Who Can and Can’t Get Vaccinated Right Now

Who Can and Can’t Get Vaccinated Right Now

Some countries have stockpiles. Others have nothing. Getting a vaccine means living in the right place — or knowing the right people.


A 16-year-old in Israel can get a vaccine.

So can a 16-year-old in Mississippi.

And an 18-year-old in Shanghai.

But a 70-year-old in Shanghai can’t get one. Older people are at high risk for severe illness from Covid-19. But Chinese officials have been reluctant to vaccinate seniors, citing a lack of clinical trial data. Neither can an 80-year-old in Kenya. Low vaccine supply in many countries means only health care employees and other frontline workers are eligible, not the elderly.

Nor a 90-year-old in South Korea. Koreans 75 and older are not eligible until April 1. Only health care workers and nursing-home residents and staff are currently being vaccinated. The government initially said it was awaiting assurances that the AstraZeneca vaccine was safe and effective for older groups.


Anyone in Haiti.

Anyone in Papua New Guinea.

Anyone in these 67 countries. These countries have not reported any vaccinations, according to Our World in Data. Official figures can be incomplete, but many countries are still awaiting their first doses.

It wasn’t supposed to be like this: Covax, the global vaccine-sharing initiative, was meant to prevent unequal access by negotiating vaccine deals on behalf of all participating nations. Richer nations would purchase doses through Covax, and poorer nations would receive them for free.

But rich nations quickly undermined the program by securing their own deals directly with pharmaceutical companies. In many countries, they have reserved enough doses to immunize their own multiple times over.

Anyone who can afford a smartphone or an internet connection in India and is over 60 can get one. Mostly wealthy Indians are being inoculated in New Delhi and Mumbai, hospitals have reported, since vaccine appointments typically require registering online. Less than half of India’s population has access to the internet, and even fewer own smartphones.

And anyone who can pay $13,000 and travel to the U.A.E. for three weeks and is 65 or older or can prove they have a health condition.

A British travel service catering to the rich offered vaccination packages abroad, and wealthy travelers to the U.A.E. have acknowledged they were vaccinated there.


member of Congress in the United States. Friends of the mayor of Manaus, Brazil. Lawmakers in Lebanon. A top-ranking military leader in Spain. The extended family of the deputy health minister in Peru. The security detail to the president of the Philippines. Government allies with access to a so-called “V.I.P. Immunization Clinic” in Argentina. Around the world, those with power and connections have often been first in line to receive the vaccine — or have cut the line altogether.


A smoker in Illinois can get one. But not a smoker in Georgia.

A diabetic in the United Kingdom can. A diabetic in Connecticut can’t.

Countries have prioritized different underlying health conditions, with the majority focusing on illnesses that may increase the risk of severe Covid-19. In the U.S., health issues granted higher priority differ from state to state, prompting some people to travel across state borders.

A pregnant woman in New York. Not a pregnant woman in Germany. Up to two close contacts of a pregnant woman in Germany. Pregnant women were barred from participating in clinical trials, prompting many countries to exclude them from vaccine priority groups. But some experts say the risks to pregnant women from Covid-19 are greater than any theoretical harm from the vaccines.


A grocery worker in Texas, no. A grocery worker in Oklahoma, yes.

Many areas aim to stop the virus by vaccinating those working in frontline jobs, like public transit and grocery stores. But who counts as essential depends on where you live.

A police officer in the U.K. A police officer in Kenya. A postal worker in California. A postal worker in North Carolina. A teacher in Belgium. A teacher in Campeche, Mexico. Other jobs have been prioritized because of politics: Mexico’s president made all teachers in the southern state of Campeche eligible in a possible bid to gain favor with the teacher’s union.


Medical staff at jails and prisons in Colombia. A correctional officer in Tennessee. A prisoner in Tennessee. A prisoner in Florida. The virus spread rapidly through prisons and jails, which often have crowded conditions and little protective equipment. But few places have prioritized inoculating inmates.


An undocumented farm worker in Southern California. A refugee living in a shelter in Germany. An undocumented immigrant in the United Kingdom. Britain has said that everyone in the country is eligible for the vaccine, regardless of their legal status.

