Factors associated with vaccination against Seasonal Influenza and SARS-CoV-2 in the UK among FluSurvey participants, 2023-2025

Seasonal Influenza and COVID-19 vaccination programmes are critical for reducing morbidity and mortality in older adults, yet uptake remains uneven across populations. We aimed to profile vaccination attitudes and examine predictors of COVID-19/influenza vaccination uptake among a UK participatory surveillance system - FluSurvey.

We analysed FluSurvey data from participants aged ≥65 years who were eligible for both vaccines in the 2023–2024 and 2024–2025 Autumn – Winter seasonal campaigns. Descriptive analyses examined self-reported attitudes to influenza vaccination. Logistic regression examined factors (age, sex, socioeconomic status, education, employment, transport, smoking and chronic conditions) associated with influenza and COVID-19 vaccination uptake in each season, adjusting for confounders.

Belonging to a risk group and reducing risk of influenza were frequently reported motivations for influenza vaccination, while building natural immunity and concerns around safety and adverse effects were frequently reported barriers. Individuals vaccinated against COVID-19 were more likely to receive an influenza vaccination (aOR _2023-2024 =13.90 [9.28-21.17]; aOR _2024-2025 =8.54 [5.82-12.60]), and vice-versa (aOR _2023-2024 =13.91 [9.30-21.19]; aOR _{2024- 2025} =8.52 [5.81-12.58]). Lower educational attainment was associated with lower odds of COVID-19 vaccination (aOR _2023-2024 =0.59 [0.45-0.78], aOR _2024-2025 : 0.56 [0.39-0.79]). Other results were weaker or demonstrated variation by season.

Our findings highlight recent attitudes and barriers to influenza and COVID-19 vaccination among the FluSurvey cohort, which may inform approaches to improve vaccination coverage in the population.

Summary

We aimed to describe influenza and COVID-19 vaccination attitudes and identify factors associated with vaccine uptake among adults aged 65 years and older participating in FluSurvey during the 2023–2024 and 2024–2025 UK autumn–winter seasons. We analysed self-reported vaccination and demographic, socioeconomic, health and lifestyle data from the FluSurvey profile questionnaire, using descriptive analyses to examine reasons for influenza vaccination decisions and multivariable logistic regression to assess predictors of influenza and COVID-19 vaccination uptake. Influenza vaccination uptake was 81% in both seasons, while COVID-19 vaccination increased from 73% to 83%. The most frequently reported motivations for influenza vaccination were belonging to a risk group and reducing influenza risk; common barriers were beliefs in natural immunity and concerns about vaccine safety or adverse effects. Prior vaccination against the other disease was the strongest and most consistent predictor: prior COVID-19 vaccination was associated with influenza vaccination (aOR 13.90, 95% CI 9.28–21.17, in 2023–2024; 8.54, 5.82–12.60, in 2024– 2025), with similar associations in the reverse direction. Lower educational attainment was associated with reduced COVID-19 vaccination. Overall, findings support integrated vaccination approaches and communication addressing perceived risk and safety concerns, while highlighting the need for larger, more representative studies.