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

Publication date: Jul 01, 2025

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.

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