A Palestinian in the West Bank without a work permit. Despite leading the world in per-capita vaccinations, Israel has so far not vaccinated most Palestinians, unless they have permits to work in Israel or settlements in the occupied West Bank.


An adult in Bogotá, Colombia. An adult in the Amazonian regions of Colombia that border Brazil. In most of Colombia, the vaccine is only available to health care workers and those over 80.

But the government made all adults in Leticia, Puerto Nariño, Mitú and Inírida eligible, hoping to prevent the variant first detected in Brazil from arriving in other areas. A police officer in Mexico City. A teacher in rural Mexico.The government of populist president Andrés Manuel López Obrador has prioritized vaccinating the poor and those in rural communities, despite the country’s worst outbreaks occurring in major cities.

Native populations not federally recognized in the United States. The pandemic has been particularly deadly for Native Americans. But only tribes covered by the Indian Health Service have received vaccine doses directly, leaving about 245 tribes without a direct federal source of vaccines. Some states, including Montana, have prioritized all Native populations.

Indigenous people living on official indigenous land in Brazil.


These 43 countries, mostly high income, are on pace to be done in a year. These 148 countries, mostly low income, are on pace to take until next year or even longer. Countries like the U.S. continue to stockpile tens of millions of vaccine doses, while others await their first shipments.

“The vaccine rollout has been inequitable, unfair, and dangerous in leaving so many countries without any vaccine doses at all,” said Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health.

“It’s a situation in which I, a 52-year-old white man who can work from home and has no pre-existing medical conditions, will be vaccinated far ahead of health workers or a high-risk person in a middle- or low-income country.”

9 numbers that show how big Walmart’s role in healthcare is

Georgia Is First State For Walmart's 'Health Center' | 90.1 FM WABE

Walmart has continued to grow its presence in healthcare over the past few years, with expansions of its primary care clinics and the launch of its new insurance arm.

Here are nine numbers that show how big Walmart is in healthcare and how it plans to grow:

Walmart has opened 20 standalone healthcare centers and plans to open at least 15 more in 2021. The health centers offer primary care, urgent care, labs, counseling and other services.

Walmart’s board approved a plan in 2018 to scale to 4,000 clinics by 2029. However, that plan is in flux as the retail giant may be rolling back its clinic strategy, according to a February Insider report.

Walmart in January confirmed plans to offer COVID-19 vaccines in 11 states and Puerto Rico.

In 2020, Walmart established 600 COVID-19 testing sites.

Walmart said it believes expanding its standalone clinics will help bring affordable, quality healthcare to more Americans because 90 percent of Americans live within 10 miles of a Walmart store.

The Walmart Health model lowers the cost of delivering healthcare services by about 40 percent for patients, according to Walmart’s former health and wellness president Sean Slovenski.

In October, Walmart partnered with Medicare Advantage insurer Clover Health on its first health insurance plans, which will be available to 500,000 people in eight Georgia counties. 

Walmart’s insurance arm, Walmart Insurance Services, partnered with eight payers during the Medicare open enrollment period in 2020 to sell its Medicare products. Humana, UnitedHealthcre and Anthem Blue Cross Blue Shield were among the insurers offering the products.

A stark global vaccine divide

The vaccine divide: Wealthy nations have 23 jabs for every one in a poorer  country | World News | Sky News

Wealthy nations — including the U.S., the U.K. and the EU — have vaccinated their citizens at a rate of one person per second over the last month, while most developing countries still haven’t administered a single shot, according to the People’s Vaccine Alliance.

Why it matters: As higher-income countries aim to achieve herd immunity in a matter of months, most of the world’s vulnerable people will remain unprotected.

  • Experts say that mutations that may arise while the virus spreads could be a danger to us all, vaccinated or not.

The big picture: Even though more vaccines will arrive in developing nations soon, only 3% of people in those countries are likely to be vaccinated by mid-2021.

  • At best, only a fifth of their population will be vaccinated by the end of the year, per the People’s Vaccine Alliance.

What we’re watching: Three dozen countries have bought several times the amount of vaccine that they’ll need to vaccinate their entire population.

