2024 National Survey: Attitudes and Behaviors about Influenza, COVID-19, Respiratory Syncytial Virus, and Pneumococcal Disease

 

The National Foundation for Infectious Diseases (NFID) commissioned an annual survey among US adults to better understand current attitudes and behaviors about influenza (flu), COVID-19, respiratory syncytial virus (RSV), and pneumococcal disease.

Overall, the survey found that while a 2/3 majority (67%) of US adults agree that an annual flu vaccination is the most effective way to prevent flu-related hospitalizations and deaths, nearly half (45%) say they do not plan to or are unsure they will get vaccinated against flu this season. Only 38% say they definitely plan to get a flu vaccine this year. The same holds true for other respiratory disease vaccines: only 26% will definitely get an updated COVID-19 vaccine, and among those for whom it is recommended, only 21% will definitely get vaccinated against RSV and 24% against pneumococcal disease.

Among those who do not plan to get vaccinated, the top reasons cited were concerns about side effects or a lack of trust in vaccines in general. Survey findings highlight the need for greater awareness about the risks of respiratory diseases as well as the safety and benefits of vaccines, both in terms of preventing infections and reducing the risk of hospitalization or death. Healthcare professionals remain the most trusted source of information about vaccines and play a critical role in protecting public health by providing clear, consistent, and strong vaccine recommendations. The survey, conducted August 8-12, 2024, included 1,160 complete responses—1,130 online and 30 by telephone—from US adults age 18 years and older representing the 50 states and the District of Columbia.

Summary of Key Results

Attitudes around Respiratory Diseases and Vaccination

• Overall, less than 1 in 5 US adults expressed concern about themselves or someone in their family getting a respiratory infection this fall and winter:
  • 16% are concerned about RSV
  • 17% are concerned about flu
  • 17% are concerned about pneumococcal disease
  • 20% are concerned about COVID-19
• Concern about COVID-19 has dropped over time (23% of US adults reported being very or extremely concerned about COVID-19 in 2023, and 34% in 2022)
• Those with a chronic health condition¹ are about 2 times as likely as those without a chronic health condition to be concerned that they or a family member will get infected with flu, COVID-19, RSV, or pneumonia

Flu and COVID-19 vaccines are recommended for everyone age 6 months or older in the US, yet only:

• 26% of US adults will definitely get an updated COVID-19 vaccine
• 38% will definitely get vaccinated against flu this fall or winter
• Among those for whom an RSV vaccine is recommended,² 18% say they have already received an RSV vaccine and only 1 in 5 (21%) say they will definitely get vaccinated
• Among adults for whom pneumonia vaccination is recommended,³ 1 in 4 (25%) say they have already received a pneumonia vaccine and 24% say they will definitely get vaccinated
• Overall, top reasons cited by US adults for not getting vaccines to protect against flu, COVID-19, RSV, and pneumonia include⁴ concern about vaccine side effects, distrust of vaccines in general, concern about getting sick from vaccines, or do not think that vaccines work well overall

Flu

Overall, the majority of US adults believe annual flu vaccination is the best protection against flu, but many do not plan to or are unsure whether they will get vaccinated against flu during the 2024-2025 season

• 2/3 (67%) of US adults agree that annual flu vaccination is the best preventive measure against flu-related hospitalizations and deaths, but nearly half (45%) say they do not plan to or are unsure they will get vaccinated against flu this season
• Among those who do not plan to get a flu vaccine, top reasons cited include:⁵
  • Concern about side effects from the vaccine (40%)
  • Distrust of vaccines in general (33%)
  • Do not think vaccines work very well (30%)
  • Concern about getting sick from the vaccine (29%)
• Among those who will or are still not sure whether they will get a flu vaccine, top reasons cited include:⁶
  • To protect themself (76%)
  • To protect their family (65%)
  • To avoid severe complications, including hospitalization and death (51%)
  • To avoid getting sick and missing work or school (51%)
• More than 3/4 (76%) of adults age 65 years and older plan to get a flu vaccine, compared with less than half (48%) of adults age 18-64 years
• Adults age 65 years and older are more likely than younger adults to report that they will get a flu vaccine because they want to protect themselves (87% vs. 72%), because their doctor recommends it (70% vs. 39%), and to avoid severe complications including hospitalization and death (70% vs. 44%)
• Nearly half (49%) of adults who are at higher risk⁷ for flu-related complications cite their chronic health condition⁸ as a reason to get vaccinated against flu this fall or winter
• Of those adults who have been diagnosed with flu in the past 2 years, nearly half (49%) say they will definitely get vaccinated and 23% probably will get vaccinated this season

