A recent survey conducted by the National Foundation for Infectious Diseases (NFID) pointed to patients’ concerns around vaccines as reason for decreased rates of vaccination. Approximately 12% of unvaccinated adults stated that vaccines don’t work well to keep them from getting sick, and 12% said they are concerned about getting sick from the vaccines themselves, according to survey data.

A decline in vaccination rates poses short- and long-term concerns for public health, according to Tom Frieden, MD, former director of the CDC, and founder and CEO of Resolve to Save Lives, a nonprofit organization of global health experts.

“Lower vaccination rates mean more preventable days lost from work, more preventable hospitalization, and more deaths,” Frieden said in an interview.

In addition, reduced vaccination may increase the risk for outbreaks of preventable diseases and result in greater strain on healthcare systems, said Frieden, who participated in the NFID briefing announcing the survey findings.

In the clinical setting, a rise in infections among high-risk groups such as older adults and immunocompromised individuals drives healthcare costs, hospitalizations, and death rates, Frieden said. “Both flu and COVID-19 can be deadly, and vaccination remains the single best protection we have,” he emphasized.

Vaccines vs Viruses

“Flu vaccine effectiveness typically ranges from 30% to 60%, but regardless of the efficacy rate, vaccination is better than anything else you can do to protect yourself against severe outcomes from flu,” said Peter Hotez, MD, in an interview.

Rates of both influenza and COVID are starting to rise again, and Americans should anticipate a possible surge in respiratory viruses in January and February, said Hotez, who also participated in the briefing on the NFID survey findings.

When asked about the new variant H3N3 flu strain that has dominated cases in the UK and elsewhere, Hotez noted that the impact of this variant in the US has been limited so far. Experts are monitoring reports closely, but influenza is unpredictable, he said, and patients should be advised that, even late in the season, vaccination reduces the risk not only of severe illness and hospitalization but also complications such as heart attacks and strokes. “Remember that influenza and COVID-19 are cardiovascular viruses that cause thrombotic events, and vaccination is one of the best ways to protect your heart health,” Hotez said.

Concern Around Vaccines Persist

Patients’ ongoing misconceptions about vaccine safety and effectiveness remain a barrier to vaccination, said Robert H. Hopkins, Jr, MD, the NFID’s medical director, in an interview.

Overall, 45% of survey respondents said they had received at least one respiratory vaccine since September 2025 (flu, COVID, pneumococcal, or respiratory syncytial virus).

“Among adults who skipped the flu vaccine, for example, 16% cited concerns about side effects,” said Hopkins, who moderated a press briefing at which the survey findings were presented. Similarly, patterns emerged for COVID-19 vaccination, with 20% of survey respondents worried about side effects.

The survey was conducted in November 2025 among a nationally representative sample of 1015 adults aged 18 years or older in the US, selected from a pool of online volunteers.

“For both flu and COVID-19, 12% of unvaccinated adults stated that vaccines do not work very well, and 12% are concerned about getting sick from vaccines,” Hopkins said.

The data underscore the public overestimation of risk and underestimation of benefits of vaccines, and their potential to prevent severe illness, hospitalization, and death even in healthy, young individuals, he said. “Potential side effects are rare and far less severe than the diseases they prevent,” he emphasized.

Despite the persistent public concerns, the survey findings also confirmed healthcare professionals as the most trusted source of vaccine information, Hopkins told Medscape Medical News. Just under half (44%) of adults ranked healthcare providers first as a trusted source, but a similar number of respondents said that the guidance on which vaccines to get this season is unclear, he said. Notably, social media was cited as the second most trusted source of information after healthcare providers by 15% of younger adults aged 18-28 years and by 13% of adults aged 18-34 years.

The key takeaway from the survey for clinical practice is that clear and confident recommendations make an impact, said Hopkins. “When healthcare professionals proactively discuss vaccines and address concerns about safety and effectiveness, patients are more likely to get vaccinated,” he said.

“The current trends are likely to persist as long as the firehose of falsehoods persists, but doctors, nurses, and others can better communicate the facts,” Frieden told Medscape Medical News. “This means listening to understand what people are hearing and believing, sticking to facts that empower people to protect themselves, and collaborating with messengers who are trusted by different communities,” he said.

“Addressing people’s concerns with empathy and transparency is essential to rebuild trust and boost vaccine uptake,” he added.

The survey and press briefing were sponsored by the NFID.

Hopkins and Frieden had no financial conflicts to disclose. Hotez disclosed being a co-inventor on nonrevenue generating patents for neglected tropical diseases owned by Baylor College of Medicine (BCM) and being a co-inventor of a COVID-19 recombinant protein vaccine technology owned by BCM.