  • The U.S. alone has ordered more than a billion extra dosesScience Magazine reports. Global health leaders are saying it’s time to figure out where all of these excess doses will go.
  • “Over the next year or two, U.S. surplus doses and those from other countries could add up to enough to immunize everyone in the many poorer nations that lack any secured COVID-19 vaccine,” Science writes.

Rural MA Enrollees Have Substantial Rates Of Switching To Traditional Medicare

Brent Langellier (@blangellier) | Twitter

In their recent Health Affairs paper, Sungchul Park and coauthors examine rates of switching from Medicare Advantage (MA) to traditional Medicare by patient characteristics. MA plans are the private insurance alternative to traditional fee-for-service Medicare overseen by the Centers for Medicare and Medicaid Services. While enrollment in MA has doubled over the past decade, Park and coauthors find that the needs of certain enrollees are not being met by MA plans.

Park and coauthors report that rural enrollees switch from MA to traditional Medicare at an adjusted annual rate of 10.5 percent, significantly higher than metropolitan residents, who switch at a rate of 5.0 percent

This phenomenon was more pronounced among those who required the use of costly services such as facility stays or hospitalizations, those who had poor self-reported health, and individuals who reported lower satisfaction with their access to care.

4 of the biggest healthcare trends CVS Health says to watch in 2021

COVID-19 accelerated a number of trends already brewing in the healthcare industry, and that’s not likely to change this year, according to a new report from CVS Health.

The healthcare giant released its annual Health Trends Report on Tuesday, and the analysis projects several industry trends that are likely to define 2021 in healthcare, ranging from technology to behavioral health to affordability.

“We are facing a challenging time, but also one of great hope and promise,” CVS CEO Karen Lynch said in the report. “As the pandemic eventually passes, its lessons will serve to make our health system more agile and more responsive to the needs of consumers.”

Here’s a look at four of CVS’ predictions:

1. A looming mental health crisis

Behavioral health needs were a significant challenge in healthcare prior to COVID-19, but the number of people reporting declining mental health jumped under the pandemic.

Cara McNulty, president of Aetna Behavioral Health, said in a video attached to the report that it will be critical to “continue the conversation around mental health and well-being” as we emerge from the pandemic and to reduce stigma so people who need help seek it out.

“We’re normalizing that it’s important to take care of our mental well-being,” she said.

Data released in December by GoodRx found that prescription fills for depression and anxiety medications hit an all-time high in 2020. GoodRx researchers polled 1,000 people with behavioral health conditions on how they were navigating the pandemic, and 63% said their depression and/or anxiety symptoms worsened.

McNulty said symptoms to look for when assessing whether someone is struggling with declining mental health include whether they’re withdrawn or agitated or if there’s a notable difference in their self-care routine.

2. Pharmacists take center stage

CVS dubbed 2021 “the year of the pharmacist” in its report.

The company expects pharmacists to be a key player in a number of areas, especially in vaccine distribution as that process inches toward broader access. They also offer a key touchpoint to counsel patients about their care and direct them to appropriate services, CVS said.

CVS executives said in the report that they see a significant opportunity for pharmacists to have a positive impact on the social determinants of health. 

“We’ve found people are not only open and willing to share social needs with their pharmacists but in many cases, they listen to and act on the advice and recommendations of pharmacists,” Peter Simmons, vice president of transformation, pharmacy delivery and innovation at CVS Health, said in the report.

3. Finding ways to mitigate the cost of high-price therapies

Revolutionary drugs and therapies are coming to market with eye-popping price tags; it’s not uncommon to see new pharmaceuticals priced at $1 million or more. For pharmacy benefit managers, this poses a major cost challenge.

To address those prices, CVS expects value-based contracting to take off in a big way. And drugmakers are comfortable with the idea, according to the report. Novartis, for example, is offering insurers a five-year payment plan for its $2 million gene therapy Zolgensma, with refunds available if the drug doesn’t achieve desired results.

CVS said the potential for these therapies is clear, but many payers want to see some type of results before they fork over hundreds of thousands.

“Though the drug may promise to cure these patients for life, these are early days in their use,” said Joanne Armstrong, M.D., enterprise head of women’s health and genomics at CVS Health, in the report. “What we’re saying is, show us the clinical value proposition first.”

