The NCSL Blog


By Erik Skinner

Between the Spanish Flu in 1918 and the swine flu in 2009, the world experienced four influenza pandemics. The Centers for Disease Control and Prevention (CDC) notes there is not currently an influenza pandemic, but responding to the flu during the COVID-19 pandemic presents challenges for states and every other level of government.

Credit: Centers for Disease Control and PreventionSeveral groups of people are at higher risk for flu complications are also at higher risk for COVID-19 complications:

  • Adults older than 65.
  • Racial and ethnic minority groups.
  • People with chronic conditions.

For decades, CDC has recommended a flu shot for every person 6 months and older. But vaccination rates remain low, with less than half the U.S. population receiving an annual influenza vaccine. The effects of widespread influenza outbreaks can be costly. The average number of deaths from flu over the last 10 years is nearly 36,000. And the 2017-2018 flu season was the most deadly in the United States in the last 10 years, killing more than 60,000 people and hospitalizing over 800,000.

In order to prevent outbreaks of influenza, states rely on annual international influenza surveillance efforts that identify and characterize the most common and deadly flu strains. Vaccine developers, drug manufacturers, health systems and state governments use this data to craft successful influenza vaccination, distribution and treatment efforts.

Recent State Action

Once the most rigorously researched flu vaccines are tested and approved, states play a crucial role in implementing strategies and policies to vaccinate the highest possible proportion of the population.

All states permit pharmacists to administer the flu vaccine, with variation in age groups among states. In the last couple of years, Indiana allowed pharmacist technicians to be authorized to administer the influenza vaccines, and North Carolina and South Carolina authorized pharmacists to administer flu shots to younger populations.

In order to keep people healthy, avoid hospitalizations and reduce costs, state legislatures also invest in treating the flu. To account for people who catch the flu, Florida enacted a bill in March to authorize pharmacists to provide diagnostic and therapeutic flu services. According the National Alliance of State Pharmacy Associations, 14 states have collaborative practice agreements that may provide for pharmacists’ prescription authority for diagnostic testing for influenza. Over-the-counter testing is also becoming more widely available and can mitigate the severity and duration of the flu.

National Vaccine Distribution

Vaccine producers estimate they will produce between 194 to 198 million doses of influenza vaccines for the 2020-2021 flu season, which is approximately 50% more doses than a typical flu season. Producing and distributing the influenza vaccine is led by the private sector. CDC also works strategically, utilizing the Vaccines for Children program to purchase and stockpile vaccines for later in the season.

In 2019-20 flu season, CDC estimates that 52% of people older than 6 months received a flu shot, which is higher than normal. CDC encourages widespread vaccination through its data on flu vaccination venues such as provider offices, retail settings, health departments, hospitals and worksites.

NCSL Resources

Erik Skinner is a policy associate in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.