Rationalizing recommendations for influenza and COVID-19 vaccines

Influenza vaccination saves lives, reduces short-term and long-term health consequences, decreases healthcare utilization, and improves pregnancy outcomes and infant health. Consequently, many, although not all, high-income countries have influenza vaccination policies that recognize both the direct (prevention of infection) and indirect (e.g., reduction in transmission and absenteeism, exacerbations of other health conditions) benefits of vaccination. Vaccination policies for COVID-19 are less consistent, even though COVID-19 continues to cause more infections than influenza. Indeed, some countries recommend COVID-19 vaccination only for older adults and individuals who are severely immunocompromised. Herein we compare influenza and COVID-19 vaccination effectiveness against both acute infection and indirect effects of infection. We find that COVID-19 vaccines are equivalent to, or outperform, influenza vaccines when comparing protection from symptomatic infection, reduction in severe disease, safety profiles, and real-world effectiveness. We propose that expansion of COVID-19 vaccination policies would reduce disruptions to school, work, and healthcare systems, in addition to preventing hospitalizations and severe disease.