Sarah Sams, MD, a family medicine doctor in Ohio, remembers what it was like for people to get very sick from vaccine-preventable illnesses. It's those very memories she hopes will help her address vaccine hesitancy this upcoming respiratory illness season.
"When I was a medical student, at that point, they were not vaccinating for Hib until two years old," she said in an interview, referencing the vaccine for Haemophilus influenza type B. "When I did the infectious disease rotation in pediatrics as a medical student, we had several kids with Hib meningitis, and it was very devastating between my third year of medical school doing that rotation."
By the time Sams was an intern, clinical practice had changed, and babies were recommended to get Hib vaccines at two, four and six months old, a vaccine schedule that she saw with her own eyes move the needle on clinical outcomes.
"During my pediatric rotation as an intern, we only had one child on the unit with Hib meningitis, and that was a child who had not been vaccinated for religious reasons," Sams recalled. "So, in my lifetime, I've actually watched that change."
Staring down another respiratory illnesses season during which the U.S. healthcare system expects to see a confluence of flu, respiratory syncytial virus (RSV) and COVID-19, Sams expressed concern about people getting their shots. These illnesses are mostly vaccine-preventable, but without high enough vaccination rates, people could get really sick and stress the healthcare system.
Vaccine hesitancy continues to rise
Indeed, vaccine hesitancy is still a problem for the U.S. public health system.
In August 2024, a Gallup poll showed steep declines in the number of people agreeing that childhood vaccines are extremely important. Right now, 40% of Americans agree, down from 58% in 2019 and 64% in 2001.
And it's not just pediatric vaccine schedules that are in the vaccine hesitancy crosshairs. According to Healthy People 2030, the number of people projected to get their flu shots this year is trending down. In the 2020-2021 flu season, the most recent year for which the government has complete data, 49.8% of people got their flu shots. That's a far cry from the 70% target vaccination rate, Healthy People 2030 said.
Another 2024 survey from the Ohio State University Wexner Medical Center showed 37% of the public have gotten flu vaccines in the past, but don't plan to do so this fall.
Part of the difficulty that we have right now with some people being vaccine-hesitant is they've not seen these illnesses.
Sarah Sams, MDMember of the board of directors, American Academy of Family Physicians
Sams credits the decline in vaccine confidence to a number of factors, not least of which include the way confidence in public health declined during the pandemic.
"COVID certainly played a role," she stated. "There was a huge divide in people's opinions on whether they should get COVID vaccine or not, and there was a lot of fear about the COVID vaccine and what it was made of or how it was made and whether it was safe and lots of factors. Vaccine misinformation abounded during COVID, and I think that has led a lot of people to be more hesitant toward vaccines than they were in the past."
There's also the simple fact that many people today do not remember how bad vaccine-preventable illnesses can be. Smallpox has been eradicated globally, and polio is eradicated in the U.S. and many other nations around the world.
"Part of the difficulty that we have right now with some people being vaccine-hesitant is they've not seen these illnesses," Sams explained. "They don't remember how severe these illnesses were."
Sams didn't live through polio herself, but she remembers people from her childhood who had physical deficits from polio or other physical disabilities from the effects of illnesses like congenital rubella syndrome.
This storytelling can and should be a key part of the patient-provider communication strategies employed when interacting with a vaccine-hesitant patient, Sams suggested.
"One of the things that I can use, and some of my colleagues can easily use, is to actually talk about what we've seen in the past and try and remind people that these were not benign viruses or bacterial infections, but these were illnesses that really were devastating and now we don't see them very much anymore," she stated.
Communication strategies for vaccine hesitancy
Sams is a family medicine provider, meaning she treats patients from infancy throughout the rest of their lives. This allows her to build strong patient-provider relationships grounded in a foundation of trust.
In other words, she's in a great position to address vaccine hesitancy among her patients, and she plans to leverage that position this respiratory illness season.
"One of the advantages of being a family physician and taking care of entire generations of a family is that you do know the whole family and you oftentimes have longstanding relationships with patients," she said.
Recognizing the trust she has with patients, Sams will tell them she would never recommend a vaccine she would not take herself. This provider testimony can go a long way with patients, and it gives Sams the lived experience to dispel certain concerns, such as the side effects of a vaccine.
Those longstanding patient relationships also allow Sams to find what motivates the patient into healthy behavior. For example, Sams recently used the birth of a new baby to motivate the grandparents to stay up to date on their vaccinations.
Central to these communication strategies is empathy and human relationship-building. Most patients are vaccine-hesitant because they don't have enough information, and that lapse has led to misunderstanding and, oftentimes, fear.
Sams recommended approaching vaccine hesitancy with compassion rather than judgment. Moving the needle on a patient with deep-seated concerns can be long and difficult work, she said, but it is important to continue to build the relationship and provide information.
Healthcare providers should stress the safety and efficacy of vaccines while also outlining the personal and public health risks of not getting vaccines. Sams said she does this using various approaches depending on the relationship she has with the patient. In some cases, she can even use humor to emphasize a key point.
All of this ties back to the role of the family physician, Sams, a member of the American Academy of Family Physicians board of directors, said. Leveraging the trust she's built with a patient to discuss sensitive topics like vaccination is crucial, and it's not something patients can get in other care settings.
"Developing that trust and having someone that you've been with that you trust as a physician as opposed to, 'oh, here's a vaccine clinic,'" is key, Sams concluded, stressing the need for better vaccine coverage under Medicare Part D. "Patients don't know those people in the clinic. Having the ability to do the vaccines in your office when you're seeing patients for various other problems and talking to them about their overall health is really powerful."
Sara Heath has covered news related to patient engagement and health equity since 2015.
