pandemic influenza: a systematic review

Evaluating the importance of policy amenable factors in explaining influenza vaccination: a cross-sectional multinational study

Bridging the intention-behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise