Childhood Flu Vaccination Rates Plummet in Israel Amidst Ministry of Health Failures
Flu vaccination rates among Israeli students have fallen by more than half in under a decade, from approximately 55% at the program's inception to about 26% in the 2025-2026 school year. This decline is attributed not only to parental refusal but also to the Ministry of Health offering the vaccine to only about 70% of eligible students in the past two years, a drop from the previous 90% availability. Professional medical associations for pediatrics and infectious diseases have released a position paper calling for significant changes to the national childhood flu vaccination strategy.
Key recommendations include launching the vaccination campaign in early September, expanding walk-in access, increasing the availability of the nasal spray vaccine, and implementing a coordinated national public awareness campaign. The paper highlights a "continuous and dangerous decline" in childhood vaccination, which leading pediatricians describe as a "direct result of ongoing failure" by the Ministry of Health. They criticize the ministry's reliance on a late and ineffective school-based injection program, warning of overloaded pediatric wards and preventable complications this winter if immediate action is not taken.
Parental attitudes are a significant factor, with about 55% of parents refusing the flu vaccine compared to only 4% refusing routine vaccinations. Many parents do not perceive the flu as a serious illness and view the vaccine as optional, compounded by fears of side effects, doubts about efficacy, and inconsistent messaging from healthcare professionals. The position paper urges medical staff to present a unified professional message emphasizing the importance of vaccination.
Regional disparities in vaccination coverage are stark, with Haifa district at around 33% coverage and the Ashkelon district at only 14%. The flu vaccine was gradually introduced into schools starting in the 2016-2017 academic year, currently offered to students in grades 2-4 in regular schools and grades 1-6 in special education. Flu vaccination rates are also low within health maintenance organizations (HMOs), with only about 16% of children aged 6 months to 4 years vaccinated in the previous season, similar rates for ages 5-12, and just 7% for ages 13-18.
The position paper also points out that Israel lags behind other countries in childhood vaccination programs, with coverage rates in nations like Spain, Finland, the US, Peru, and Cuba ranging from 33% to 91%. The paper stresses that parental hesitancy is only part of the problem; difficulties in accessing vaccines through HMOs, limited afternoon and weekend hours, and insufficient availability of the preferred nasal spray vaccine contribute to the low rates. The current school-based program often starts vaccinations in November or December, after the flu season has already begun.
To address these issues, the paper proposes opening the campaign in early September, aiming for the majority of vaccinations to be completed by the end of November. It also suggests improving the school program by prioritizing low-vaccination institutions, using simple digital consent forms with reminders, and ensuring separate, explicit consent for the flu vaccine type. For HMOs, recommendations include walk-in appointments, extended hours, and offering the vaccine during regular clinic visits. Mobile vaccination units in communities and shopping centers, as well as integrating flu shots into "Tipat Halav" (mother and child health centers), are also recommended. A regulatory review for providing nasal spray vaccines for home administration, with strict conditions, is also proposed.
