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Background/Aim: For the flu vaccine, the WHO and the EU have set a target vaccination rate of 75% for people aged 60 and older [1]. In 2025, the European Society of Cardiology declared vaccination to be the fourth pillar of cardiovascular prevention [2]. Older patients and those with multiple chronic conditions are at increased risk of dying from the disease. The aim of the study was to determine the influenza vaccination rate among people aged 60 and older (2017–2023) as well as among high-risk patients who had suffered a heart attack and those in long-term care (2023).

Methods: Study population: BARMER insurees aged 60 and older who were continuously insured throughout the observation year. Influenza vaccination: Fee schedule codes 89111, 89112, 89112 Y, specific codes of the Associations of Statutory Health Insurance Physicians, vaccinations provided as statutory benefits by the health insurance, pharmacy vaccinations (special codes). Nursing care: at least 14 days of inpatient nursing care, including day care, night care, and short-term care. Heart attack: 2021–2023 continuously insured individuals with an acute heart attack in 2022 (inpatient discharge diagnosis ICD-10 I21, I23) excluding those with a heart attack in 2021 (confirmed outpatient diagnosis, inpatient discharge and secondary diagnoses I21, I22, I23, I24.1, I25.2) [3].

Results: In 2023, 40.8% of insured individuals aged 60 and older were vaccinated against influenza. After peaking at 48.9% in the first year of the COVID-19 pandemic, vaccination rates fell almost back to the pre-pandemic level (38.6% in 2019). The highest vaccination rates were found in the eastern federal states (Saxony-Anhalt: 55.2%), and the lowest in the south (Bavaria: 30.0%, Baden-Württemberg: 29.7%). More than half of the patients at particularly high risk from influenza – those in inpatient care (vaccination rate: 48.9%) or those who had suffered a heart attack (43.3%) – were not vaccinated against influenza. In 2023, 0.6 percent of the vaccinations were administered in pharmacies and 99.4 percent by physicians. Family physicians administered 94.8% of all vaccinations.

Discussion/Conclusion: The WHO’s target influenza vaccination rate is not even close to being met, not even among particularly vulnerable patient groups such as people who have had a heart attack or those receiving inpatient care. The option to get vaccinated at pharmacies, available since 2022 in Germany, has so far made only a minor contribution to the vaccination rate. Strategies are needed that enable primary care physicians – as key players – to significantly increase vaccination rates, particularly among at-risk patients. In addition, awareness of the importance of vaccinations must be raised among nursing staff and residential care facilities.

Literatur

[1] World Health Organization. Compendium of indicators for the monitoring and evaluation framework of the European Immunization Agenda 2030. WHO/EURO:2024-9113-48885-72799. WHO Regional Office for Europe; 2024.
[2] Heidecker B, Libby P, Vassiliou VS, Roubille F, Vardeny O, Hassager C, Gatzoulis MA, Mamas MA, Cooper LT, Schoenrath F, Metra M, Amir O, Solomon SD, Landmesser U, Lüscher TF. Vaccination as a new form of cardiovascular prevention: a European Society of Cardiology clinical consensus statement: With the contribution of the European Association of Preventive Cardiology (EAPC), the Association for Acute CardioVascular Care (ACVC), and the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2025 Sep 22;46(36):3518-3531. doi: 10.1093/eurheartj/ehaf384
[3] Grandt D, Lappe V, Schubert I. Arzneimittelreport 2025 (Teil 2) - Fokus Impfen. Influenza-Impfung: Impfquote immer noch weit hinter den Zielen zurück. Berlin: BARMER Institut für Gesundheitssystemforschung (bifg); 2026. DOI: 10.30433/arzneimittel.2025.02