COVID-19

The majority of US adults (61%) do not plan to or are unsure they will get an updated COVID-19 vaccine this season

• Nearly half (45%) of US adults say they will not get an updated COVID-19 vaccine and 16% are unsure
• Of those at higher risk for COVID-19-related complications, including adults age 65 years and older and those with a chronic health condition, half (51%) say they will get an updated COVID-19 vaccine
• Among those who do not plan to get an updated COVID-19 vaccine, top reasons cited include:⁹
  • Concerns about side effects from the vaccine (56%)
  • Distrust of vaccines in general (37%)
  • Concern about getting sick from vaccines (32%)
  • Do not think that vaccines work well (30%)
• Only about 1 in 4 (26%) US adults say they will definitely get an updated COVID-19 vaccine
• Among those who definitely will (26%), probably will (14%), or are unsure (16%) if they will get an updated COVID-19 vaccine, top reasons cited include:¹⁰
  • To protect themself (79%)
  • To protect their family (73%)
  • To avoid severe complications, including hospitalization and death (65%)
  • To protect their community (54%)

RSV

Among US adults for whom an RSV vaccine is recommended,¹¹ only 38% say they will get vaccinated, while nearly half (44%) do not plan to or are unsure if they will get an RSV vaccine

• Among those who definitely will (21%), probably will (17%), or are unsure (18%) they will get vaccinated against RSV, the top reasons cited include:¹²
  • To protect themself (72%)
  • To avoid severe complications, including hospitalization and death (61%)
  • Doctor recommendation (59%)
  • To protect their family (58%)
• Among eligible US adults who said they will not get an RSV vaccine (26%), top reasons cited include:¹³
  • Concerns about side effects from the vaccine (45%)
  • Concerns about getting sick from the vaccine (38%)
  • Distrust of vaccines in general (38%)
  • Doctor has not recommended it (24%)

Concerns about Flu and COVID-19 Vaccine Coadministration

Most US adults (61%) would not or are unsure if they would get vaccinated against flu and COVID-19 at the same time

• Only 39% of US adults would get a flu and COVID-19 vaccine at the same time
• Half (50%) of adults age 65 years and older say they would get a flu and COVID-19 vaccine at the same time, an increase from 41% in 2023
• Among those who would not get a flu and COVID-19 vaccine at the same time, reasons cited include:¹⁴
  • Concerns about side effects (56%)
  • Do not think it is safe to get both vaccines at the same time (39%)
  • Doctor has not recommended it (15%)
  • Do not think the vaccines will work well if received at the same time (13%)

Knowledge and Attitudes around Pneumococcal Disease

Among those at higher risk for pneumococcal disease¹⁵, 1 out of 4 (25%) say they have already been vaccinated and less than half (44%) plan to get vaccinated

• Among those who do not plan to get a pneumococcal vaccine, the top reasons cited include:¹⁶
  • Concern about side effects from the vaccine (41%)
  • Concerns about getting sick from the vaccine (32%)
  • Distrust of vaccines in general (32%)

Sources of Information and Trust

Healthcare professionals are the primary and most trusted source of information about vaccines

• The vast majority of US adults (75%) trust doctors, nurses, and pharmacists a great deal or a lot¹⁷
• Slightly more than half (55%) of US adults trust the Centers for Disease Control and Prevention (CDC) and 51% trust state and local health departments a great deal or a lot¹⁸

Masking Behaviors This Fall and Winter

• Less than 1 in 5 US adults (19%) say they will wear a mask in a doctor’s office, pharmacy, or hospital this fall and winter
• Nearly half of adults (49%) will only wear a mask in healthcare settings this fall and winter if they are required to do so
• Black (38%) and Hispanic (23%) adults are more likely than White (13%) adults to wear a mask in healthcare settings this season

Key Messages

Survey findings reinforce the importance of addressing misconceptions about flu, COVID-19, RSV, and pneumococcal disease, and raising awareness about the importance of prevention. Healthcare professionals, as the most trusted source of information, are best positioned to share knowledge and provide strong vaccine recommendations for their patients.

