1048: Flu on the Rise: Vaccine Uptake, New Variants, and Protecting the Most Vulnerable

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, January 7, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

Today, as flu cases climb across the country and pediatric deaths rise, Dr. Natasha Bagdasarian, Michigan's chief medical executive, joins us to break down what this flu season means for families, health agencies, and health care systems, and why flu vaccination remains critical, even when it doesn't prevent every infection.

NATASHA BAGDASARIAN: 

The message is, we're trying to keep you out of the ICU. We want to keep you out of the hospital.

SHEEHAN: 

Dr. Bagdasarian, welcome back to the show.

BAGDASARIAN: 

Thanks for having me on.

SHEEHAN: 

So, across the country, flu cases are on the rise. Last year, there was an increase in pediatric deaths. How should health agencies respond to that, as they're looking forward to this year?

BAGDASARIAN: 

Well, you know, I can speak from my own state's data. In Michigan, we've seen a decline in flu vaccine uptake every year since 2020. So in in 2020, folks were very interested in getting a flu vaccine, as we were talking about COVID-19. And every year since, we've seen fewer and fewer people getting the flu vaccine, and this is across, actually almost all age groups, with the exception of those over the age of 65, so those over the age of 65 are continuing to get vaccinated at reasonable levels, but we in my particular state have seen a decline in all other age groups. And statewide in Michigan, we're at about 20% uptake for flu vaccine this year, which is nowhere near where we would want it to be. And so, one of the things that I really worry about is, what are the implications this flu season, especially if, as we've seen in previous years, we see overlapping peaks of flu, COVID, RSV, which puts an additional strain on our healthcare systems and what we're trying to prevent. We know, of course, we can't prevent all cases of the flu, but what we're trying to prevent is our health systems being inundated with flu, COVID, RSV, to the point where they can't take care of someone who's had a motor vehicle accident or a heart attack.

SHEEHAN: 

Absolutely. And you know, if I'm hearing you correctly, flu cases are up. Flu vaccine uptake is down. People aren't getting the vaccine as much. That seems like a correlation there.

BAGDASARIAN: 

Absolutely, you know, we do have to be clear, though, that when we're talking to the public, we have to emphasize that the flu vaccine doesn't necessarily prevent all cases of influenza. So, I think there are two big misconceptions. Number one, I think folks over the winter season assume that any upper respiratory illness they get is the flu. It's just in our nomenclature, we call things the flu that aren't influenza. And so, I think a lot of people think, well, I got the flu vaccine, and then I got the flu, not really understanding that there are 200 subtypes of other viruses that circulate this time of year. And then the other point that we really have to make clear to people is that we don't expect the flu vaccine to prevent all cases of mild influenza. What we're really, again, trying to do is keep people out of the hospital, out of the ICU, out of the emergency department, so that, yes, you may still get the flu, even if you've had a flu vaccine, but it won't be as severe.

SHEEHAN: 

Exactly. It doesn't prevent all cases, but it can make things not as bad.

BAGDASARIAN: 

Exactly.

SHEEHAN: 

You shared a pretty powerful personal experience of experiencing severe influenza during pregnancy. How has this affected how you approach maternal vaccinations?

BAGDASARIAN: 

Well, I'll talk first about why I shared that story. I think that, and my story was that I, with my first pregnancy, I had influenza A during the first trimester, and I subsequently lost my baby.

SHEEHAN: 

I'm so sorry.

BAGDASARIAN: 

Thank you. You know it's incredibly, it's an incredibly difficult story for me to tell, but I think it's important, because what I have found as I've engaged with people in the vaccine space is that a lot of folks in the general public aren't really responding to data. A lot of people will say, I want to see the data. I want the data on this topic, but really, people are more moved by stories. And I think what we haven't done a good job of doing in public health is marrying storytelling with the data. I think that for folks who are on the fence about the flu vaccine, not only do they need to hear a little bit about the data, but I think stories can be very powerful tools. So, that is why I shared the story. I think that in terms of my approach, for me, it really, it really brings home the point that pregnant women are so vulnerable. This is a time where your immune system is suppressed to a certain degree, and making sure that our pregnant women not only have an opportunity to get flu vaccine and COVID vaccine, but all of the other vaccines that are recommended during pregnancy. And I think that it's also a vulnerable time when people are really questioning everything that they are putting into their body. So, it's a time where some folks are more reluctant to get vaccinated, not quite understanding all of the risks of not getting vaccinated during this time.

