State health officials are desperately ramping up flu vaccination efforts, hoping to prevent health care systems already taxed by Covid-19 from being overrun by the rapidly approaching influenza season.

Massachusetts is requiring every kid to get a flu shot to attend school or childcare. Michigan Gov. Gretchen Whitmer got vaccinated on live television, stressing that immunization could help save precious hospital resources. Local and state health departments are buying record amounts of vaccine, hiring new staff to provide shots at senior residences and homeless shelters, and they are planning to offer immunizations at Covid-19 testing sites.

“I don’t think the health system in the U.S. could support a surge in Covid and a hard season of influenza,” said Arkansas health secretary Jose Romero. “I think it would crack the health care system.”

States are facing new urgency with schools in some parts of the country reopening, increasing the risk of spread for both viruses. Underscoring the uniquely deadly threat posed by this year’s flu season, the Centers for Disease Control and Prevention has purchased over 20 times the typical amount of flu vaccine and for the first time is helping fund state immunization messaging campaigns.

But it will largely be left to state health officials —  still consumed with the coronavirus pandemic — to marshal limited resources to help persuade a crisis-fatigued public to overcome their apathy to the flu shot. Fewer than 50 percent of adults opt to get vaccinated in a typical season, a rate that CDC Director Robert Redfield hopes to elevate to 65 percent during this once-in-a-lifetime health crisis.

“It’s definitely been a struggle,” said Crystal Rambaud, a vaccine-preventable disease manager at the health department in Pima County, Ariz., who cited competing priorities of managing flu and the coronavirus.

“For people like me, immunization was my full-time job, and then Covid happened and that was my full time job,” she said. “Now I’m shifting back, and now I find myself in a situation where I’m trying to manage both.”

States are leveraging federal resources on vaccination campaigns and striking up new partnerships to distribute the flu shot far and wide starting the next couple of weeks. The CDC says September and October are the best months for immunization.

Michigan for the first time ever purchased flu vaccines for poor residents and is running television ads encouraging people to get flu shots, spending $3 million in federal funds on a campaign that also includes social media outreach. Vermont’s health department is working with long-term care facilities and prisons to ensure people at particularly heightened risk of Covid-19 get flu shots. After squashing the nation’s most devastating coronavirus outbreak, New York City is embarking on a $4.6 million vaccination media campaign and has bought 63,000 doses — more than six times the typical amount — with a focus on immunizing high-risk people.

The CDC estimates there were between 410,000 and 740,000 flu-related hospitalizations last year, and as many as 62,000 deaths. Public health officials fear that a similarly bad flu season this year would mean a return of crowded emergency rooms and shortages of personal protective equipment that hampered many health systems this spring.

Making matters more complicated, it’s possible to be infected with both viruses — and to be able to spread them at the same time. Just figuring out who has what could be chaotic, because the symptoms are similar.

The stakes are especially high in some states recovering from severe coronavirus outbreaks this summer — Arizona, Florida, Georgia and Louisiana — which typically have some of the lowest flu vaccination rates in the country.

Communities of color, who have been hit especially hard by the coronavirus, also tend to have lower vaccination rates. While 49 percent of white adults received the flu vaccine last year, only 39 percent of Black and 37 percent of Hispanic adults were inoculated, according to the CDC. Louisiana’s outreach includes targeted efforts to reach minority populations, including partnering with churches and barber shops to encourage flu vaccinations, said Frank Welch, medical director for emergency preparedness at the Louisiana Department of Health.

Young adults, who’ve emerged as major spreaders of Covid-19 this summer and as schools reopen, were the least likely of any age group to get flu shots last year, according to a survey from the American Academy of Physicians.

There are some encouraging signs, however, that this year’s flu season may be mild. New Zealand, which has immunization rates similar to the U.S., saw record demand this year for the flu vaccine — and it’s seen lower levels of infection, along with other Southern Hemisphere countries who’ve gone through flu season. Mask wearing and social distancing are likely to help keep the flu at bay this year, experts predict, and the fear of getting coronavirus may encourage people to be more proactive about getting vaccinated this fall.

“The fear of Covid is a driver to get people vaccinated against the flu,” said Barry Bloom, an infectious disease expert and public health professor at Harvard.

Christine Finley, the immunization director for the Vermont Department of Health, said her office has been inundated with calls from the public and health care providers about flu shots. The agency is still finalizing plans for vaccine distribution, but she said the level of interest is an encouraging sign.

“I don’t think we’ve ever had the number of questions on flu vaccines that we’re seeing this year,” Finley said. “We’re dancing as fast as we can.”

Others are less optimistic, citing the lack of a robust national campaign to get people vaccinated.

“I cannot predict what will happen but I’m not optimistic that we will see a rush to take the flu vaccine,” said Oscar Alleyne, chief of programs at the National Association of County and City Health Officials.

With millions of people losing their jobs and health insurance during the pandemic, health officials said they’re buying up more flu vaccine than ever. Arizona’s Maricopa County, home to Phoenix, has used $7 million in stimulus funding from the CARES Act to purchase eight times the normal share of vaccine and raise awareness.

“We want to ensure that anyone who wants a flu vaccine will have a flu vaccine,” said Marcy Flanagan, the county’s public health director.

Manufacturers of flu vaccines said they plan to have about 200 million doses ready this year, a historic amount and up 13 percent from an average year. The CDC is giving states nearly $150 million for public campaigns and mobile vaccine sites for rural areas. The Trump administration, aiming to make vaccines more accessible, last week authorized pharmacists to administer childhood immunizations after vaccination rates dropped off as people avoided doctors’ offices.

The CDC this year will also launch a digital campaign, which will include targeted outreach to older adults, minority populations and people with underlying health conditions, a spokesperson said. The agency also plans to resume regular press briefings, which were largely curtailed during the coronavirus response.

The CDC has purchased more than 11 million doses for low-income populations, up from the 500,000 it usually provides to community health centers serving those groups. However, much of that supply won’t arrive until at least November, just after the recommended time for vaccination — though doctors say a shot is still useful then.

But as with the coronavirus, some of these efforts are undercut by President Donald Trump, who has downplayed the severity of the flu and questioned whether a flu shot was necessary. This spring, he also disputed warnings from Redfield, the CDC director, that the confluence of this year’s flu season and the coronavirus pandemic could be especially dangerous.

Conflicting messages could undermine both state and federal efforts, public health officials fear.

“I think it’s going to be a challenge,” said Richard Webby, a flu virologist at St. Jude Children’s Hospital and the World Health Organization. “Are we going to get the people who don’t typically don’t get a flu shot to get a flu shot? I hope so but that’s not realistic.”

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