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Vaccine Questions
How I Address Questions on Vaccination

Released: April 23, 2025

Expiration: April 22, 2026

Robert H. Hopkins, Jr.
Robert H. Hopkins, Jr., MD, MACP
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Key Takeaways
  • Involving the whole healthcare team in vaccine recommendations provides additional opportunities to reach people who are vaccine hesitant as they are more likely to accept recommendations from those they see as their peers.
  • An open and empathetic exchange is key to shifting vaccine hesitancy to vaccine confidence, but conversations may continue over multiple visits.

We are in a challenging place regarding vaccines and vaccination. Not only have we seen an increase in vaccine misinformation on social media and in other types of media, but we now are seeing individuals who have been selected to lead federal agencies actively interfering with established processes for experts and the public to inform vaccine authorization and use. This is a perfect setup for worsening vaccine hesitancy, declines in vaccination rates, and increases in vaccine preventable diseases. This makes our approach towards recommending vaccines to our patients and families, the structure of our vaccine recommendations, and how we discuss vaccination all that much more important. 

I hear all too often from learners, and even from some of my colleagues in primary care, that “This is a fool’s errand,” that “It seems like everyone is anti-vaccine,” or most concerning, “I just give up, it’s too hard and takes too much time to convince people to get their vaccines. I’m just going to vaccinate when patients ask for it.” 

I’m here to tell you, do not despair! Yes, there are people out there who will not accept vaccines, but far more people with hesitancy have questions than are ardently “anti-vax.”

Building Vaccine Confidence

A Team Effort
So, how do I address vaccine hesitancy? First, I start by spending time with my healthcare team, with the goal of getting all of us on the same page about vaccines. That is, our united stance must be that vaccines are safe, with far less risk than getting the diseases that they are designed to protect against, and that vaccines are effective at reducing the risk for severe disease, often preventing disease altogether. Vaccination—in accord with the Advisory Committee for Immunization Practices—is the norm in my practice.

With the whole team on the same page, we have the opportunity to reach patients who may respond better to their neighbor who works at the front desk, the medical assistant they go to church with, or the nurse whose husband coaches their daughter’s softball team. 

Presumptive+ Approach  
Second, my approach to recommending vaccines is, what I call “presumptive+.” The plus is an important reason for the patient to get vaccinated that I have elicited during my interactions with them.

For example, “Let’s give you the COVID-19 and influenza vaccines today, so you can stay healthy to enjoy your grandson’s basketball season.” The final component of this step is my observation of the patient listening and looking for any sign of concern, question, or declination of my recommendation.

The PATHe to Vaccinations
When the patient raises any concerns, or I perceive concerns based on their facial expression or behavior, I use a technique that I call “the PATHe to vaccinations.” This acronym reflects the steps in this brief counseling process that generally takes me less than 8 minutes.  

  • Prepare for the conversation: As the healthcare professional, we must be prepared with knowledge about the vaccine and be prepared to have an open and empathetic exchange. Our voice, attitude, and appearance must reflect our entrance into a respectful and nonjudgmental discussion. 
  • Approach your patient about their concerns: If they are willing to tell me about their concerns, I give them time to do so. If the patient is unwilling to give you permission to discuss their concerns or indicates ardent anti-vaccine beliefs, there is likely not much benefit in proceeding with the following steps in the process. In those cases, I make a respectful exit with a statement such as: “This vaccine is safe and effective, I want you to have the same protection that my family and I have received from it, but I respect your decision. Do you mind if we discuss this issue again at our next visit?” 
  • Talk to your patient in a culturally humble manner: Regardless of how well I may know the patient, I know only part of their story. If I am to maximize the opportunity to get them vaccinated, I have to respect them and their beliefs. My response to their concerns depends on what concerns they tell me about. I commonly include brief positive messages about vaccine safety and/or the impact on disease risk. I identify misinformation, but I do not repeat or directly rebut that misinformation, as there is evidence that this may increase hesitancy and reduce the likelihood of vaccination. Finally, it is critically important to acknowledge when patients have legitimate concerns. 
  • Humanize your message: I think it is critical to phrase vaccine recommendations in terms of why getting this vaccine is of value to each patient, their family, and/or their community.
  • Embrace the long game: If the patient is willing to get vaccinated today, that is ideal, but refusal of vaccination today is not a loss. If the patient is not willing to be vaccinated right now, it is important to document your conversation, plan to revisit the issue at the next visit, and, most important to follow through.

As much as I want to see all my patients and everyone in our communities vaccinated, I realize that there are some who are not reachable. Our challenges in achieving and maintaining high rates of vaccination and immunity in our communities will persist, but we need to continue to give our best efforts in reaching as many as we can. It will take all of us in the healthcare professional community— medical, pharmacy, nursing, public health—to achieve this goal of a highly vaccinated and confident population. Let’s all work together to get there!

Your Thoughts
How do you navigate conversations about vaccine hesitancy in your practice? Do you find presumptive recommendations to be an effective method for improving vaccine uptake? Leave a comment to join the discussion.