CASE SCENARIO

I had a routine well-child visit with an established patient, MC, and their parent, DC. I finished the examination by saying the nurse would be in to administer the scheduled childhood immunizations, which were part of a vaccine series the child had received in the past. Today, though, DC said, “I don't want any more vaccines for MC.” When asked the reason, DC explained that a middle-aged friend who was previously fit and healthy must now walk with a cane. DC clarified that the friend had experienced several uneventful COVID-19 infections before getting the COVID-19 vaccine and blamed the vaccine for the friend's health decline. I understood that DC was concerned about the adverse effects of vaccines, but having run out of time, I decided to address the issue at the next visit. How can I gain insights about patients' attitudes regarding vaccinations? How do I begin a constructive conversation that leads to shared understanding and shared decision-making?

COMMENTARY

Vaccine skeptics have long existed, but vaccines are currently the subject of intense rhetoric and dialogue. Most patients and caregivers still opt for many, if not all, available vaccines, but vaccine hesitancy and questioning have been increasing. In 2019, the World Health Organization named vaccine hesitancy as one of its top 10 global health threats.¹ Since 2020, the discourse surrounding vaccination has intensified. Isolating measures during the COVID-19 pandemic moved vaccination from a private office visit with one's personal physician to impersonal parking lots and pharmacies, administered by anonymous people shrouded in personal protective equipment. This physical relocation largely removed the opportunity for decisions and actions to be made in the context of a relationship with one's personal physician.