Combating ‘No thanks’ replies to respiratory vaccines | Expert Opinion

“No thanks, not this time.”

“I think I’ll pass on that one.”

“When is this all going to end?”

“I’ve had enough.”

You would think these are responses to irksome requests for a donation or offering of a second portion of an unsavory entrée. They are actually the common responses I am hearing this year when I recommend seasonal respiratory virus vaccinations (flu, COVID, and RSV) to my primary care patients, and it has me worried.

This year, more so than any in recent memory, I have observed a very negative way of thinking about adult vaccines, especially the most recent COVID-19 booster. While there has always been some degree of apprehension or vaccine hesitancy, this year it has been replaced by a preponderance of outright rejection. A recent Gallup survey revealed that 51% of adults surveyed did not plan to get the newest COVID booster.

Why is this so? Studies have sighted a variety of reasons, including lack of trust in the organizations making, promoting, and providing guidance on vaccination, as well as safety concerns. What I have noticed in my practice is more negativity and apathy. Rather than expressing a sense that seasonal vaccines are important and acknowledging their worries about safety or tolerability, many patients are now presenting a hard stop. A firm no. Clinicians may consequently be less motivated to provide a counterpoint.

With the COVID booster, the prevailing sentiment is “enough is enough” and “people who got the vaccine are getting COVID anyway.” My patients’ memory of our conversations about how vaccines are not necessarily designed to prevent infection entirely but rather to limit severity has faded. False narratives about the COVID vaccines, amplified by social media, seem to have congealed and hardened since the pandemic peak.

My colleagues and I have pondered how to address this heightened resistance to vaccination while we concurrently watch hospitalization rates climb and see our message boxes fill to the brim with requests for appointments and medicines to treat a triple-demic surge of COVID, influenza, and RSV, among other common winter viruses. One approach to those who are refusing vaccines with “absolutely not, no way, no how” ferocity is to return to the basics and review some facts:

• Vaccines are among the most positively impactful health interventions in human history.
• They may not always prevent infection, but significantly reduce their severity and save lives.
• Side effects are usually very mild like arm soreness, fatigue, achiness, or low-grade fever.
• No medical intervention is without some risk. Serious adverse reactions from vaccines are far more rare than severe consequences of the illnesses they mitigate or prevent.
• There is no such thing as “too many” vaccines. We are fortunate to live in a time when new technology has enabled development of new vaccines faster than ever before. Our immune systems can handle it.

There are no more adult vaccine mandates. We are back to the fundamental idea that vaccination is one of the most foundational and effective ways to stay alive and well and protect our community.

Even if you are not concerned for your own health, consider the vulnerable babies, pregnant people, chronically ill, and immunocompromised people you inevitably cross paths with. For reluctant readers, I implore you to reassess your views and consider a more positive mindset on COVID boosters, flu shots and, if you are age 60 and over, RSV vaccine. Now that no one is forcing your hand, make it your own thoughtful and healthy decision.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.

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