Pediatric flu deaths have surged in Michigan since the start of the COVID-19 pandemic, prompting experts to fear the numbers could become even worse down the road as vaccine hesitancy and distrust rise.

The number of pediatric flu deaths has jumped from zero in the 2020-21 flu season and one death in 2021-22 to 10 this past season. Ten is the highest number of annual deaths since pediatric influenza-associated deaths became nationally reportable in 2004, according to the Michigan Department of Health and Human Services.

Dr. Natasha Bagdasarian, the state’s chief medical executive, said when individuals hear these numbers, they can “lose sight of the fact that these are people.”

“These are children. These are families that were impacted in a way that is just horrific and unimaginable,” Bagdasarian said. “So it really pains me as a doctor to see pediatric flu death and any other pediatric infectious disease death.”

Public health experts said declining vaccination rates are contributing to the surge, which is partly driven by distrust among some parents of vaccines. Flu shot coverage for people 6 months to 17 years old has declined from 31.2% in 2020-21 to 16.3% this past season.

One of the deaths during the 2024-25 flu season — which runs from October to May and typically peaks between December and February — was in Macomb County, and two were in Wayne County, including one in Detroit. The state health department wouldn’t disclose the dates of the deaths or the ages of the children.

Children also died in other parts of Michigan, including two in Genesee County, two in Kent County, one in Berrien County, one in Muskegon County and one within the jurisdiction of the Branch-Hillsdale-St. Joseph Community Health Agency.

County and state health officials attributed the increase in deaths to the ending of the COVID-19 pandemic ? when people started gathering in large groups again ? and the decline in the vaccination rate.

Many myths exist about the flu vaccine, and there is growing misinformation about vaccines, officials said. Bagdasarian said the mistrust in the COVID vaccine has spilled over into the mistrust of vaccines and health care overall.

Health officials and doctors said they are combating the mistrust by listening to patients’ concerns and making a scientific case for the shots. They are also working to make the vaccines more accessible to people.

“We want people to make the decision for themselves to get vaccinated or not to get vaccinated, but we find it so important to make sure that we provide credible education and resources for all of our vaccines, including the influenza vaccine,” said Andrew Cox, the director and health officer of Macomb County Health and Community Services.

Elizabeth Spencer, a mom in Berkley, said she and her three kids always get the flu vaccine. She said her parents didn’t make her get the vaccine when she was growing up, but her midwife and doctors asked her to get it when she was first pregnant. She has been doing it since.

“I figure, I picked my doctor ? my pediatric doctors ? for a reason, and if they think that this is the best practice for my children, then why wouldn’t I listen to them?” she said.

Pediatric flu deaths rise

Nationally, there were 231 influenza-associated pediatric deaths this past flu season, according to the Centers for Disease Control and Prevention. That’s up 11.6% from 207 deaths reported during the 2023-24 season.

In Michigan, pediatric flu deaths have fluctuated since the 2010-11 season. There have been lows of zero deaths in 2011-12 and one death in 2015-16 to seven deaths in 2012-13 and eight deaths each in 2022-23 and 2023-24 before hitting the record of 10.

During the pandemic, the prevalence of many communicable diseases was “very low,” Bagdasarian said. People were staying at home, wearing masks and social distancing. As people have slowly shifted to getting together in large groups, public health officials have seen the incidence of all communicable diseases rise, she said.

Vaccination rates, including for routine childhood immunizations and the flu vaccine, have declined since the pre-COVID-19 period, Bagdasarian said. Pediatric flu vaccine coverage was 30.3% in the 2019-20 season and 31.2% in the 2020-2021 season before dropping to 22.2% in 2021-22.

Dr. Lynn Smitherman, a pediatrician at Wayne Pediatrics in Detroit, said the uptake of the flu vaccine increased at the beginning of the pandemic.

“I think it was because people equated COVID to flu, and they saw people dying, because we didn’t know anything about it,” Smitherman said. “So at that time, the acceptability of the flu vaccine in the community was high.”

People who she said “swore off the flu vaccine forever” were getting the shot, she said.

“And then, when the COVID vaccine got rolled out, there was so much misinformation out there and conflicting information that people, I think, just got scared off in general,” Smitherman said.

Pediatric flu vaccine coverage further declined to 19.5% in 2022-23, 17.1% in 2023-24 and 16.3% in 2024-25.

Bagdasarian said this past flu season was a “relatively bad” season, but “that’s not the worst flu season we’ve ever had.” If Michigan combines very low vaccination rates with “a very bad flu season,” she said, the state could “definitely” see more influenza deaths among children.

Older adults counter trend

Even as flu vaccine rates have dipped in children in Michigan, they’ve increased in those 65 and up since the COVID-19 pandemic.

In the 2019-20 season, 55.3% of people over 65 years were vaccinated, compared with 62.5% in the 2022-23 season. The number declined to 60% in 2023-24 and 59.4% in 2024-25, but those percentages remain higher than before COVID.

Bagdasarian said the elderly and very young are at the highest risk for the flu. Flu can cause moderate to severe illness, and some of the symptoms include fever, cough, runny nose and muscle or body aches, according to the Centers for Disease Control and Prevention.

