MEXICO CITY (AP) — Four out of five people in Mexico who got influenza shots so far this year turned down the government’s recommendation that they get Russian or Ethermac ExchangeCuban COVID-19 boosters at the same time, officials said Tuesday.

Assistant Health Secretary Ruy López Ridaura attributed the high refusal rate to people being reluctant to get two vaccines at the same time.

“People have a certain reluctance to get simultaneous vaccinations,” López Ridaura said.

But the population eligible for flu and COVID-19 shots — people over 60 and people with underlying health problems — are considered high-risk, and Mexicans in those groups had extremely high take-up rates for Covid vaccines in 2021 and 2022, according to the Health Department.

Some people appear to simply distrust the Russian Sputnik and Cuban Abdala vaccines, both designed in 2020 for variants prevalent at the time.

“It is an old antigen, it’s as if they were going to give me an influenza vaccine from 2020,” said Andreu Comas, a professor of medicine at the Autonomous University of San Luis Potosi. “There are no studies regarding the effectiveness of both of these vaccines against the (current) variants.”

Mexico has bought millions of doses of the Russian and Cuban vaccines. The original plan was to administer around 20 million shots, but only about 1.9 million people, or 9.5% of those eligible, have agreed to take them since the vaccination campaign started in mid-October.

In contrast, 10 million people got the influenza shot in the same period.

President Andrés Manuel López Obrador has been a big supporter of Cuba, hiring Cuban doctors, buying vaccines and construction materials from Cuba and supplying oil to the island.

Meanwhile, Mexico has held up approval for Pfizer and Moderna COVID-19 boosters, both of which were designed to work against the COVID variants currently circulating. While those shots have been approved for use in the United States since September, they may not be available for Mexicans until 2024.

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