Peter Salgo, MD: There’s a combined vaccine out there: the COVID-19/influenza vaccine. Does that make sense in terms of public health and public relations to you?

Jason Gallagher, PharmD:In my opinion, a lot of the issues we have with vaccine uptake in general comes back to the flu vaccine and how relatively mediocre it is. When the COVID-19 vaccines were in development, we never thought they’d be as good as they’ve ended up being, particularly the mRNA vaccines. But when people think of vaccines they have to take all the time, they think of the flu vaccine. A proportion of the public gets it, a not high enough proportion. Then some people develop flu anyway because when there’s a mismatch, it’s not very good. It’s always better at keeping people from being severely ill than having mild symptoms and other factors.

It makes me wonder if a combined vaccine will have any better uptake because of the fear of COVID-19 and the eventual possible need for boosters leading people to seek out care for that and saying, “While I’m getting it, I could do this 2-in-1.” It’s not yet available, but it’s in clinical trials and making its way forward. I can see some interesting almost psychological effects there coming together.

Peter Salgo, MD: Let me play devil’s advocate and look at the contrary side, which is that there’s all this COVID-19 vaccine reluctance. If you combine the COVID-19 vaccine with the flu vaccine, will that decrease acceptance of the flu vaccine? Bill, what do you think?

William Schaffner, MD:I’ve been thinking about this combined vaccine. Should there be a recommendation in the future for a regular booster for the COVID-19 vaccine, this combined vaccine looks ideal for getting people their annual flu shot and their annual COVID-19 shot. Of course, we’re not there yet, but looking forward, a lot of people would prefer that to having to roll up the sleeves of both arms and get 1 vaccine in each arm, which we’ve been thinking might have to be the case in the future. None of those recommendations are out there yet, but people and professionals generally like combination vaccines.

Peter Salgo, MD: But people often underestimate the flu. There was one prominent politician who said, and I remember this word for word, “I didn’t know you could die from the flu.” Those of us who’ve been in medical ICU [intensive care unit] sure know that you can die from the flu. Perhaps to some degree, it’s the vaccine that has kept the death rate low, but people die of the flu. My recollection is that 20,000 to 80,000 people a year in this country die in a typical flu season. That’s a lot of dead people from a disease that most people don’t think about very much.

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Transcript edited for clarity.