CVS said it’s also offering a stop-loss program for gene therapy to self-funded employers contracted with Aetna and/or Caremark to assist them in capping the expenses associated with these drugs.

4. Getting into the community to address diabetes

Diabetes risk is higher among vulnerable populations, such as Black patients, and addressing it will require local and community-based solutions, CVS executives said in the report. Groups at the highest risk for the disease are less likely to live in areas with easy access to a supermarket, for example, which boosts their risk of unhealthy eating, according to the report.

The two key hurdles to addressing this issue are access and affordability. The rise in retail clinics and ambulatory care centers can get at the access issue, as they can offer a way to better meet patients where they are.

At CVS’ MinuteClinics, patients can walk in and receive a number of services to assist them in managing diabetes, including screenings, consultations with providers and connections to diabetes educators who can assist with lifestyle changes.

Retail locations can also assist with medication costs, creating a one-stop-shop experience that’s easier for many diabetes patients to slot into their daily lives, CVS said.

“Diabetes is a case study in how a more connected experience can translate to simpler, affordable and more accessible care for underserved communities,” said Dan Finke, executive vice president of CVS Health and president of its healthcare benefits division.

‘Really difficult nut to crack’: MedPAC torn over telehealth regs post-COVID-19

https://www.healthcaredive.com/news/really-difficult-nut-to-crack-medpac-torn-over-telehealth-regs-post-covi/593466/

Dive Brief:

  • Members of an influential congressional advisory committee on Medicare are torn on how best to regulate telehealth after the COVID-19 public health emergency, hinting at the difficulty Washington faces as it looks to impose guardrails on virtual care without restricting its use after the pandemic ends.
  • During a Thursday virtual meeting, the Medicare Payment Advisory Commission expressed its support of telehealth broadly, but many members noted snowballing use of the new modality could create more fraud and abuse in the system down the line.
  • Key questions of how much Medicare reimburses for telehealth visits and what type of visits are paid for won’t be easily answered, MedPAC commissioners noted. “This is a really, really difficult nut to crack,” Michael Chernew, MedPAC chairman and a healthcare policy professor at Harvard Medical School, said.

Dive Insight:

Virtual care has kept much of the industry running during the coronavirus pandemic, allowing patients to receive needed care at home. Much of this was possible due to the declaration of a public health emergency early 2020, allowing Medicare to reimburse for a greater swath of telehealth services and nixing other restrictions on virtual care.

However, much of that freedom is only in place for the duration of the public health emergency, leaving regulators and legislators scrambling to figure which new flexibilities they should codify, and which perhaps are best left in the past along with COVID-19.

It’s a tricky debate as Washington looks to strike a balance between keeping access open and costs low.

In a Thursday meeting, MedPAC debated a handful of policy proposals to try and navigate this tightrope. Analysts floated ideas like making some expansions permanent for all fee-for-service clinicians; covering certain telehealth services for all beneficiaries that can be received in their homes; and covering telehealth services if they meet CMS’ criteria for an allowable service.

But many MedPAC members were wary of making any concrete near-term policy changes, suggesting instead the industry should be allowed to test drive new telehealth regulations after COVID-19 without baking them in permanently. 

I don’t think what we’ve done with the pandemic can be considered pilot testing. I think a lot of this is likely to go forward no matter what we do because the gate has been opened, and it’s going to be really hard to close it,” Marjorie Ginsburg, founder of the Center for Healthcare Decisions, said. But “I see this just exploding into more fraud and abuse than we can even begin imagining.”

Paul Ginsburg, health policy chair at the Brookings Institution, suggested a two-year pilot of any changes after the public health emergency ends.

However, it would be “regressive” to roll back all the gains virtual care has made over the past year, according to Jonathan Perlin, CMO of health system HCA.

“These technologies are such a part of the environment that at this point, I fear [it] would be anachronistic not to accept that reality,” Perlin said.

Among other questions, commissioners were split on how much Medicare should pay for telehealth after the pandemic ends. 

That parity debate is perhaps the biggest question mark hanging over the future of the industry. Detractors argue virtual care services involve lower practice costs, as remote physicians not in an office don’t need to shell out for supplies and staff. Paying at parity could distort prices, and cause fee-for-service physicians to prioritize delivering telehealth services over in-person ones, some commissioners warned.

