Health care workers for the elderly need to get flu vaccinations. But why aren’t more of them doing that?

Each year, hundreds of workers who care for some of Massachusetts’ most vulnerable residents, including those in nursing homes and dialysis centers, fail to get a flu shot. Now a push is on for them to get vaccinated under a new state mandate that seeks to head off a devastating “twindemic” of flu and COVID-19.

© Damian Dovarganes
A push is on for health care workers to get the flu vaccine under a new state mandate that seeks to head off a devastating “twindemic” of flu and COVID-19.

Facility administrators say they’re striving to meet the end-of-year vaccination deadline. But they say they are contending with spot shortages of the vaccine as well as antivaccine sentiment among some workers.

Nursing homes are “combating widespread myths about the dangers and efficacy of the flu vaccine” among workers, said Tara Gregorio, president of the Massachusetts Senior Care Association, a nursing home trade group.

It may come as a surprise that some front-line health workers balk at one of the pillars of public health. But their resistance appears to mirror antivaccine sentiment among the larger population whose anxiety often stems from misinformation about the flu shot.

Some people mistakenly believe it can cause them to get the virus. Some cultures are less familiar with vaccines and Western medicine, while others distrust the government and pharmaceutical companies, or don’t believe the vaccine affords sufficient protection.

Gregario said they have turned to large pharmacy companies to help work around the shortages experienced by their usual vendors.

Complications from the flu are more common among older adults, who typically suffer from other chronic health conditions. Health care leaders are hoping to avoid the confluence of flu and COVID-19, which could prove deadly to older patients and swamp the health care system.

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The state health department earlier this month mandated that workers, contractors, and volunteers at nursing homes, rest homes, assisted living centers, out-of-hospital dialysis units, and adult day health programs receive a flu shot, something that had been strongly encouraged but not required in years past. The order noted that roughly two-thirds of COVID-19 deaths in Massachusetts have occurred in long-term care facilities.

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State records for the 2018-2019 flu season, the most recent data available, show many clinics, dialysis centers, nursing and rest homes, and adult day health centers reported worker vaccination rates well below 90 percent, the state and federal goal for health facilities.

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Among the lowest vaccination rates in Massachusetts facilities were nursing homes, at 72 percent; rest homes, 64 percent; and 61 percent at day health programs, which provide community-based nutritional, rehabilitative, and other health services to disabled adults.

A report last December from the state’s health department indicated that during the 2018-2019 flu season, 16 percent of nursing home workers declined to get a flu shot, as did 29 percent of those working in rest homes, and 33 percent in adult day health programs.

Data from last year’s flu season are unavailable because the Baker administration suspended the requirement for facilities to report that information so they could focus on caring for patients during the pandemic. Additionally, the state’s Executive Office of Elder Affairs was unable to provide any vaccination history for assisted living facilities, which are not considered health care facilities under the agency’s rules. This is the first season the agency has required flu vaccinations for those workers and volunteers.

Massachusetts nursing homes, with about 40,000 residents, aren’t the only facilities saying they face spot shortages of flu vaccines. Assisted living residences, home to over 17,000 people, are also confronting the same problem, said Brian Doherty, president of the Massachusetts Assisted Living Association.

“In some cases, assisted living providers have been notified by their third-party vaccine providers that there are delays in both the high dose and low dose vaccine,” Doherty said. “At some assisted living residences, all flu vaccines were provided on time as scheduled, and at others there have been delays ranging two to eight weeks.”

The high-dose version of the vaccine, which is more potent, is intended for people 65 and older, who typically have a weaker immune system.

The recent state mandate now requires health care facilities covered under the order to provide vaccines to health care personnel free of charge.

“Our members have a long history of seeking to attain as close to a 100 percent staff immunization as possible,” Doherty said. “And the public health conditions this year add new impetus to achieving that.”

A spokeswoman for the state health department said the agency doesn’t believe there is a meaningful flu vaccine shortage in Massachusetts. She said the department bought 1.1 million doses this year, a 28 percent increase over the usual amount. The spot shortages reported by assisted living and nursing home facilities, she said, may be linked to an earlier delay in the nationwide release of the Fluzone High-Dose Influenza Vaccine, manufactured by Sanofi Pasteur Inc.

Just before the pandemic hit, operators of adult day health programs, where roughly a third of workers had declined shots two years ago, started offering training sessions about the critical need to get vaccinated, said Michele Keefe, executive director of the Massachusetts Adult Day Services Association.

This year, they’ve made it a priority, but it’s been challenging, she said.

“It’s hard because a lot of the programs are small mom-and-pop organizations,” Keefe said. “They don’t have a lot of excess staff, and right now it’s all hands on deck trying to take care of people in the program.”

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Flu vaccination rates have typically been higher at dialysis centers, averaging about 83 percent, according to the state’s data. But the centers are included in the recent state order as patients receiving dialysis are at particular risk for serious complications from the flu and COVID-19 because they often have a greatly weakened immune system.

Fresenius Medical Care North America, the largest dialysis center chain in Massachusetts with more than 35 centers, requires its health care workers to get a flu shot each season, said spokesman Brad Puffer.

“As people living with underlying medical conditions such as chronic kidney failure are more at risk of complications from flu and COVID-19, we will continue our significant efforts to educate patients, physicians, and care teams on the importance of the flu vaccine this year,” Puffer said.