What It Will Take to Avoid a Tripledemic This Winter


Over the coming months, more than 100,000 Americans will likely die, mostly unnecessarily, from respiratory infections. Yes, that is the reality we are now facing this fall and winter—and likely every fall and winter for the foreseeable future. Unless we act. Between flu, COVID-19, and RSV, we are likely looking at a very large number of Americans getting sick, ending up in the hospital, and dying. Most of these Americans will be our most vulnerable: older Americans, the youngest children, and those with chronic diseases. And that number of 100,000 may be an underestimate, given that many of these infections go undetected and can substantially increase the risk of heart attacks or strokes weeks later.

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It doesn’t have to be this way. We can prevent another “tripledemic” and more—we can stop respiratory infections from harming and killing so many people.

For the first time, this fall and winter, we have highly effective, safe vaccines available to protect Americans against all three major causes of serious respiratory infections. In addition to flu shots, which should work well this year (their efficacy can vary from year to year), we now have effective RSV vaccines for people 60 years of age or older. Substantial data now show that the updated COVID-19 vaccine is effective against the latest variants.

But as the pandemic has shown many times, having tools—like vaccines and treatments—to save lives is just the beginning. We now need to provide broad and easy access to these shots for every American. Along the way, we need to rebuild trust in vaccines.

The work starts with acknowledging that for many Americans, vaccines are not a top priority amidst other pressing economic, health and safety challenges right now. To reach them in the coming weeks, we need to continue the progress we made during the pandemic in meeting people where they already are, be that at the barber shop, the fall festival or the community kitchen.   

We also need to counter the mis- and disinformation that has permeated the information landscape, bad information that discourages Americans from protecting themselves and their families through vaccinations. Around the nation, many public health communicators are trying new approaches to do just that. We know that billions of people around the world and in our country got safely vaccinated against COVID-19, and that helped end the emergency phase of the pandemic. These vaccines are safe. And they work.

Read More: Pandemics Don’t End. They Echo.

Finally, we need to help people navigate when is a good time to get the vaccine, based on their risk profile. That’s because the vaccine guidance is different for people at lower risk—younger people who are not immunocompromised without other severe medical conditions—than for those at higher risk.

People under the age of 60 who do not have an immunocompromising or other severe medical condition are, relatively speaking, at lower risk of complications from respiratory illness. They should get their annual flu and COVID shots because they will have milder infections if they are vaccinated and they are less likely to spread it to others if they get infected. They can get the shots as soon as it is convenient to do so. Getting these vaccines early in the season should provide a good degree of protection throughout the fall and winter.

For more vulnerable Americans—and there are around 100 million adults in the U.S. who are considered at higher risk—the situation is a bit different. Our strategies to protect older Americans, those with substantial chronic illnesses, and the very youngest children, need to consider three sets of factors: When do flu, COVID and RSV infections rise? When does protection from vaccines begin to wane? And when will vaccines be widely available to the people who need them the most? For high-risk Americans, timing may matter.

Over the last three winters, we have seen COVID peak in late December to mid-January. Flu generally peaks later. And RSV can be quite variable but is often earlier. For older and other vulnerable Americans, the protection from vaccines against infection and even serious illness can begin to wane within months of vaccination. This is largely due to an immune response to the vaccine that is less robust than it is for younger people.

High-risk Americans who get vaccinated in September, when flu shots are first made available, may experience some waning immunity by the time flu peaks, which typically happens between late January and early March. Given that there is no recommendation for a 2nd flu shot late in the season, it may make sense to wait on taking the flu shot until a little later. One could make the same case for COVID shots.

Given that RSV can come early, it may be reasonable to get RSV vaccines now and flu and COVID shots later in October. But getting all three shots together sometime during October, not later than Halloween, is also a reasonable option. And to be sure: the administration of multiple vaccines at one time has been extensively studied and the evidence shows that it is both safe and as effective as getting shots spaced out over time.

Around the nation, pharmacies, workplaces, and community clinics have started fall flu and COVID vaccinations. People can get both in one visit. Pharmacies, state and local health departments and the agencies and institutions that care for older Americans should work with community partners on intensive outreach in the upcoming weeks, standing up accessible clinics with convenient hours that offer all three vaccinations. Family caregivers should mark their calendars and schedule appointments.

For years, we tolerated tens of thousands of our vulnerable citizens dying each year from the flu and RSV. With the arrival of COVID, the number of Americans dying of respiratory infections has increased substantially. We can save many of these lives. All Americans are better off getting both the flu and COVID vaccines. But all of us also have an obligation to ensure that the nearly 1 in 3 Americans who are most vulnerable get these life-saving vaccines. If we do, we can break the deadly cycle of respiratory viruses and save lives, particularly those of the oldest and youngest among us.

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Contributor: Dr. Ashish K. Jha