Other MedPAC members pointed out a lower payment rate could stifle technological innovation at a pivotal time for the healthcare industry.

MedPAC analysts suggested paying lower rates for virtual care services than in-person ones, and paying less for audio-only services than video.

Commissioners agreed audio-only services should be allowed, but that a lower rate was fair. Commissioner Dana Gelb Safran, SVP at Well Health, suggested CMS should consider outlining certain services where video must be used out of clinical necessity.

Previously, telehealth services needed a video component to be reimbursed. Proponents argue expanded access to audio-only services will improve care access, especially for low-income populations that might not have the broadband access or technology to facilitate a video visit.

Another major concern for commissioners is how permanently expanding telehealth access would affect direct-to-consumer telehealth giants like Teladoc and Amwell. If all telehealth services delivered at home are covered, that could allow the private companies to “really take over the industry,” Larry Casalino, health policy chief in the Weill Cornell Department of Healthcare Policy and Research, said.

Because of the lower back-end costs for virtual care than in-office services, paying vendors the same rate as in-office physicians could drive a lot of brick-and-mortar doctors out of business, commissioners warned.

Trump Administration Approves First Medicaid Block Grant, in Tennessee

Trump Administration Approves First Medicaid Block Grant, in Tennessee |  Kaiser Health News

With just a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee that for the first time would give the state broader authority in running the health insurance program for the poor in exchange for capping its annual federal funding.

The approval is a 10-year “experiment.” Instead of the open-ended federal funding that rises with higher enrollment and health costs, Tennessee will instead get an annual block grant. The approach has been pushed for decades by conservatives who say states too often chafe under strict federal guidelines about enrollment and coverage and can find ways to provide care more efficiently.

But under the agreement, Tennessee’s annual funding cap will increase if enrollment grows. What’s different is that unlike other states, federal Medicaid funding in Tennessee won’t automatically keep up with rising per -person Medicaid expenses.

The approval, however, faces an uncertain future because the incoming Biden administration is likely to oppose such a move. But to unravel it, officials would need to set up a review that includes a public hearing.

Meanwhile, the changes in Tennessee will take months to implement because they need final legislative approval, and state officials must negotiate quality of care targets with the administration.

TennCare, the state’s Medicaid program, said the block grant system would give it unprecedented flexibility to decide who is covered and what services it will pay for.

Under the agreement, TennCare will have a specified spending cap based on historical spending, inflation and predicted future enrollment changes. If the state can operate the program at a lower cost than the cap and maintain or improve quality, the state then shares in the savings.

Trump administration officials said the approach adds incentive for the state to save money, unlike the current system, in which increased state spending is matched with more federal dollars. If Medicaid enrollment grows, the state can secure additional federal funding. If enrollment drops, it will get less money.

“This groundbreaking waiver puts guardrails in place to ensure appropriate oversight and protections for beneficiaries, while also creating incentives for states to manage costs while holding them accountable for improving access, quality and health outcomes,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services. “It’s no exaggeration to say that this carefully crafted demonstration could be a national model moving forward.”

Opponents, including most advocates for low-income Americans, say the approach will threaten care for the 1.4 million people in TennCare, who include children, pregnant women and the disabled. Federal funding covers two-thirds of the cost of the program.

Michele Johnson, executive director of the Tennessee Justice Center, said the block grant approval is a step backward for the state’s Medicaid program.

“No other state has sought a block grant, and for good reason. It gives state officials a blank check and creates financial incentives to cut health care to vulnerable families,” she said.

The agreement is different from traditional block grants championed by conservatives since it allows Tennessee to get more federal funding to keep up with enrollment growth. In addition, while the state is given flexibility to increase benefits, it can’t cut them on its own.

Democrats have fought back block grant Medicaid proposals since the Reagan administration and most recently in 2018 as part of Republicans’ failed effort to repeal and replace major parts of the Affordable Care Act. Even some key Republicans opposed the idea because it would cut billions in funding to states, making it harder to help the poor.

Implementing block grants via an executive branch action rather than getting Congress to amend Medicaid law is also likely to be met with court challenges.

