With the elderly comprising an estimated 90 percent of seasonal influenza’s death toll, the flu vaccination rate among a group of professionals working closely with this age group — staff at hospitals, clinics and nursing homes — should be 100 percent or very close.

The public has every right to expect that doctors, nurses and other health care professionals have done everything possible to protect all patients — but especially those whose immune systems have weakened with age — from one of the nation’s leading causes of death. Influenza, along with pneumonia, a common complication of the seasonal virus, makes a perennial appearance on the annual top 10 list of killers and currently ranks eighth.

Unfortunately, Minnesota hospitals and nursing homes fall alarmingly short when it comes to the annual shot, according to new data from the Minnesota Department of Health’s FluSafe program. Just 34 state hospitals participating in the program had at least 90 percent of their staff vaccinated against this highly contagious virus.

Only 26 participating nursing homes crossed the 90 percent threshold, a level that has been deemed by public health officials as being critical for flu protection.

A total of 213 facilities participated in FluSafe for the 2013-14 flu season. For perspective, there are about 145 hospitals in Minnesota and around 375 nursing homes, suggesting that the slender slice of state facilities achieving the 90 percent rate is likely even slimmer than it first appears.

The FluSafe program is in its fourth year, and its goal is admirable: to encourage the state’s hospitals and nursing homes to boost flu vaccination rates through friendly competition. Participation in the program, which also provides tools and promotional materials for providers, is voluntary.

Slow progress in improving health care workers’ vaccination rates has long been lamented by infectious-disease experts. Nationally, about 72 percent of health care workers get the annual shot, a figure well below the 90 percent threshold officials are aiming for by 2020. While the flu shot isn’t as effective as previously thought, it remains a vital tool to prevent influenza spread.

In the spirit of the ongoing State Fair, FluSafe awarded blue, red and white “ribbons” to Minnesota facilities with laudable vaccination rates. Those given blue-ribbon status hit the 90 percent mark or above. Red was awarded for 80 to 89 percent, with white ribbon recognition for rates between 70 to 79 percent.

While health officials said in a news release that they are pleased that the program had awarded “more ribbons than ever before,’’ a closer look at the results undercuts the positive spin.

Just 28 percent of the Minnesota facilities participating during the 2013-14 flu season received a blue ribbon. Big metro hospitals were also disappointingly underrepresented in the blue-ribbon category. Only two had vaccination rates of 90 percent of higher: Children’s Hospitals and Clinics’ Minneapolis and St. Paul locations.

The metro’s other big hospitals were awarded red or white ribbons. (The Fairview system, which doesn’t participate in FluSafe, said its flu vaccination rate was 83 percent during the last flu season.)

Metro nursing homes were somewhat better represented in the blue-ribbon category. Still, only five achieved this recognition.

Vaccination rates at red- and white-ribbon facilities are at or above the national average but far short of where they should be for maximum protection. Leadership at these facilities, as well as those that didn’t achieve ribbon status or participate in FluSafe, must toughen policies and find ways to boost participation rates as the annual flu season looms just a few months ahead. Clearly, traditional approaches such as pizza parties or other lighthearted incentives aren’t good enough.

It’s worth noting the hard-nosed approach that blue-ribbon winner Children’s Hospitals and Clinics has taken. According to a spokeswoman, the health care system “strongly recommends” the shot and requires “all staff to document their vaccination status on their employee badge. If staff decline a vaccination, they must wear a mask in patient care areas.”

State lawmakers also need to scrutinize the latest FluSafe results. During the last session, a bill championed by the Minnesota Hospital Association would have mandated “annual flu vaccinations for hospital and clinic employees with certain exceptions based on allergies or religious concerns.” Health care employers would have been required to pay for the shot.

The bill didn’t get a hearing in either the state House or Senate. The website for the Minnesota Nurses Association union still boasts of the organization’s pressure on legislators to drop the issue. Next year, lawmakers’ priority must be on public health and protecting patients. The legislation should at least get a hearing, and medical experts should be brought in to weigh its merits.