accepted vaccines without hesitation. 4
These groups require different approaches. Patients with concern-based hesitancy often respond to clear, empathetic communication. They want to understand risks and benefits and to feel heard. Those whose hesitancy is rooted in mistrust may require a longer-term approach focused on relationship-building and consistency rather than a single conversation.
Treating all hesitancy as identical risks missing opportunities to connect with the large group of patients who are still open to discussion. Recognizing where a patient falls on this spectrum allows physicians to tailor conversations in a way that is more likely to be effective.
The Post-COVID-19 Shift
The COVID-19 pandemic did not create vaccine hesitancy, but it reshaped it. Public health became highly visible and, at times, politicized. Messaging evolved as new data emerged, which is a normal part of science but was often perceived as inconsistency. Trust in institutions declined across multiple sectors, including healthcare, and has been closely linked to vaccine attitudes and uptake. ⁵
As a result, vaccine decisions are now more likely to be influenced by factors beyond clinical evidence. Patients may approach recommendations through the lens of trust, identity and prior experiences with the healthcare system, shaping how evidence is interpreted in the first place. ⁶
The Gap Between Online and Clinical Reality
There is also a growing disconnect between how vaccine hesitancy is portrayed publicly and how it presents clinically. Online spaces tend to amplify polarization. Extreme views receive more engagement, which can make them appear more common than they are. 7 In contrast, many patients seen in primary care settings fall into a middle category. They are not strongly opposed to vaccines, but they are not fully confident either. This“ movable middle” is critical.
It is also where physicians can have the greatest impact. Studies consistently show that healthcare professionals remain among the most trusted sources of vaccine information. 2 A strong recommendation from a physician is one of the most influential factors in a patient’ s decision to vaccinate.
What Still Works
Despite these challenges, there are strategies that remain effective. Clear recommendations matter. Patients are more likely to accept vaccines when physicians present them as standard and expected, rather than optional or uncertain. Framing vaccines as routine care reinforces their role in protecting individual and community health.
Listening matters. Patients who feel dismissed are less likely to engage. Addressing specific concerns without judgment can help build trust, even if the decision is not immediate.
Consistency matters. Repeated conversations over time can shift perspectives. A parent who declines a vaccine at one visit may accept it at the next.
And perhaps most importantly, relationships matter. Trust is not built in a single conversation. It develops over time, through continuity, reliability and shared decision-making. 8
Moving Forward
Vaccine hesitancy is often framed as a growing problem, and in many ways it is. Vaccination rates for certain routine childhood immunizations have declined in recent years, contributing to the reemergence of preventable diseases. Focusing only on the problem, however, can obscure an important opportunity.
Many patients described as hesitant are still listening, still asking questions and still showing up to care. Even as concern about hesitancy increases, much of what we see in practice is not firm opposition but uncertainty that has not yet been resolved. For physicians, that means recognizing the diversity within hesitancy, maintaining trust in the face of broader skepticism and continuing to engage even when conversations are difficult.
In a landscape shaped by uncertainty and noise, the exam room remains one of the few places where thoughtful, evidence-based dialogue can still occur.
References
1
The Lancet. Restoring trust in US health institutions. Lancet. 2026; published online. doi: 10.1016 / S0140-6736( 26) 00414-9.
2
KFF. KFF Health Information and Trust Survey. 2026. Available at: https:// www. kff. org / health-information-trust /. Accessed May 1, 2026.
3
MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015; 33( 34): 4161-4164.
4
Dubé E, Gagnon D, MacDonald NE. Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine. 2015; 33( 34): 4191-4203.
5
Garvey K, et al. Associations between trust in public health authorities and COVID-19 vaccine confidence and uptake in the United States. Vaccine. 2025.
6
Nwachukwu G, et al. Understanding COVID-19 vaccine hesitancy in the United States: A systematic review. Vaccines( Basel). 2024; 12( 7): 747.
7
Vosoughi S, Roy D, Aral S. The spread of true and false news online. Science. 2018; 359( 6380): 1146 – 1151.
8
Barton SM, Calhoun AW, Bohnert CA, Multerer SM, Statler VA, Bryant KA, Arnold DM, Felton HM, Purcell PM, Kinney MD, Parrish-Sprowl JM, Marshall GS. Standardized Vaccine-Hesitant Patients in the Assessment of the Effectiveness of Vaccine Communication Training. J Pediatr. 2022 Feb; 241:203-211. e1. doi:
10.1016 / j. jpeds. 2021.10.033. Epub 2021 Oct 23. PMID: 34699909.
Dr. Heather Felton practices pediatrics with Norton Healthcare and the University of Louisville.
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