Feb. 28, 2024

By Steven Furr, M.D., FAAFP
AAFP President

I’ll never forget a shift during residency at the Huntsville Hospital when I stayed up all night monitoring multiple children who were suffering with Haemophilus influenzae type b epiglottitis. I watched and listened to them struggle to breathe and hoped they wouldn’t need to be intubated.

Although I still see patients of all ages in my clinic and at the hospital, I haven’t seen a case of Hib in decades. That’s extraordinary because before the first Hib conjugate vaccines were approved for children in 1987 (and expanded to infants in 1990), Hib was a leading cause of bacterial meningitis in children under age 5. Roughly 20,000 U.S. children contracted severe Hib disease each year, and about 1,000 died.

By 1998, invasive Hib disease had decreased 99% among U.S. children due to widespread use of vaccines. A generation later, most young parents (and even young doctors) have never seen the disease. And those parents likely don’t know that Hib also can lead to complications like epiglottitis, pneumonia, purulent pericarditis and septicemia. 

So, how do we help our patients appreciate the severity and the risks associated with diseases they’ve never encountered?

Unfortunately, when our communities are complacent about vaccines, they are more likely to encounter diseases that have been nearly eradicated. We already are experiencing that with measles. That disease was declared eliminated in the United States in 2000 due the efficacy and widespread use of the measles, mumps and rubella vaccine, but there were large outbreaks in 2014 (667 cases) and 2019 (1,274).

As of Feb. 22, a total of 35 measles cases were reported by 15 jurisdictions: Arizona, California, Florida, Georgia, Indiana, Louisiana, Maryland, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania, Virginia, and Washington. (Resources from the AAFP and the CDC offer clinicians the latest information about measles, and patients can find evidence-based information at familydoctor.org.)

Sadly, it’s not surprising. Vaccination rates have been falling since the pandemic. A CDC report showed that national coverage with state-required vaccines among kindergarten students declined to 93% during the 2021-22 school year, meaning that roughly a quarter of a million children were not protected against measles, mumps, rubella, varicella, diphtheria, tetanus, pertussis and polio.

Many patients were leery of the new COVID vaccines, and that skepticism has spilled over and is affecting acceptance of other vaccines with proven track records of safety and efficacy.

So what’s a family doctor to do?

First, don’t take the decision personally when a patient declines an immunization. If they continue to come to you for treatment of their diabetes or hypertension, their rejection of a vaccine isn’t about you.

As with smoking cessation, patients might not accept our help the first time it’s offered. But if we’re persistent and continue to offer encouragement and evidence over time, they may eventually take that step.

My practice offers recommended vaccines to every patient at every visit. Some will take all. Some will take none. Others are somewhere in the middle, and it’s in that latter group that we might be able to make a big difference in the short term.

Second, we can make our advice personal. I’ve told parents about those children with Hib that I cared for so many years ago. I’ve also told them about watching my grandma walk with a limp and a brace because she had polio as a child.

But what’s more important is what I tell patients about what I’m doing now. One of the nurses here recently roomed a patient and offered a COVID vaccine, which was declined. During my visit with the patient, I told them that I had received the vaccine, as had my wife and other family members. I told them that being vaccinated would protect not only themselves but also their loved ones, co-workers and others.

When I left the exam room, I told the nurse the patient had agreed to be vaccinated.

“How did you do that?” she asked.

The simple answer is that I’m a family physician, and the relationships we build over time can build trust with patients and help them understand that our actions are motivated by the desire to do what’s best for our patients and community, including stopping the spread of preventable diseases.

Share your own stories with patients. Not all will listen, but we can make a difference for those who do.