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Championing Vaccine Uptake
Championing Vaccine Uptake in the Age of Uncertainty  

Released: November 12, 2025

Carolyn Bridges
Carolyn Bridges, MD, FACP
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Key Takeaways
  • Healthcare professionals play a critical role in countering misinformation and helping patients understand the significant benefits vs the low risks of adverse events with vaccination.
  • Personalizing vaccine recommendations is an effective approach to discussing vaccines, as the individualized framing helps patients understand how the recommendation specifically applies to their health or circumstances.
  • Coordination across the care team and partnerships with trusted community organizations can also help improve vaccine confidence and uptake.

In this commentary, Carolyn Bridges, MD, FACP, shares practical strategies for championing vaccination, including ways to address vaccine hesitancy, build patient trust, and coordinate care to improve vaccine uptake.

What are the Department of Health and Human Services (DHHS) recommendations for COVID-19 vaccination, and how does this differ from society recommendations?
DHHS and CDC very recently updated their recommendations for the COVID-19 vaccine. They now recommend shared clinical decision-making for the COVID-19 vaccine for everyone 6 months of age or older. Clinical considerations were updated on November 4, 2025, including recommendations for vaccination of people 65 years of age or older and adults who are immunocompromised with the 2025-26 COVID-19 vaccine.

The recommendation for shared clinical decision-making—also called individual decision-making by DHHS—for all adults, including during pregnancy, differs from the FDA-approved indications for COVID-19 vaccines for adults 19-64 years of age with 1 or more high-risk condition and all adults 65 years of age or older. In addition, the adult immunization schedule was changed in the spring from a recommendation for vaccination during pregnancy to no recommendation during pregnancy and now to recommendation for individual decision-making for COVID-19 vaccination during pregnancy.   

In contrast, the American Academy of Family Physicians, American College of Physicians, and American College of Obstetricians and Gynecologists have continued to recommend the COVID-19 vaccine for all adults, including people who are pregnant.

At this point, any adult can get the 2025-26 COVID-19 vaccine. The 1 logistical issue is that some pharmacies in some states might need a physician order or prescription to provide vaccination due to state differences in scopes of practice. Healthcare professionals (HCPs) are encouraged to work with pharmacists in their community to be aware of any logistical issues to address to help reduce the burden on patients to get a COVID-19 vaccine.  

From your clinical experience, what are the most common reasons that patients in primary care settings either decline or delay vaccines?
In my experience, many people with vaccine hesitancy are concerned about things they hear from social media and other external sources, particularly regarding vaccine safety. However, I think it is important to remember that most people's concerns differ by vaccine. For instance, someone may be open to getting a shingles vaccine but not tetanus, or flu vaccine but not COVID-19. This is where personalization of the vaccine recommendations can be very helpful, so people understand how the vaccine recommendation specifically applies to them.

In terms of safety, the COVID-19 vaccine tends to raise the most questions. Nonetheless, once I talk to patients about their personal risk, why it would be recommended for them, and the safety data, they often become more open to vaccine recommendations.

Have you noticed any cultural, socioeconomic, or regional factors that play a major role in vaccine confusion in your patient population?
I think nationally, considering surveys done by the Kaiser Family Foundation and others, there are some regional differences, and unfortunately, there are differences by political affiliation. I just want to point out that vaccines were not a partisan issue even just a few years ago. This is an unfortunate recent change. 

Kaiser Family Foundation and CDC surveys have also found that living in rural areas, not having insurance, and lower income and education levels have been associated with lower vaccine confidence. However, a unifying factor among all patients is trust in their HCPs and having an HCP’s recommendation for vaccination is strongly associated with vaccination. HCPs are the number 1 most trusted person from whom people want to get their vaccine information. I’ve found that patients are interested in hearing from their HCP about why certain vaccines are recommended for them.

So, although there may be regional or socioeconomic factors that contribute to vaccine hesitancy, HCPs are really the key to helping all patients understand the risks and benefits of vaccines.

What specific language or framing have you found effective in increasing vaccine acceptance during primary care visits?
I’ve found that personalizing the vaccine recommendation is the most effective strategy. That is, I emphasize what is recommended for each patient and why I recommend it for them. I make sure to discuss which of their personal circumstances, be it age, chronic medical conditions, or family living situation, make vaccination important for their health and circumstances.

