It's a blustery fall day and the Collinwood High School marching band is playing enthusiastically to a crowd of about a thousand people inside Cleveland's Public Auditorium.
Nearly everyone is over 65. They've gathered for the city's annual Senior Walk. It's a chance for older folks to get some exercise and learn about community resources for healthy living. And for some, it's also a chance to get their annual flu shot.
There's a line for the table giving them out . but not everyone is in it.
"Well, I'd rather just depend on the Lord to take care of me and he's done that so far and so I'm OK with it," says Joephine Macklin.
Macklin, who is standing outside after the event, says too many people get sick after getting the shot so she won't get near the vaccine. But Macklin's friend, Ethel Moore, says she was convinced by her doctor to get the vaccine.
"It's just been recommended so highly. And the doctor's like you need this and so I take it. And I might be like Josephine if I wasn't a diabetic, which leaves me open for it more. I probably wouldn't be taking it either… ," Moore says.
This mistrust and reluctance is frustrating to someone like Mary Jo Slattery, a registered nurse in the senior outpatient program at MetroHealth.
"Flu is so deadly to seniors. Up to 30,000 seniors can die from the flu every year and people still do not understand the importance of the flu vaccine. They don't understand what the flu vaccine is," Slattery says.
The body's immune system weakens with age. And it can struggle to fight viruses even more if it's already suffering from chronic conditions such as diabetes or high blood pressure.
The National Council on Aging says that each year, NINE out of 10 flu-related deaths occur in seniors. Hospitalization rates are high as well.
Vaccinations are the best protection from the virus. And federal officials believe so strongly in the shots that they map vaccination rates among fee-for-service Medicare members. For Northeast Ohio about 50 to 60 percent of seniors were vaccinated during the last season. And that rate is actually a bit higher because the data doesn't account for those enrolled in private Medicare insurance plans who get vaccinated.
"Influenza is a very, very serious respiratory disease that can lead to multiple complications such as pneumonia, sepsis - which is overwhelming infection - and therefore death," Slattery says.
But what of the concerns, like those expressed by Macklin? Will the vaccine make her sick? You can tell this is a notion Slattery is used to refuting:
"The flu vaccine is not a live virus," Slattery says. "You cannot catch the flu"
There is a version of the vaccine out there that contains a weakened live virus - but, it's not recommended for the young and old. And those over 49 will ONLY be given the standard/ inactivated flu shot. Healthy seniors can also ask for a higher-dose shot that offers more protection.
Een with the shots, Slattery says, it's normal to be sore, get the chills and to run a slight fever.
"But that's gone within 24 hours. That's just your body's response to building up the antibodies. It's fighting it, that's actually a good thing," Slattery says.
As for those who do get sick? Well, perhaps they have another seasonal bug-the flu shot only protects you from the top viruses in circulation. Or they could've gotten the vaccine too late.