COST OF WELLNESS - A hospital bill is not the only bill an illness can leave behind. There may also be a missed shift, a smaller paycheck, an unfinished assignment or the cost of finding someone else to care for a child. For a household with little room in its budget, a few days of sickness can become much more than a few days of discomfort.
That is the part of flu season I believe deserves more attention. We should continue to count hospitalizations and deaths. But we should also ask what illnesses take from people who never become hospital statistics.
As a physician and public health researcher, I see influenza prevention as more than an annual vaccination message. It is also a question of household stability: whether Californians can protect their health without putting their income, education or caregiving responsibilities at risk.
California has already issued immunization guidance for the 2026-2027 respiratory virus season. An annual flu vaccine is recommended for everyone 6 months and older, with rare exceptions. Those recommendations provide a foundation. The next task is making protection practical for the people being asked to obtain it.
An appointment that a worker cannot attend is not meaningful access. Advice to stay home is incomplete when the person receiving it does not know whether doing so will cost a day’s pay.
The costs we do not always count
In a study published in Pharmacy, my colleagues and I analyzed responses from 463 adults aged 18-49 who lived, worked or studied in the San Francisco Bay Area during the 2025-2026 season. More than a third (38.4%) reported influenza-like illness.
Among ill respondents with information available for each measure, median recovery time was five days, median absence from work or school was two days, and median direct out-of-pocket spending was $20.
These were self-reported illnesses, not consistently laboratory-confirmed influenza. Our highly vaccinated convenience sample does not represent California as a whole. Nor did the study establish vaccine effectiveness or prove that vaccination reduced costs. Those boundaries matter.
Still, the findings invite a question that belongs in a statewide conversation: What does it take for a household to absorb several days of illness?
A $20 expense may sound modest. But direct spending and total household consequences are different things. Consider two workers who each miss two days. One has sufficient paid leave and reliable help at home. The other has exhausted available leave and must arrange replacement childcare. Their time away may be the same. Their ability to absorb it is not.
Think, too, of a community college student catching up on missed coursework while working evening shifts, or an unpaid caregiver arranging help for an older relative. These are illustrations, not additional costs we quantified in the survey. They show why a medical bill alone is too narrow a measure of what a family stands to lose.
A person’s health matters whether or not that person earns a wage. The economic argument for prevention should strengthen that principle, not replace it.
The evidence for vaccination extends well beyond our study. In its March 2026 analysis of the 2024-2025 season, the Centers for Disease Control and Prevention estimated that flu vaccination prevented approximately 10 million illnesses, 180,000 hospitalizations and 12,000 deaths nationwide. These are model-based estimates, subject to revision—not predictions for this season or guarantees for an individual. They nevertheless give us a substantial reason to invest in prevention.
We should not require a preventive measure to eliminate every infection before recognizing its value.
A statewide goal, with locally workable solutions
California should set a clear expectation: residents should be able to find a recommended vaccine, understand what it may cost and obtain it without unnecessary barriers. How we meet that expectation should reflect local needs.
A plan built around a large urban health system should not be assumed to work equally well for a rural community. Where distance is the barrier, mobile services or coordinated transportation may be appropriate. Where work schedules are the problem, evening, weekend or workplace appointments may be more useful. Where uncertainty is the obstacle, another reminder may accomplish less than a conversation with a trusted clinician.
State and county health departments should use vaccination data and community feedback to identify those gaps, then support clinics and other local partners in addressing them. The purpose should be to improve access where it is missing, not simply to increase activity where services are already easiest to deliver.
Pharmacies ranked second both as vaccination sites and as preferred future sites in our survey. They should be included alongside primary care practices, community clinics and campus health services, with realistic support for staffing and outreach.
Public notices should answer practical questions: Where can I go? When is it open? Do I need an appointment? What will it cost? Is help available in my language? Libraries, schools, employers and community organizations can help distribute that information. A telephone option should remain available for people who cannot use an online scheduling system.
We should also resist treating every missed vaccination as a rejection of science. Before deciding how to persuade someone, we should understand what is preventing that person from acting.
Greater trust in public health agencies was associated with vaccination in our study, although that does not establish causation. I would put that lesson into practice by giving people time to ask questions and receive understandable answers about benefits, side effects and individual precautions.
Honesty matters. Flu vaccine protection varies by season and individual, and vaccinated people can still develop influenza. Vaccination reduces risk; it does not promise an illness-free winter. Clear expectations are part of earning trust, not a reason to weaken the recommendation.
Make staying home a workable choice
California has another important foundation: its paid sick leave law. The state generally requires at least 40 hours or five days of paid sick leave each year, whichever is greater, for covered employees. Available leave can be used for preventive care, including flu shots. Eligibility, accrual and use rules apply, and some local requirements are more generous.
That protection should be part of the public health message. Before illness disrupts the workplace, employers should explain available balances, how to request leave and whom to contact when problems arise. State and local agencies should make rights information understandable and respond to violations.
We should also recognize the limits. A worker who has already used available leave to care for a child may have little remaining when becoming ill. Legal entitlement does not mean every household has enough time or financial flexibility to recover. Policymakers should examine those gaps rather than assume that the existence of a law resolves them.
Small employers need workable staffing plans, too. Business associations and public health agencies could help them prepare before absences occur. Recognizing operational pressures should lead to planning, not pressure on sick employees to report to work.
Schools, colleges and employers should also consider the environments people return to. CDC recommends cleaner indoor air to reduce respiratory illness risk. Ventilation and filtration deserve attention as routine building maintenance, alongside reasonable arrangements for illness-related absences.
None of this is cost-free. Longer clinic hours require staff. Outreach takes time. Buildings need maintenance. State and local leaders should explain what they fund, whom it reaches and whether access improves. Our survey cannot tell us about the statewide financial return on these investments, and we should not pretend otherwise.
But doing less does not make illness free. It leaves families and employers to absorb the consequences when prevention falls short.
The measure of California’s response should not be how many flu reminders were posted. It should include whether residents could obtain a recommended vaccine, get their questions answered and use available leave without improper barriers. Those are practical questions for state officials, county leaders, health providers and employers alike.
The purpose is not to frighten Californians into treating every cough as a crisis. It is to stop treating seasonal illness as a private inconvenience that each household must manage alone.
Flu season will come again. That predictability should strengthen our preparation, not weaken our concern.
California should make prevention accessible before people become ill—and recovery possible when they do. Protecting health also means protecting the everyday lives that illness can interrupt.
(Taiwo Opeyemi Aremu, MD, MPH, PhD, is a physician, public health expert, health economics and outcomes researcher, and assistant professor in the College of Pharmacy at Touro University California. He is the lead author of the Bay Area study discussed here. The views expressed are his own.)
