# The Influence of the Coronavirus Disease 2019 Pandemic on Influenza Vaccination Refusal and Patient Satisfaction

## TL;DR

The study found that the COVID-19 pandemic led to lower flu vaccination rates and reduced patient satisfaction, especially among high-risk and disadvantaged groups.

## Contribution

The study identifies pandemic-related changes in vaccination behavior and satisfaction, highlighting disparities in healthcare engagement.

## Key findings

- Vaccination rates dropped significantly during the pandemic, especially among those who were intermittently or never vaccinated before.
- Patients in deprived areas and with lower education levels were more likely to refuse vaccines and report healthcare disengagement.
- Those with severe comorbidities were less likely to be vaccinated and more dissatisfied with care during the pandemic.

## Abstract

We examined how the COVID-19 pandemic influenced influenza vaccination, healthcare engagement, and patient satisfaction.

We retrospectively analyzed influenza vaccination records and patient experience surveys of adult primary care patients in southeastern Minnesota during two 3-year phases: Prepandemic (1 January 2017–28 February 2020) and Pandemic-Plus (1 March 2020–31 December 2023). Vaccination status was defined as “always vaccinated” (AV), “never vaccinated” (NV), or “intermittently vaccinated” (IV) for seasonal influenza.

During the Pandemic-Plus phase, 7.0% (n = 3556) of the Prepandemic AV and 48.7% (n = 16 710) of the Prepandemic IV patients never received another influenza vaccine. Compared to AV, IV and NV patients were more likely to reside in areas with greater socioeconomic deprivation (odds ratio [OR], 1.58 [95% confidence interval {CI}, 1.53–1.62] and 1.99 [1.94–2.05], respectively), have a high school education or less (2.86 [2.74–2.98] and 3.38 [3.23–3.53]), and report healthcare disengagement (1.59 [1.55–1.64] and 4.21 [4.09–4.33]). After adjusting for Area Deprivation Index and medical comorbidities, healthcare disengagement increased among the NV versus AV between phases (3.33 [3.24–3.41] and 4.23 [4.10–4.35]). In a subgroup analysis those with severe comorbidities were less likely AV (NV vs AV: 1.21 [1.14–1.27]) and more dissatisfied with care (NV vs AV: 1.25 [1.18–1.33]).

The COVID-19 pandemic altered vaccination behaviors and healthcare satisfaction, especially among those at high risk of developing influenza-related complications. Medical providers and public health officials should be aware of factors associated with vaccine refusal to better target interventions.

We observed a decline in vaccination rates and patient satisfaction following the COVID-19 pandemic, particularly among those with severe health comorbidities. Decline in vaccination is associated with residing in areas with high deprivation, self-identifying as Black, and having a lower education level.