How do you handle situations or patients' beliefs that are strongly influenced by misinformation? Or, what is the balance between respecting patient autonomy and advocating strongly for vaccination?
It can be difficult to allay a patient’s concerns if they are simply adamant about not getting vaccinated. In those cases, I think HCPs should do their best to leave the door open to further conversations.

What I do is provide information and emphasize that my focus is giving them the best recommendation for their health. I talk about the risk–benefit ratio of vaccines and how severe side effects are actually very rare, especially relative to the benefits of getting a vaccination. Being knowledgeable about vaccines also helps make people feel more comfortable.

The key is keeping the door open to the conversation and showing respect. It is important to listen to what people have to say, understand their reasons for not wanting to get vaccinated, and address concerns as best you can. If they really do not want to talk about vaccines at all, I accept it and make sure that I offer vaccines again at their next visit. If they are open to it, I provide them information on the vaccine and vaccine preventable disease using a vaccine information statement.

What unique challenges do you encounter when counseling an immunocompromised patient or their family about vaccination?
One of the main challenges I encounter is making sure that immunocompromised patients understand that they may not have a robust immune response to the vaccine if they are moderately or severely immunocompromised. However, it is still recommended that they receive vaccination, although they should not receive live vaccines, of course. 

I also stress that, because they may not have the best immune response to the vaccine, it is even more important for their family and other close contacts to be vaccinated as well, to help protect them. 

Are there any best practices that you would like to share for coordinating care between primary care HCPs, specialists, and public health services for optimizing vaccine uptake among immunocompromised patients?
I would say the number 1 best practice is to make sure that you and your electronic health record (EHR) are reporting immunizations to the immunization information system (IIS) or vaccine registry in your state, and encouraging your colleagues and health systems to do the same. Bidirectional exchange of immunization information between EHRs and IIS is very helpful to make sure the vaccination alerts are accurate and reflect vaccinations that are still needed.

Patients generally do not have hard copy records of their immunizations anymore, and adult patients tend to see multiple HCPs, making it even more challenging to keep track of immunization records and determine what vaccines they truly need. Consistently checking the vaccine registry and, ideally, automatic bidirectional exchange of immunization data between your EHR and your state’s IIS is the best way to ensure that vaccine records are consolidated and that all HCPs have access to an accurate vaccine history.

What role do reminder systems, standing orders, and EHR prompts play in improving vaccine coverage?
In my clinic, those tools are very important and helpful to remind both the staff and the HCP which vaccines are needed for any given patient.  There has been a lot of research showing that these tools are very helpful in improving vaccination rates. Text or EHR reminders can also help improve vaccination rates by approximately 5 percentage points. Taking advantage of all these systems is likely to maximize vaccine uptake since not all patients will be seen in a clinical practice each year or in the fall to get seasonal vaccines.

Standing orders are very helpful for allowing staff to practice at the top of their license. They help make immunization practices run more smoothly and take some of the burden off of the HCP. They can also help with screening patients for which vaccines they need and assessing for contraindications to vaccination. Overall, they help ensure that patients receive the right vaccine at the right time.  

How do you engage the broader care team—medical assistants, nurses, pharmacists—to address vaccine confusion and to facilitate vaccination?
I think the first step is to make sure that all staff are on the same page and are aware of what the vaccine recommendations are. I emphasize that the staff who are rooming patients should initiate the discussion about vaccination by conducting an initial review and screening to identify which vaccines the patient needs and making the recommendation. The HCP can briefly reiterate the recommendation and patient’s decision to get vaccinated.  This alleviates some of the time burden with vaccination and enables the HCP to have a bit more time to spend with patients who have more questions about vaccination.

Are there community partnerships or outreach strategies that you have seen that work well in improving vaccine confidence?
During the COVID-19 pandemic, many community-based organizations performed vaccine outreach to the patient populations that they had already been serving for a very long time. These organizations are trusted messengers in the community. They can partner with local medical clinics or state and local health departments to bring vaccines to where people are, where that organization is already providing some type of medical or other service.

Another strategy that proved effective during the pandemic was bundling immunization services with other services that communities needed. So, for example, let us say a community was concerned about hypertension, with vaccines as a secondary interest. Combining blood pressure screening with vaccine services could help increase uptake or at least help initiate conversations about vaccines.

Resources for Addressing Vaccine Confusion in Your Practice

Your Thoughts
What are your biggest challenges regarding vaccine hesitancy in your practice? What tips can you offer your colleagues to increase the number of patients who agree to vaccinations? Join the discussion by leaving a comment below.

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