Peter Salgo, MD: How do we use the risks associated with the flu to promote the vaccination for the flu with perhaps vaccination for COVID-19? People know you die of COVID-19, but they don’t know you die of flu. George?

George Loukatos, MD: We do this every season. It seems like we put the statistics out there. We publicize it that, yes, the flu can kill you. Yes, the flu will lead to surges in hospitalizations and stretch the medical system and infrastructure as a whole. But there’s still that reluctance. Not that anything positive is coming from the Delta variant, but the 1 positive I can say is that, as our hospitalizations are spiking here, our vaccine requests have gone through the roof. We’ve been in an area where there’s been a lot of vaccine reluctance, but as people are seeing the hospitals fill up, it’s now changing. We publicize the data at our local hospital system. There are 3 community hospitals in the area, and 98% of those hospitalized or in the ICU [intensive care unit] are unimmunized. I couldn’t give the vaccine away a month ago, but as we publicize that, I’ve got 15 people scheduled today to get vaccinated in my clinic.

Peter Salgo, MD: I keep hearing this. “My husband was a vaccine resistor, a vaccine denier, and he’s in the hospital now. I need my vaccine yesterday. Can I get it? Can we speed this up?” It’s in New York, where I live, where the infection rate is not all that high at the moment. Anyone who gets this can get really sick, but I suspect it’s in the 2% to 2.5% range now.

Jason Gallagher, PharmD: Yes. I haven’t seen the same effect of our vaccine clinics picking up just yet. It’s also spiking in the Philadelphia area, as it is everywhere in the United States, unfortunately. We’ll see.

Peter Salgo, MD: Go ahead, Bill.

William Schaffner, MD: I love that in many parts of the country, interest in the COVID-19 vaccine has increased. We’re going to have to work hard on the basis of the influenza vaccine this season. I’m an optimist, but this is a reality check. There’s a certain amount of vaccine fatigue out there. To come along now and say, “I’m glad you got your COVID-19 vaccine, but come back in because you also need the flu vaccine,” will make it difficult to get people interested. And then, as George and Jason were saying earlier, there’s this memory that the flu vaccine isn’t nearly as good as the COVID-19 vaccine. Getting people interested in preventing this other respiratory illness that they hadn’t seen for a year will be difficult. We have a challenge in front of us this year to get people vaccinated against influenza. We’re going to have to work hard.

Jason Gallagher, PharmD: I agree.

George Loukatos, MD: That makes more of a case to push the combination vaccine.

Peter Salgo, MD: Then you don’t have to make a choice. You just get the vaccine and you’re done. But that implies that you need a booster for COVID-19. If you don’t need the booster for COVID-19, then the fact that there’s a combined vaccine doesn’t help you, right?

Jason Gallagher, PharmD: Yes, it’s going to be interesting. I don’t know what else to say about it. One of the things that we have to realize is that we’ve had so many failures of medical communication throughout the pandemic in ways you certainly wouldn’t anticipate.

This year, I’ve learned about the importance of medical communication professionals for the first time in my career. People are trying to talk about how much worse COVID-19 is than the flu. Saying it’s worse than the flu somewhat downplays how important flu is. Some very prominent professionals and politicians have been saying this, especially now as the narrative shifts a little to, “Take the vaccine, you won’t get infected,” which was a little disingenuous in the first place, even though it does decrease the likelihood of infection. Since the main benefit is that you don’t get that sick, I’m now starting to hear, “Take the vaccine for COVID-19, it’ll only be like the flu.” What is the effect that will have downstream on people and their perception of influenza, which is a pretty terrible disease?

Peter Salgo, MD: Let me put a number out there, because you guys are the experts. I’ve heard the following argument from professionals, that the percentage of people who get deathly ill from COVID-19 of all comers, all people who are infected, is not all that different from people who get deathly ill from the flu, but fewer people get the flu and COVID-19 is so much more spreadable. Is that a fair argument, Bill? You’re laughing.

William Schaffner, MD: I’ve heard variations of that discussion going on now for a good year, and I’m actually not sure where I wind up. I actually think that COVID-19 is more transmissible than influenza.

Peter Salgo, MD: That’s for sure.

William Schaffner, MD: That’s one thing. And it’s also more severe. But that doesn’t denigrate the severity of influenza. I’ve been a proponent of influenza vaccine for a long time, and that’s a respiratory disease you really have to respect. I’m a big proponent of the flu vaccine.

Peter Salgo, MD: The answer I give to people who ask me about this is that I don’t want either of them. I don’t want the flu, and I don’t want COVID-19. Either one of them can knock you off. How about we just vaccinate? That would be a good idea.

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Transcript edited for clarity.