Europe's Combined COVID-Flu Shot Is the Next Mandate They're Already Planning

How These Things Work

The European Medicines Agency has recommended approving Moderna's combined influenza and COVID vaccine. The health press is covering it the way it covers all vaccine approvals — as straightforward good news, a scientific advance, a step forward in simplifying the vaccination schedule. One shot instead of two. Efficient. Convenient. Sensible.

I've been through this cycle enough times now to know how the next eighteen months unfold from here. Approval in Europe. Data submitted to the FDA. Advisory committee review with a recommendation in favor. FDA approval. CDC recommendation. School districts begin consulting their vaccine requirement policies. States that have loosened COVID vaccine mandates face pressure to reconsider. And parents who have questions are told, as they have always been told, that the science is settled and their concerns are either misinformation or ignorance.

I'm not anti-vaccine. I want to be clear about that before the people who refuse to engage with any nuance use that frame to dismiss everything that follows. My children are vaccinated. I follow my pediatrician's recommendations on the childhood vaccine schedule. But the COVID vaccine experience broke something in the public health establishment's credibility that a combined flu-COVID shot isn't going to repair — and the agencies behind this recommendation don't seem to understand why.

What the COVID Vaccine Experience Actually Taught Parents

Between 2021 and 2023, the public health establishment told parents things about the COVID vaccine that were not true. Not uncertain. Not later revised in light of new evidence. Demonstrably not true at the time they were said.

Parents were told that vaccinated people don't spread COVID. The CDC itself later walked this back after it became impossible to sustain in the face of the data. Parents were told that myocarditis cases post-vaccination were rare and mild and resolved quickly. The data from Nordic countries — which have more comprehensive tracking systems than the U.S. — told a more complicated story, particularly for adolescent males. Parents who raised these concerns in 2021 were labeled as vaccine hesitant, as spreaders of misinformation, as threats to public health. Some had their social media posts removed. Others were told by their pediatricians that their concerns had no basis.

The institutions that made these errors have not conducted anything resembling a serious public accounting. They didn't say: we told you things that weren't accurate, here's how we're going to improve our processes so that doesn't happen again. They moved on. The same voices that told parents not to worry about myocarditis in adolescent males are now telling parents not to worry about combined COVID-flu vaccines. The credentials are the same. The confidence is the same. The track record is the one thing that's changed.

A friend of mine — her son is seventeen — noticed his heart was racing after his second booster dose. She took him to the pediatrician, who initially dismissed it. She pushed. Eventually a cardiologist confirmed mild myocarditis. He recovered fully. But she spent three months being treated like a paranoid mother for noticing that something was wrong with her own child. That experience is not unique to her. It's happening in pediatricians' offices across the country, and the health establishment has not reckoned with what it means for trust.

The Combination Problem

The specific concern with a combined COVID-flu vaccine isn't about either component in isolation. It's about what combination shots do to the informed consent process.

When vaccines are administered separately, parents and patients make discrete decisions. I choose to get the flu shot. I choose or decline the COVID booster. Those are separate choices with separate risk-benefit considerations. A combined shot collapses that decision tree. If you want flu protection — a vaccine with a well-established decades-long safety record — you now must also take the COVID component. If you have concerns about the COVID component specifically, based on your own health history or your child's health profile, you lose the ability to make that distinction.

This is not a hypothetical concern in a country that has mandatory school vaccine schedules. The moment a combined COVID-flu vaccine exists and is approved, the pressure to add it to those schedules begins. And the moment it's on the schedule, the opt-out process in most states becomes bureaucratic and adversarial. Parents who would willingly vaccinate their children against influenza but want to think carefully about the COVID component face an all-or-nothing choice they didn't ask for.

Moderna's incentive structure here is worth noting. The COVID vaccine market has contracted dramatically as the emergency authorization period ended and demand declined. A combined product that captures the annual flu shot market — a market that renews every year with every age cohort — is a business solution to a revenue problem. That doesn't make the vaccine unsafe. But it means the commercial incentive and the public health case are aligned in ways that make independent scrutiny more important, not less.

The Conversation Parents Deserve

Here's what I'd want from public health agencies before this product reaches American shores: full transparency on the immunogenicity and safety data for the combination versus the individual components. Specific information on subgroup outcomes — adolescent males, immunocompromised individuals, people with prior COVID infection. Clear communication about whether the combination product will be recommended as a replacement for or addition to existing vaccine schedules. And an explicit commitment that the product will not be added to mandatory school vaccination requirements without a separate, deliberate public process.

None of this is unreasonable. All of it should be standard. The fact that asking for it will get me labeled as vaccine hesitant by a public health establishment that still hasn't apologized for what it told parents in 2021 tells you everything about why the trust problem isn't going away.

The EMA's recommendation is a scientific and regulatory process working as designed. Fine. But American parents watching that process have a different question. Not 'does it work?' but 'do these institutions tell us the truth when they recommend things?' Right now, for millions of parents, the honest answer is: we're not sure they do. That's the problem this combined shot inherits. And no approval recommendation resolves it.