SHEEHAN: 

Yeah, and is there a gap there between vaccination uptake during pregnancy?

BAGDASARIAN: 

Well, you know, we certainly know that there's a lot of hesitancy in pregnant women to get vaccinated, and, and that hesitancy can be different for different vaccines. I think there's a lot of hesitancy around COVID vaccine. We've actually seen fairly good uptake of the RSV vaccine in pregnant women. And so, some of it has to do with what people are seeing on the news, what they're hearing from their health care providers, but we've just got to do a better job, I think, of advising pregnant women about the risks of these types of illnesses during pregnancy.

SHEEHAN: 

Switching gears: There's a new flu variant, subclade K. Could you fill us in on what the public should know and what public officials should know?

BAGDASARIAN: 

Yeah, so we have been seeing in other countries, so when we look at the UK, for example, we've seen that they've had a an earlier and somewhat more severe flu season than normal, and they seem to be seeing a spike in H3N2 subclade K, which has caused this, this bump in influenza a little bit earlier than expected, so we've been following that. The good news is that our current flu vaccine does have an H3N2 subcomponent, so there is some coverage. There's always a worry when there is a genetic drift like this, that maybe there will be a slight mismatch between the vaccine and the flu strain that's, that's circulating, but the early data from the UK is actually still showing good efficacy for the current vaccine, this year's flu vaccine. So, in children under the age of 18, they're seeing about 75% efficacy in keeping them out of the ER and out of the hospital, which is good, and for adults, it's closer to about 40% but again, this early data shows that it's not a complete mismatch, and really, even with that little bit of antigenic drift, getting the vaccine is still the best possible way to protect yourselves against this flu strain.

SHEEHAN: 

Yeah, to be clear, the vaccine is effective against this new variant. And are we seeing a rise in this variant in the U.S. yet? Do you expect to?

BAGDASARIAN: 

You know, I think that whatever we see in other parts of the world, we know that we are so interconnected, and so, it is very likely that we will see the same sort of trends here. It's very early in our flu season. At least in Michigan, we're just seeing the very beginnings of this upward trend in influenza. So, we're watching it carefully. We have all kinds of different surveillance systems. We have syndromic surveillance, we've got wastewater surveillance, and so, we're going to use all of those tools to see not only when flu goes up, what the trend looks like, but which subtypes.

SHEEHAN: 

Gotcha. And this gets back to your original point about communicating clearly that this is a bit of a complicated subject, that while the vaccine was developed for a different strain of the flu virus, you know, it's still very effective against this other strain coming out, and that's this, that's sort of a complicated message that we don't want to get in the way of the, of the very basic message of: "Get the flu vaccine."

BAGDASARIAN: 

It is a complicated message. I've given a lot of interviews about it recently, and I find it sometimes difficult to explain we're worried about it, because there could be a little bit of a mismatch, but you should still get vaccinated again. I think the message is we're trying to keep you out of the ICU. We want to keep you out of the hospital, and even with a little bit of a mismatch, the current data suggests that this flu vaccine will continue to do those things that we are most worried about.

SHEEHAN: 

Dr. Bagdasarian, thanks so much.

BAGDASARIAN: 

Thanks for having me on.

SHEEHAN: 

Dr. Natasha Bagdasarian is Michigan's chief medical executive, ASTHO member, and ASTHO's liaison to CDC Advisory Committee on Immunization Practices.

ASTHO has received a 2025 Certified Impact Award in the category of Industry Collaboration from Accredible, the world's leading credentialing platform. Through partnerships with CDC, Morehouse School of Medicine, and others, ASTHO has created portable, high-impact credentials that strengthen public health leadership and expand access to national service recognition. Congratulations to all the winners on advancing collaboration and excellence in public health.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.