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Recommending Vaccines
The Why, When, and How of Recommending Vaccines

Released: June 17, 2026

Camille Nelson Kotton
Camille Nelson Kotton, MD, FIDSA, FAST
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Key Takeaways
  • HCPs have a duty to promote equal access to healthcare and vaccination, and we can do so with strong, personalized recommendations.

As healthcare professionals (HCPs), we are experts on the “why” and the “when” of vaccine recommendations, but it can be increasingly difficult to encourage confidence in these recommendations, given the growing distrust in vaccines. With outbreaks of vaccine-preventable diseases occurring, now more than ever, it is crucial to encourage appropriate vaccination for people who would benefit.

Recommending Vaccines and Gaps in Insurance Coverage
Given that the Advisory Committee on Immunization Practices (ACIP) is not functioning as it previously was, and that many of the government websites are not kept up to date, along with differing guidelines from multiple medical professional groups, it can be very challenging to understand current up-to-date vaccine recommendations.

In the US, a common piece of advice for HCPs who are unsure of current government vaccine recommendations is to instead look to professional medical organizations, such as the Infectious Diseases Society of America (IDSA). However, 1 key issue with this advice can be insurance coverage. Although under HHS policy, insurance companies must cover vaccines recommended by the ACIP, they are not obligated to cover vaccines that are not recommended for a specific age group or cohort. So, although it may be simple to recommend that we rely on vaccine recommendations provided by professional medical organizations, there may still be gaps in vaccine uptake because the recommended vaccines may not be covered by insurance.

For example, the IDSA recommended RSV vaccination for immunocompromised people between the ages of 18 and 50. However, there is no ACIP recommendation in place for that, so insurance companies do not necessarily have to cover vaccination in that population.

Similarly, in pediatric vaccines, the ACIP votes on which vaccines are covered by a program called Vaccines for Children (VFC). Approximately half of all American children get vaccinations through this program. However, the VFC program does not necessarily have to cover vaccines that are not recommended by ACIP.

Banding Together
In an attempt to address this gap, health officials from multiple Northeastern states and New York City formed the Northeast Public Health Collaborative. The governors of California, Oregon, and Washington formed a similar collaboration: the West Coast Health Alliance.

In those states, vaccination coverage is often mandated by the governor and other healthcare officials. These like-minded states came together to develop their own regional policy for vaccine recommendations. These state collectives show that there are significant regional efforts to ensure access to appropriate recommended vaccines. However, we remain concerned about geographic disparities in regions with less vaccine access.

Geographic inequity is something that the CDC and ACIP historically worked very hard to overcome. Great efforts were made to ensure that all Americans—in urban areas, rural areas, or on reservations—would have equal access to healthcare and vaccination. Equal access to vaccines was considered part of healthcare policy, to protect people from vaccine-preventable diseases, especially where healthcare access might be less easily attainable.

Vaccine inequity is healthcare inequity. I believe that professional medical societies and individual HCPs have a duty to continue the historic work done by the CDC and ACIP to promote equal access to healthcare and vaccination.

The “How”: Discussing Vaccine Benefits
There is no denying that our jobs have become harder. One of the best ways to encourage vaccination is for HCPs to make strong recommendations. Data show that many patients who are unsure of what to do will accept recommendations from a trusted HCP.

Discussing our own personal experiences with vaccination also helps. I often tell patients that I've vaccinated myself and my children, and I encourage all my loved ones to do the same. That seems to carry a lot of weight, because it emphasizes that vaccination is not just something I recommend for you, but something I choose for me and my family.

In particular, vaccine rates for influenza, RSV, and COVID-19 are lower than ever. Rather than talking about preventing severe illness and hospitalization, which patients have no doubt heard, one strategy that I find useful is focusing on the less well-known benefits of vaccination.

For example, I talk about the cardioprotective effects of respiratory vaccination. Influenza, RSV, COVID-19, and pneumococcal disease put patients at much higher risk for cardiovascular events like heart attack, stroke, and death. Getting vaccinated against these illnesses also mitigates the risk for cardiovascular events, even if patients do get sick.

Another example is a patient with severe kidney disease who is vaccine reluctant. They qualify for a kidney transplant and want to avoid dialysis before their transplant. I say, “I share your goal, and one of the main preventative, actionable things you can do to avoid needing dialysis is get vaccinated for all vaccine-preventable infections.”

Ultimately, I try to frame vaccination in the context of protecting against increased risk of exacerbating other health conditions. I always say that vaccines are like a seatbelt. We wear our seat belts for every car ride, even if we don’t think we are going to get in a car accident. Wearing a seatbelt is always a good idea: Even if there's no safety guarantee, we know it's a much better idea to wear a seatbelt than not to.

Your Thoughts
What strategies have you developed for discussing vaccines with hesitant patients? Leave a comment to join the discussion!

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