“This is an illegal move that could threaten access to health care for vulnerable people in the middle of a pandemic,” Rep. Frank Pallone (D-N.J.), chair of the House Energy and Commerce Committee, posted on his Twitter account. “I’m hopeful the Biden Administration will move quickly to rollback this harmful policy as soon as possible.”

The block grant approval comes as Medicaid enrollment is at its highest-ever level.

More than 76 million Americans are covered by the state-federal health program, a million more than when the Trump administration took charge in 2017. Enrollment has jumped by more than 5 million in the past year as the economy slumped with the pandemic.

Medicaid, part of President Lyndon B. Johnson’s “Great Society” initiative of the 1960s, is an entitlement program in which the government pays each state a certain percentage of the cost of care for anyone eligible for the health coverage. As a result, the more money states spend on Medicaid, the more they get from Washington.

Under the approved demonstration, CMS will work with Tennessee to set spending targets that will increase at a fixed amount each year.

The plan includes a “safety valve” to increase federal funding due to unexpected increases in enrollment.

“The safety valve will maintain Tennessee’s commitment to enroll all eligible Tennesseans with no reduction in today’s benefits for beneficiaries,” CMS said in a statement.

Tennessee has committed to maintaining coverage for eligible beneficiaries and existing services.

In exchange for taking on this financing approach, the state will receive a range of operating flexibilities from the federal government, as well as up to 55% of the savings generated on an annual basis when spending falls below the aggregate spending cap and the state meets certain quality targets, yet to be determined.

The state can spend that money on various health programs for residents, including areas that Medicaid funding typically doesn’t cover, such as improving transportation and education and employment services for enrollees.

The 10-year waiver is unusual, but the Trump administration has approved such long-term experiments in recent years to give states more flexibility.

Tennessee is one of 12 states that have not approved expanding Medicaid under the Affordable Care Act, leaving tens of thousands of working adults without health insurance.

“The block grant is just another example of putting politics ahead of health care during this pandemic,” said Johnson of the Tennessee Justice Center. “Now is absolutely not the time to waste our energy and resources limiting who can access health care.”

State officials applauded the approval.

“It’s a legacy accomplishment,” said Tennessee Gov. Bill Lee, a Republican. “This new flexibility means we can work toward improving maternal health coverage and clearing the waiting list for developmentally disabled.”

“This means we will be able to make additional investments in TennCare without reduction in services and provider cuts.”

The AMA declares racism a public health threat

https://mailchi.mp/4422fbf9de8c/the-weekly-gist-november-20-2020?e=d1e747d2d8

AMA Declares Racism a Public Health Threat and Adopts Anti-Racist Policies  - Non Profit News | Nonprofit Quarterly

On Monday, the American Medical Association (AMA) voted to recognize racism as an “urgent threat to public health”. At its annual meeting, the organization’s House of Delegates voted to take actions to confront systemic, cultural and interpersonal racism, including acknowledging harm and bias in medical research and healthcare delivery, funding research to identify risks of racial bias to health, and encouraging medical schools to teach students about the causes and effects of racism, and strategies to prevent adverse health outcomes.

The resolution was one of several proposed items aimed at addressing racial diversity and equity in medical education and care delivery. Over the past two years, the AMA has been moving toward a more progressive stance on health and social policy; in June the AMA Board of Trustees also pledged action against racism and police brutality in response to the murder of George Floyd.

A generational divide between older and younger doctors was also apparent during last year’s debates on Medicare for All, when the organization narrowly voted to maintain its opposition to single-payer healthcare in a close vote that would have been unimaginable a decade ago.

At this week’s meeting, however, the group gave its stamp of approval to proposals for a more limited “public option” coverage expansion. As more young physicians enter the field of medicine, we’d expect the AMA to become a stronger voice on a range of social and policy issues. 

Fearing a ‘Twindemic,’ Health Experts Push Urgently for Flu Shots

Fearing a 'Twindemic,' Health Experts Push Urgently for Flu Shots ...

There’s no vaccine for Covid-19, but there’s one for influenza. With the season’s first doses now shipping, officials are struggling over how to get people to take it.