• Safe, effective vaccines are available in the US to help protect against flu, COVID-19, RSV, and pneumococcal disease
  • An updated COVID-19 vaccine and an annual flu vaccine are recommended for everyone age 6 months and older
  • RSV vaccines are currently recommended for all adults age 75 years and older, adults age 60-74 years with certain risk factors, and pregnant women to protect their infants. For infants born to mothers who did not get an RSV vaccine while pregnant, a monoclonal antibody is recommended.
  • Pneumococcal vaccines are recommended for all children younger than age 2 years, all adults age 65 years and older, and those with certain chronic health conditions, including heart disease, lung disease (asthma or COPD), kidney or liver disease, diabetes, sickle cell disease, or other conditions and treatments that weaken the immune system
• Even in cases when vaccination does not prevent infection entirely, it can reduce the duration and severity of illness and can help prevent serious complications, including hospitalization and death
• Potential side effects associated with vaccines are rare and are much less severe than the diseases they prevent
• Vaccines cannot cause the diseases they are designed to prevent
  • Flu vaccines contain either killed or weakened viruses, making it impossible to get the disease from the vaccine
  • None of the COVID-19 vaccines contain the live virus that causes COVID-19
• It is safe to get a flu vaccine at the same time as a COVID-19 vaccine
• Getting vaccinated, washing hands, wearing a mask, and staying home when you are sick can help stop the spread of flu, COVID-19, and other respiratory diseases

 

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About the National Foundation for Infectious Diseases

Founded in 1973, the National Foundation for Infectious Diseases (NFID) is a non-profit 501(c)(3) organization dedicated to educating and engaging the public, communities, and healthcare professionals about infectious diseases across the lifespan. For more information, visit www.nfid.org.

About the Survey

This NFID-sponsored survey was conducted by NORC at the University of Chicago. Data were collected using the AmeriSpeak Omnibus®, NORC’s probability-based panel designed to be representative of the US household population.

Interviews for this survey were conducted between August 8-12, 2024, with adults age 18 years and older representing the 50 states and the District of Columbia. Randomly selected US households were sampled with a known, non-zero probability of selection from the NORC National Sample Frame and 1,160 completed the survey—1,130 online and 30 by telephone. Interviews were conducted in English. The final stage completion rate is 17.8%, the weighted household panel response rate is 26.2%, and the weighted household panel retention rate is 77.0%, for a cumulative response rate of 2.6%. The overall margin of sampling error is +/- 3.6 percentage points at the 95% confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

Once the sample has been selected and fielded, and all the study data have been collected and made final, a poststratification process is used to adjust for any survey nonresponse as well as any noncoverage or under and oversampling resulting from the study specific sample design. Poststratification variables included age, gender, census division, race/ethnicity, and education. Weighting variables were obtained from the 2024 Current Population Survey. The weighted data reflect the US population of adults age 18 years and older.

1. US adults with chronic health conditions are defined as those with asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease or stroke, kidney disease, liver disease, or a weakened immune system due to cancer treatment or other immune therapy
2. RSV vaccination is currently recommended for all adults age 75 years and older, adults age 60-74 years who have certain risk factors, and pregnant women to protect their infants
3.  Pneumococcal (pneumonia) vaccination is currently recommended for all adults age 65 years and older and those with certain chronic health conditions, including heart disease, lung disease (asthma or COPD), kidney or liver disease, diabetes, sickle cell disease, or other conditions and treatments that weaken the immune system
4. Top responses reflect survey respondent answers when asked to select “all that apply”
5. Top responses reflect survey respondent answers when asked to select “all that apply”
6. Top responses reflect survey respondent answers when asked to select “all that apply”
7. People at higher risk for complications from flu, COVID-19, RSV, or pneumococcal disease as defined in the survey include those age 65 years and older or adults who have or have had asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease or stroke, kidney disease, liver disease, or a weakened immune system due to cancer treatment or other immune therapy
8. Chronic health conditions include asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart disease or stroke, kidney disease, liver disease, or a weakened immune system due to cancer or other immune therapy
9. Top responses reflect survey respondent answers when asked to select “all that apply”
10. Top responses reflect survey respondent answers when asked to select “all that apply”
11. RSV vaccination is currently recommended for all adults age 75 years and older, adults age 60-74 years who have certain risk factors, and pregnant women to protect their infants
12. Top responses reflect survey respondent answers when asked to select “all that apply”
13. Top responses reflect survey respondent answers when asked to select “all that apply”
14. Top responses reflect survey respondent answers when asked to select “all that apply”
15. Pneumococcal vaccination is currently recommended for children younger than age 2 years, adults age 65 years and older, and those with certain chronic health conditions
16. Top responses reflect survey respondent answers when asked to select “all that apply”
17. Responses reflect survey respondents ranking selections on a scale of “trust a great deal/a lot,” “trust somewhat,” and “trust a little/not at all”
18. Responses reflect survey respondent answers when asked to select “all that apply”