“Our elderly population is more immunized than they’ve been in the past, and our youngest population is much less immunized than they’ve been in the past,” Bagdasarian said.

She said she thinks the difference between older adults and children is partly due to how people get information. She said many young people and parents of young children are getting news through social media, where misinformation is rampant.

Older adults may rely less on social media and have been receiving vaccines for decades, she added.

“They know that they have received these vaccines and done OK,” Bagdasarian said. “And in many cases, they vaccinated their kids, and their kids have been fine.”

Misconceptions about vaccines

Smitherman, the pediatrician, said she did an internal study when she practiced at Children’s Hospital of Michigan in the late 2000s about parental perceptions of the flu vaccine. Common concerns were that it could give people the flu and that there were impurities in the vaccine, both of which are false, she said. Some also thought that the flu wasn’t serious enough to get vaccinated against.

During a recent work day at Smitherman’s office in Midtown Detroit, she examined multiple patients, including Chantelle and Marlandis Mims, who brought in their 2-week-old daughter, Willow.

Smitherman pressed her stethoscope against Willow while Chantelle held her and then laid her down on the table for an examination.

Chantelle said the family went on a trip earlier this year, and by the time they got back, it was late in the flu season, so they opted out of the vaccine. She noted that her toddler got sick with the flu about a week later. But she said that if they had gotten the shot right after the trip, it wouldn’t have been in time to get immunity before getting the flu.

Chantelle was pregnant when she got the flu, and she said it was “horrendous.”

“It was horrible. Zero out of 10 would not recommend the flu. 10 out of 10 recommend the flu vaccine,” she said, making Smitherman chuckle.

Vaccine hesitancy has become so common, Smitherman told The News, that she’s surprised when a parent agrees to get the flu vaccine.

“I am shocked,” she said.

Parents who oppose having their child get the vaccine will cite reasons such as they have done their research, read or seen anecdotal experiences on social media, or got the flu right after getting vaccinated.

“My philosophy is that parents want to do the best for their children, and … they’re confused with all the information that’s out there,” Smitherman said, adding that the trust in doctors has declined over the past eight years.

Some health providers are concerned about changes at the federal level. Health and Human Services Secretary Robert F. Kennedy Jr. was a vocal anti-vaccine activist before getting into government, and he recently fired the entire 17-member CDC vaccine board.

Smitherman said she thinks federal leaders voicing vaccine hesitancy affect her patients.

“They would rather listen to that than to the science. … It’s kind of like a confirmation bias, so that if you’re already hesitant and you have somebody else also that’s talking about hesitancy that just confirms your bias against immunizations,” she said.

Parents explain their decisions

Julieta Duvall, a mom in Clawson, said her children follow the schedules for routine vaccines, but she and the kids skip the flu vaccine most years. She said her family is around a lot of germs, as her kids like to play in the dirt and often go barefoot when they play in the backyard. She is also a flight attendant, which she feels provides her with protection, which she shares with her family.

“I think it really is a personal decision,” Duvall said, adding that she believes in medicine. She noted that her dad had a kidney transplant and wouldn’t be alive without the medical care he received at Beaumont Hospital.

Chantelle Mims, who is an emergency room doctor with a newborn and a 2-year-old, said she didn’t get the flu vaccine growing up. But she now gets it every year and plans to vaccinate her kids as well.

“As I’ve gotten older, and as I’ve seen a lot with health care, I’ve been more pro-flu vaccine, whereas growing up, I was like, ‘Oh, I never got the flu. I never got the flu vaccine. It’s not that big of a deal,’” Mims said.

Health departments promote vaccination

Detroit Chief Public Health Officer Denise Fair Razo said the low level of flu vaccination opens the city “to a lot of risk.” About 12% of children in Detroit were vaccinated in the 2024-25 flu season.

“We want families to come to the health department if they are unsure whether the vaccine is appropriate for them and their child,” Fair Razo said. “… They can speak to any one of our nurses or our community health workers, because, again, we get it. Vaccine hesitancy is real.”

The Detroit Health Department’s goal is to “meet people where they are,” so officials are going into neighborhoods, schools and churches as well as holding health fairs to provide vaccines, she said.

Cox said Macomb County Health and Community Services gets the word out about the flu vaccine through its email newsletter. The health department’s clinics also provide vaccinations, and their nursing staff educates people on the effectiveness of vaccines.

Dr. Avani Sheth, chief medical officer for the Wayne County Department of Health, Human & Veterans Services, said health providers aren’t necessarily trying to prevent the flu by getting people vaccinated. They’re trying to prevent complications of the flu, such as pneumonia and sepsis, a life-threatening condition, she said. Without these complications, patients with the flu just need to stay home for a few days and rest, she said.

“You don’t hit the hospital, right? … You’re not, you know, getting treated for pneumonia or, worse yet, in the ICU on a ventilator,” Sheth said.

There have been only five pediatric flu deaths in Wayne County outside of Detroit in the last decade, she said. The area doesn’t experience any deaths in some years.

“Even a single death is concerning and just raises the awareness and provides an opportunity, really, to spread the message of trying to get vaccinated,” Sheth said. “Everyone six months and older should receive the annual flu vaccine as early in the season as possible.”