As public health officials look to fall and winter, the specter of a new surge of Covid-19 gives them chills. But there is a scenario they dread even more: a severe flu season, resulting in a “twindemic.”

Even a mild flu season could stagger hospitals already coping with Covid-19 cases. And though officials don’t know yet what degree of severity to anticipate this year, they are worried large numbers of people could forgo flu shots, increasing the risk of widespread outbreaks.

The concern about a twindemic is so great that officials around the world are pushing the flu shot even before it becomes available in clinics and doctors’ offices. Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention has been talking it up, urging corporate leaders to figure out ways to inoculate employees. The C.D.C. usually purchases 500,000 doses for uninsured adults but this year ordered an additional 9.3 million doses.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has been imploring people to get the flu shot, “so that you could at least blunt the effect of one of those two potential respiratory infections.”

In Britain, Prime Minister Boris Johnson has been waging his own pro flu-shot campaign. Last month, he labeled people who oppose flu vaccines “nuts” and announced the country’s largest ever rollout of the shots. In April, one of the few reasons Australia allowed citizens to break the country’s strict lockdown was to venture out for their flu shots.

The flu vaccine is rarely mandated in the U.S. except by some health care facilities and nursery schools, but this month the statewide University of California system announced that because of the pandemic, it is requiring all 230,000 employees and 280,000 students to get the flu vaccine by November 1.

A life-threatening respiratory illness that crowds emergency rooms and intensive care units, flu shares symptoms with Covid-19: fever, headache, cough, sore throat, muscle aches and fatigue. Flu can leave patients vulnerable to a harsher attack of Covid-19, doctors believe, and that coming down with both viruses at once could be disastrous.

The 2019-20 flu season in the United States was mild, according to the C.D.C. But a mild flu season still takes a toll. In preliminary estimates, the C.D.C. says that cases ranged from 39 million to 56 million, resulting in up to 740,000 hospitalizations and from 24,000 to 62,000 flu-related deaths.

According to the C.D.C., flu season occurs in the fall and winter, peaking from December to February, and so was nearing its end as the pandemic began to flare in the United States in March.

But now, fighting flu proactively during the continuing pandemic presents significant challenges: not only how to administer the shot safely and readily, but also how to prompt people to get a shot that a majority of Americans have typically distrusted, dismissed and skipped.

With many places where the flu shot is administered en masse now inaccessible — including offices and plants that offered it free to employees on site and school health clinics — officials have been reaching out to local health departments, health care providers and corporations to arrange distribution. From now through Oct. 31, publicity campaigns will blast through social media, billboards, television and radio. Because the shot will be more difficult to access this year, people are being told to get it as soon as possible, although immunity does wane. There will be flu shot tents with heaters in parking lots and pop-up clinics in empty school buildings.

Because of the efforts, vaccine makers are projecting that a record 98 million flu shots will be given this year in the United States, about 15 percent more than doses ordered last year. The Kaiser Permanente health care system will be flooding more than 12 million of its members with flu shot reminders via postcard, email, text and phone calls.

Pharmacies and even supermarkets are expected to play a bigger role than they have in previous years. As of this week, Walgreens and CVS will have flu shots available. Walgreens will be hosting additional off-site flu vaccine clinics in community centers and churches. To reduce contact time, CVS is allowing patients to fill out paperwork digitally.

In New York City, which averages about 2,000 flu-related deaths a year, the health department has been reaching out to hundreds of independent pharmacies to administer the shots, because they are often located in outer-borough neighborhoods where the coronavirus has been rampaging. The health department has a detailed online flu vaccine locator.

“Access is a problem for all adult vaccines,” said L. J. Tan, chief strategy officer for the Immunization Action Coalition, a nonprofit group that works to increase vaccination rates, who was an early promoter of the term twindemic. “Adults may think, If I can get the flu shot easily, I might consider it.”

But as difficult as getting the flu shot to people safely will be, perhaps harder still will be persuading them to actually get it. In the 2018-19 flu season in the United States, only 45.3 percent of adults over 18 got the vaccine, with rates for those ages 18 to 50 considerably lower.

