Nearly 29 million Americans over 60 years of age — about one in three — say they don’t plan to get a flu shot this season. Health departments, pharmacy chains, and drugmakers will spend heavily on omnichannel ad campaigns and in-person activations across the country to drive that number down this fall. But all of it rides on a question most teams answer wrong: where are these low-intent seniors sufficiently concentrated to drive campaign ROI? State maps are too blunt to say. And the data marketers trust most — where flu shots have already been administered — often points them in the wrong direction. Aim by yourself, and you’ll burn scarce budget trying to convert the already converted. Or, even worse, blow the budget blanketing consumer deserts.

So you reach for a map — and the obvious one looks decisive. Senior flu-shot reluctance runs highest in the Mountain West and the Deep South: 53% of Wyoming’s seniors and 47% of Mississippi’s say they’ll skip a flu shot, compared with barely 19% in Washington, D.C. It maps neatly onto the political fault lines you’d expect, which is exactly why it’s so easy to trust.

Source: Fraym data and analysis

Density of Low-Intent Seniors

However, we need to understand the density of low-intent seniors, not just their percentages. The largest pools of low-intent seniors are actually in big metros with high overall intent levels. New York City holds 1.6 million seniors who don’t plan to get a shot. Los Angeles, 950,000. Miami, Chicago, Houston, Dallas, and Phoenix each clear half a million. The 20 largest metro pools account for a third of all unvaccinated seniors in the country — and many of those metros, like San Francisco and Boston, at 76% intent, sit way above the national average. The reluctant aren’t all hiding in rural counties. They’re scattered through the same cities you’d never flag as a cause for concern.

Source: Fraym data and analysis

One Metro, Many Neighborhoods

Philadelphia highlights this point. The region is one of those big metro pools: nearly half a million seniors don’t plan to get vaccinated, hidden behind a very healthy-looking 70% average vaccine intent. Yet, zoom into the city itself, and that average shatters. Across urban Philadelphia’s 400+ census tracts, intent runs from the low 30s in some neighborhoods to nearly 90% in others — a huge range inside a single city. The inner core sits at 61%, and Philadelphia’s lowest-intent quintile tracts — roughly 67,000 seniors in places like West Philadelphia, Logan, and Germantown — sit at 40%. They aren’t in one corner of town. They’re pockets, threaded almost block by block through the city. The metro-level average hid them. Census tract-level intent data finds them.

Source: Fraym data and analysis

It’s a Persuasion Problem, Not a Logistics Problem

The instinct now is to address logistical blockers in these low-income Philly neighborhoods through pop-up clinics, ride vouchers, and evening hours. But seniors’ leading concern isn’t reaching a clinic; it’s the shot itself. This is part of a trend we see played out across the country at the local level – seniors who plan to skip the flu shot cite concerns about safety and side effects at far higher rates. These seniors aren’t blocked. They’re skeptical. And that’s a persuasion problem that must be addressed through highly targeted communication campaigns.

Reach Them Where They Actually Are

These highly customized messaging campaigns can be geo-targeted with laser precision because of neighborhood-level digital ad-targeting tools. YouTube leads: it reaches 77% of the target area’s seniors (see image below) — and can be targeted down to the ZIP code, even the tract level. Nextdoor adds a smaller but equally targetable lift, and Facebook brings scale, reaching nearly 60% of seniors in the target area. The constraint is linear TV. The broadcast news brands that index highest here — ABC, NBC, and CBS — primarily sell on a DMA-wide basis. So, reaching low-intent seniors in the city means paying to reach all 2.2 million ABC News-watching adults across the Philadelphia DMA. That makes highly targetable, customizable digital campaigns the way to go.

Source: Fraym data and analysis

The 29 million senior flu-shot gap isn’t a number to passively concede. It’s made up of 480,000 people in a known set of Philadelphia metro area neighborhoods — and similar other pockets nationwide — each with a known intent rate, known concerns, and a known media channel mix. There’s no reason to rely only on data about where shots have already been put in arms. We can identify the geo-targetable pockets, message the specific concerns, and buy ads on the digital channels with the highest penetration among skeptical seniors. That’s the difference between a campaign that drives high-ROI uptake and one that blows the budget converting the already converted.

Fraym tracks flu vaccination intent, plus hundreds of other issues, each month across 84,000+ US census tracts. For more information about hyperlocal vaccination-related data and campaign targeting, contact Melissa Persaud at [email protected].