The flu kills between 24,000 and 36,000 people in an average year, according to CDC, but rarely do more than half of Americans get a flu shot—a pattern that some experts worry will happen in the future with Covid-19.

Now is the time to move the needle on flu vaccinations

Will attitudes towards Covid-19 mirror the flu?

Generally, the flu mostly kills older people and babies, but in some bad years when new strains emerge, the flu can be much deadlier to the larger population. In 1957, 70,000 Americans died of the flu, and 100,000 died in 1968. In both of those years, more than half of those who died of the flu were under the age of 65, the New York Times reports.

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"I think, for the public, 'flu' means minor illness," said Arnold Monto, a public health researcher at the University of Michigan. But, he added, in bad flu years, hospitals can fill up and start postponing elective surgeries. "People forget that," he said.

"Statistics on flu have been given to the public; the public has been beaten to death with them for decades," said David Morens, a flu researcher and senior adviser to the director of the National Institute of Allergy and Infectious Diseases. "And they just don't care."

Getting people vaccinated against the flu has also proven to be difficult. According to Alison Buttenheim, a behavioral scientist at the University of Pennsylvania, getting half of Americans to receive a flu show is "considered a good year."

One reason so few Americans get the shot "is the normalization of death," according to Gregory Poland, a physician and vaccinologist at Mayo Clinic. He believes a similar pattern will occur with Covid-19.

"It's a story of how we get used to living with the toll of a virus and don't count it or see it or care or fear it too much," said Robert Aronowitz, a historian of science at the University of Pennsylvania.

Despite the flu's death toll being "not so far behind heart disease or cancer," Americans don't seem to worry about it, Morens said. "People get excited about acute things, shocking things that happen all at once," he added, referencing diseases like Covid-19 or Ebola.

"I'm guessing that flu-vaccine coverage is going to be a ceiling," Buttenheim said. "I just don't think we'll have 70% of U.S. adults saying, Oh, an annual Covid shot? Sure."

That pattern is already playing out to an extent with booster shots, as just half of eligible Americans have received one, The Atlantic reports—and that's while over 1,000 people are dying of Covid-19 each day. "We're already losing the immediate motivator of I'm afraid I'll get sick and die," said George Dehner, a flu historian at Wichita State University.

Flu vaccines can also be high maintenance, requiring a shot every year, and even then, while the shots are good at preventing hospitalization and severe cases of flu, they're less effective at preventing infection.

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"A lot of times, you still end up getting the flu even if you've had the vaccine," which has given flu vaccines a bad reputation, said Seema Mohapatra, a health law expert at Southern Methodist University.

Tom Ewing, a flu historian at Virginia Tech University, said he believes that future attitudes about Covid-19 will become similar to attitudes towards the flu.

"Historians hate to prognosticate about the future," said Nancy Bristow, chair of the history department at the University of Puget Sound, but she's already seeing a shift in the way people talk about Covid-19.

How the US can avoid this pattern

There are ways to increase vaccine uptake that the United States could use with Covid-19, The Atlantic reports.

For example, mandates are helpful when they can be implemented. The military requires flu shots, as do many universities and health care settings. In fact, flu vaccine mandates in the early- to mid-2000s increased vaccination rates from around 40% to around 70% to 80%, The Atlantic reports.

However, while mandates are "tremendously effective," according to Gretchen Chapman, a cognitive scientist who studies vaccine behaviors at Carnegie Mellon University, "[p]eople just hate them."

In absence of mandates, nudge tactics can also be useful, especially if they're coupled with financial incentives like gift cards, coupons, or salary bonuses, The Atlantic reports. But the nudges have to remain nudges, not coercion. "You still want there to be autonomy," Mohapatra said.

Making Covid-19 shots more affordable and convenient can also help. In 2009, pharmacists were allowed to provide flu vaccines, which was an "absolute game changer," said Ross Silverman, a vaccine policy expert at Temple University's College of Public Health. Community vaccination sites and mobile clinics can also help boost vaccine uptake, said Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill.

To ease the financial burden, lawmakers could ensure that all vaccines are free, regardless of insurance status, said Angela Shen, a vaccine expert at Children's Hospital of Philadelphia. And lawmakers could also implement policies ensuring those who have to travel to get vaccinated have their costs covered and are given paid sick leave.

Still, shifts in attitudes towards vaccines are needed, The Atlantic reports. According to Tony Yang, a health policy expert at George Washington University, a strong recommendation for a flu vaccine from a health care provider can be influential towards getting someone vaccinated.

Similarly, conversations from community messengers focused on compassion rather than dismissal, could also help increase vaccine uptake, according to Rupali Limaye, a vaccine behavior expert at the Johns Hopkins Bloomberg School of Public Health.

These conversations are necessary because obstinance to Covid-19 vaccines could be even worse than resistance to flu vaccines. Vaccination has become "a hot-button issue in a way that it has never been," Silverman said. (Kolata, New York Times, 3/18; Wu, The Atlantic, 3/18)