Skepticism to this vaccine runs high, particularly in communities of color because of longstanding distrust and discrimination in public health.2017 study in the journal Vaccine noted that, compared with white people, “African Americans were more likely to report barriers to vaccination, were more hesitant about vaccines in general and the flu vaccine specifically, more likely to believe in conspiracy theories and use naturalism as an alternative to getting vaccinated.”

Across all demographic groups, perhaps the most striking reason given for avoiding the flu vaccine is that people do not see it as efficacious as, say, the measles vaccine.

Indeed, it is a good vaccine but not a great one. It must be repeated annually. Immunity takes up to two weeks to kick in. But its efficacy also depends on how accurately infectious disease centers worldwide forecast which strains are expected to circulate in the coming year. And then those strains can mutate.

Although the flu shot confers immunity at all ages over six months, it can be less complete in people over 65. Depending on many factors, the shot’s effectiveness in a given year can range from 40 to 60 percent.

“But a vaccine not given won’t protect anyone,” said Dr. Jane R. Zucker, assistant commissioner for the Bureau of Immunization at the New York City Health Department, which has been hosting webinars for providers about how to have conversations about the flu shot with hesitant patients.

As health officials note, should a vaccinated person contract the flu, the severity will almost certainly be reduced, hospitalization rarely necessary. Especially with Covid-19 raging, public officials reason, those odds look pretty good.

Another reason people give for not getting the shot is they think it makes them sick.

“People who say ‘I’ll never get it because it gives me the flu’ have not had the flu and don’t know what it is,” said Patsy Stinchfield, senior director of infection prevention at Children’s Minnesota.

“What you’re feeling is your body’s immune response to the virus’s antigens,” said Ms. Stinchfield, a member of the C.D.C.’s influenza work group. “You may feel flu-ish. And that’s a good thing. It’s your body’s way of saying, ‘I am ready for the flu, and I won’t get as sick if I get the real one.’”

Public campaigns will describe the shot as a critical weapon during the pandemic. “Hopefully people will say, ‘There’s no Covid vaccine so I can’t control that, but I do have access to the flu vaccine and I can get that,’” Ms. Stinchfield said. “It gives you a little power to protect yourself.”

Other campaigns will emphasize familial and community responsibility.

Usually, flu vaccine compliance rates among people ages 18 to 49 are low. Vermont’s, for example, is only about 27 percent.

Christine Finley, the state’s immunization program manager, believes that rates will improve because of the pandemic’s stay-at-home households. “People are more aware that the risks they take can negatively impact others,” she said. “They’re often taking care of young children and older parents.”

If any example could prove instructive about protective behavior and flu vaccines during the coronavirus epidemic, it could well be Australia.

Australia’s flu vaccine rate tends to be modest, but this year demand was high. The government’s rollout of the shot began earlier than usual for the June-through-August winter because the coronavirus pandemic was exploding. Though the government had also issued strict no-entry limits among many states and territories and bans on international travel, the flu shot was one of the few reasons people could emerge from lockdown.

The prevalent strain circulating in the country is Type A, the most common and virulent form of flu, said Dr. Kelly L. Moore, a public health expert at the Vanderbilt University School of Medicine.

According to the C.D.C., Type A is the most likely to circulate globally. It mutates readily, particularly as it jumps between animals and humans.

“There are two strains of Type A influenza in the vaccine,” Dr. Moore said, “and so the very best way to protect yourself is to get the shot.”

Reported cases of flu in Australia have dropped 99 percent compared with 2019.

Australia’s milder-than-usual flu season is likely the result of a number of factors — strong flu vaccination uptake, social distancing, but also severely decreased movement of people,” said Dr. Jonathan Anderson, a spokesman for Seqirus, a supplier of flu vaccine.

But though American public health authorities usually look to Australia’s flu season as a predictive, Australians say this year it’s not a reliable indicator.

“This situation is of no comfort as these measures do not apply to the United States where the populace has never been effectively physical distancing,” nor have the country’s entry restrictions been as onerous, said Dr. Paul Van Buynder, a public health professor at Griffith University in Queensland, Australia.

All that Americans can do is get vaccinated against flu, he added, because circulation of the coronavirus remains high.

“It is likely they will have a significant influenza season this northern winter,” he said.