Health Insurance

Only Half the Country Receives the Flu Vaccination, Leaving Work to be Done

Only Half the Country Receives the Flu Vaccination, Leaving Work to be Done

Flu vaccines have become commonplace within the United States, but that wasn't always the case. A decade ago, less than half of the U.S. population received the seasonal flu vaccine.

Fast forward to 2020, and a flu-like disease has spread across the world with no vaccine in sight. Although COVID-19 is a respiratory illness, it differs in that it originates from a different virus when compared to influenza.

However, the country is hopeful that a coronavirus vaccine will be created in the near future. For this reason, ValuePenguin decided to investigate which states participate in seasonal flu vaccines and understand if they are linked to median income to infer if people are as likely to eventually get the COVID-19 vaccination.

Key findings

Nationally, influenza vaccinations have increased by more than 14% since 2010.

The largest increases in vaccinations occurred in Montana (+32%), Oregon (+29%), Washington state (+26%) and Pennsylvania (+25%). Impressively, Montana jumped from a 37% vaccination rate to 49% — the largest percentage jump over that time period.

2010-11 Vaccination Rate
2018-19 Vaccination Rate
% Change
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There are several reasons vaccination rates improved during the period we analyzed. For example, technology improved. New intradermal vaccines reduce the amount of antigen needed per dose, which means the same amount of antigen can be used to make more doses of the vaccine. Then, more doses are available throughout the year.

Louisiana had the largest decrease in flu vaccinations over the period, falling by 10%.

Following this state was South Dakota (-2%), Wyoming (-2%) and Hawaii (-2%). Incredibly, these were the only states to see an overall decrease in vaccination rates between 2010 and 2018.

This is a positive sign for the health of the nation. Vaccines are a way to build your body's natural immunity to a disease before you get sick. By receiving a vaccine, you are preventing yourself from getting a disease but also reducing the overall spread of the virus. An increase in nationwide vaccinations is a telling sign we are reducing the spread of dangerous pathogens.

For the most recent data year (2018–2019), Nevada had the lowest flu vaccination rate of 38%.

This is 11% lower than the national U.S. vaccination rate of 49%. On the other hand, all other U.S. states have vaccination rates above 40% for the most recent year data was available. This represents a strong trend since 2010, when 10 states vaccinated less than 40% of their population.

Young children and the elderly have the highest rates of flu vaccinations when compared to other age groups: 64% and 68%, respectively.

This can be expected, as the Centers for Disease Control (CDC) says children and seniors are the most at-risk for catching the flu. However, when looking at their change over the past decade, both of these groups only increased their vaccination rates by 9% and 1.5%.

But during the same time frame, adolescents aged 13–17 received 18% more flu vaccinations — the largest bump among all age groups. This is likely because of the severe flu season during the prior year. According to the CDC, the 2017–2018 flu season was a "high severity season" for hospitalizations and outpatient visits for individuals with influenza.

Higher incomes only have a slight positive correlation with higher vaccination rates.

However, some states have higher-than-average median household incomes and low vaccination rates.

For example, California's $75,227 median income ranks within the top quartile across the nation. But it only had a vaccination rate of 47% — less than the national average of 49%.

Median household income
2018–2019 vaccination rate
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Health insurance and vaccinations

Typically, your health insurance policy will provide coverage and pay for vaccinations that you may receive or need. This is due to vaccinations and preventative services being an essential health benefit which was put into law under the Affordable Care Act (ACA). Essential health benefits are a group of 10 benefits which must be covered and provided for all comprehensive health insurance plans.

The 10 essential benefits include:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse care
  • Prescription drugs
  • Rehabilitative services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services

If you are currently uninsured, there are still ways to receive vaccinations. For children, vaccination programs such as The Vaccines for Children Program (VFC) provide a vaccine at no cost for individuals younger than 19. Adults who may need a vaccine have the option of visiting a local health center or state health department. At both of these places, adults can get preventive services and wellness care at low costs.


ValuePenguin used a combination of CDC year-by-year influenza data and American Community Survey income information to create this study. The CDC database includes a variety of surveys that are conducted through different channels, such as in person and targeted phone calls.

However, the CDC database did have a limitation. Influenza estimates for New Jersey and the District of Columbia were unavailable for the 2017, 2018 and 2019 flu seasons. For this reason, they were removed for the purpose of this study.

Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.