Vaccine Hesitancy: Addressing Patients’ Faith-Based Concerns

Kenny Lin, MD, MHP
November 17, 2025

Although I strive to make evidence-based recommendations to my patients about vaccines, I freely admit that my personal decisions to be vaccinated are also based on anecdote and faith. When I was in college, I contracted influenza and fell miserably ill for several days. Every fall since then for the past three decades, even if I have not been working for an employer that requires it, I have gotten a flu shot, and I’ve never had the flu again. Similarly, over a few days during the second year of the pandemic, everyone in my immediate family contracted COVID-19 except me, the only one who had been vaccinated. I have received an annual COVID-19 vaccine in subsequent years and, despite caring for many patients with the infection, I have not become sick myself.

I get my vaccines every year, and I do not get sick.

At that same time, I recognize that the best evidence indicates that neither influenza nor COVID vaccines are impenetrable shields against infection or serious illness. A systematic review performed for the Vaccine Integrity Project found that seasonal influenza vaccination was 67% effective in preventing hospitalization in children and 48% in adults, whereas COVID-19 vaccines were 46% to 68% effective, depending on the study type and predominant subvariant. But my personal faith in these vaccines is unshaken by these data. I get my vaccines every year, and I do not get sick.

In a special communication in the Journal of the American Board of Family Medicine, Dr. William Cayley explored the other side of the coin: patients’ faith-based concerns leading to vaccine hesitancy. Although churches mobilized early in the pandemic to encourage Black and Latino individuals to receive the initial COVID-19 series, a recent study found that people who reported attending religious services at least weekly were less likely to have received a bivalent COVID-19 booster in 2022-2023 than those who never attended services.

Faith incorporates one’s internal spiritual beliefs and external religious expression in the community (eg, church attendance). None of the canonical and theological teachings of the world’s major religious traditions prohibit or discourage vaccination, Dr. Cayley asserted,

many personal vaccine objections attributed to faith-based reasons are more likely matters of personal faith interpretation rather than based on the teachings or traditions of a religious community. … Religious vaccine skepticism is driven by 1 or more of 5 sets of concerns: 1) a clash with a worldview specific to the patient’s religion, 2) a passive fatalistic trust in divine will, 3) an ethical objection due to vaccine production or effects, 4) an impurity perception that vaccines defile the body, and 5) a conspiracy perception that vaccines target a religious group.

How can family physicians address patients’ faith-based concerns about COVID-19, influenza, and other recommended vaccines? Potential strategies include framing vaccination using metaphors based on an appropriate religious text (eg, Noah, the Biblical flood, and the ark for human papillomavirus vaccination) and involving faith-based organizations in public health campaigns tailored to the concerns of their members to mitigate barriers and establish trust.