Trusted Relationships Key to
Vaccine Acceptance

Cold and flu season is here again, and family physicians have both the opportunity and challenge to protect our patients and communities with immunizations.

The opportunity to prevent disease is greater than ever because we now are armed with vaccines to prevent not only influenza and COVID, but also respiratory syncytial virus. However, the challenge also has grown exponentially due to the spread of misinformation as well as potential for vaccine fatigue four years post-pandemic.

So, what’s a family physician to do with patients who are skeptical about or resistant to the immunizations we recommend?

For starters, we can lean into the relationships we have spent years building with patients. Here are a few recent examples from my practice.

Protect Families

A patient I’ll call John recently came to see me for an annual visit. The 75-year-old has always been reluctant to get immunized, but I asked if we could talk about vaccines and he agreed.

I knew John had a new grandchild on the way, and I reminded him that child is going to be born during cold and flu season. I told him though infants can’t be vaccinated against severe respiratory diseases until they are 6 months old, he could protect himself and his family right now.

I talked about protecting John from disease that can lead to hospitalization and the need for supplemental oxygen and even a ventilator, but the idea of protecting that precious baby was the strategy that made the difference.

“I don’t want anything to happen to my new grandbaby,” he said, “so let me just go ahead and roll up my sleeve and get these vaccines.”

Reflect on Past Outcomes

I’ve been at the same clinic on the south side of Richmond, Va., for more than four years, so I know my patients’ health histories well. When Anna came to see me for a routine checkup, I recommended that she receive vaccinations for flu and COVID as well as RSV, which was approved last fall, based on her age (60) and chronic condition (diabetes).

“Oh, here we go again,” she said. “Another new vaccine. Why should I get it?”

I told Anna that RSV, like flu and COVID, is a virus that can cause severe respiratory disease, especially in someone with chronic conditions and advanced age.

I also reminded her that she had similar misgivings about the COVID vaccine when it was introduced.  Unfortunately, she declined that vaccine when it was first available, got COVID and experienced severe respiratory disease that required hospitalization. Her stay lasted nearly a month and included being placed on a ventilator. She eventually went home with supplemental oxygen. She experienced temporary cognitive impairment during her recovery, which lasted more than six months. We know from an unrelated scan that she has scarring on her lungs from the ordeal.

Anna is back to regular activity without supplemental oxygen, but I told her I was worried that she could get RSV from her grandchildren or others because it’s easily transmissible, and she could have severe respiratory disease again and become extremely ill.

We talked about the rigorous authorization and review process that the new vaccine had been through, the fact that it’s highly effective and that the side effects are typically minimal (injection site pain and redness).

The memory of her traumatic experience with COVID convinced her that she didn’t want to go through anything like that again. Anna has been getting her COVID vaccines since her hospitalization, and she received the RSV vaccine during our more recent visit. Now she’s all caught up.

Make It Personal

Healthy young patients sometimes need more information about immunizations, too, because they believe they are less likely to get sick and won’t experience severe illness.

One such young man came to see me recently for an annual checkup, and I reminded him that at this time of year it would be a good idea for him to get flu and COVID vaccines.

“I’m young, healthy and I don’t usually get sick,” said Robert, who is in his 30s, “so I probably don’t need the vaccines.”

But then he paused and asked me a question.

“Doc,” he said, “did you get your COVID-19 and flu vaccines this year?”

I told him that I had received both flu and COVID vaccines on the same day the previous week so that I would be protected — even though I’m also young and healthy.

“I guess if you got yours,” he said, “I should get mine, too.”

These are the general principles I follow when working with patients on immunizations:

• I always I ask permission to discuss vaccines so it feels more like a shared decision than a prescriptive order.

• I’m straightforward with patients about the benefits of the vaccination for them specifically, especially if they have chronic conditions that put them at increased risk, as well as the benefits for the people around them and our community at large. I also discuss the typical side effects.

• I try to discuss vaccinations at every patient encounter, whether it’s a wellness visit, chronic disease management or even acute care because every visit is an opportunity to protect patients and our communities.

Denée Moore, M.D., FAAFP, is an assistant professor in the Department of Family Medicine and Population Health at Virginia Commonwealth University School of Medicine in Richmond, Va. She is a member of the AAFP's Commission on Health of the Public and Science and a Technical Expert Panel member for the AAFP's Improving Adult Immunization Rates Among Racial and Ethnic Minority Populations quality improvement project.