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Why Do I Need This Shot
“Why Do I Need This Shot?” Nuanced Ways to Navigate a Common Question

Released: June 17, 2026

Richard Zimmerman
Richard Zimmerman, MD, MPH, MA
Activity Information

Activity

Key Takeaways
  • Many vaccine-hesitant patients are, in fact, open to vaccination, but feel a lack of urgency for same-day vaccination.
  • For people who are vaccine hesitant but stop short of outright refusal, employing strategies such as presumptive recommendations, mirroring their concerns, and personalizing the vaccine recommendation may move these patients closer towards vaccine acceptance.

To practice talking to the patient mentioned in this ClinicalThought through an interactive case simulation, click here. To see other interactive cases about vaccine communication, click here. 

A common adult vaccine counseling scenario is discussion of annual vaccines at a routine wellness visit. Patients in this setting will often be open to vaccines, but they may express hesitance to being vaccinated that day. This lack of urgency is frequently influenced by vaccine complacency, competing priorities, and flawed conclusions drawn from experience and mixed messages on social media.

In this ClinicalThought, I explore one such case study, and demonstrate strategies to shift patients towards vaccine acceptance.

Clinical Scenario: Richard, a 73-year-old man with COPD, class III obesity, hypertension, and dyslipidemia, presents for a routine annual wellness visit in the fall. He has declined the influenza vaccine for the past 3 years.

It is much more difficult to convince patients to start annual vaccinations if they have not been in the habit of getting them. However, I strive to get people into that habit, using a variety of opportunities. Here, I’ve found that using a presumptive approach helps initiate the discussion. This technique is also proven to increase vaccine acceptance. I would initiate the conversation by saying the following:

Provider: “Richard, we have completed all the social determinants of health questions, and now we’re moving to the preventive medicine portion of the visit. Given your medical history of COPD and other risk factors, you are due for the influenza vaccine today—specifically, an enhanced vaccine designed to better protect those of us who have reached the age for senior discounts.”

Richard: “I don’t plan to take it because the flu is just a bad cold.”

Often, patients like Richard are not against vaccines as a whole, but they do not understand the importance of staying up to date with annual vaccines, or are not aware of their risk factors for severe disease. This is a common misconception that I strive to correct:

Provider: “Many people think that way, but you are at higher risk due to your lung disease, age, and weight. In fact, most hospitalizations and deaths from influenza occur in people in your age group who have chronic medical conditions. I have had patients with a similar history to yours require ICU care because they became so sick from the flu. Afterwards, some needed rehabilitation in a nursing home because they were not strong enough to return home. I don’t want that to happen to you.”

Richard: “But I feel well today, and nothing happened the last 3 years when I skipped the shot.”

This demonstrates a logical fallacy that is commonly cited by vaccine-hesitant patients. It is important to point out that prior safety from infection does not change the probability of being infected with the flu later on. Just because the patient did not catch the flu in the past does not mean that their risk of infection is low, but rather it indicates that they have been lucky thus far.

I point out that the patient is still at risk, despite having avoided the flu in the past. However, I avoid sounding preachy or pedantic, as an overly corrective tone can put patients on the defensive. Rather, I maintain an empathetic approach and personalize my recommendation by connecting it to something that the patient values.

Provider: “I’m glad you haven’t gotten the flu in recent years. You’re right that not everyone is exposed every year, which may explain why you weren’t sick. However, being around crowds increases your chances of catching influenza. I know how much you and your wife are looking forward to your winter cruise. I would hate for you to miss it or cut it short because you became ill.”

Richard: “I certainly would hate to miss that cruise—we’ve saved for many months for it. But my sister tells me she got sick from the flu shot; she had a cough for a week afterward.”

This is another common misconception about the flu vaccine. In this situation, it is important to first acknowledge the patient’s concerns before educating them that getting the flu from a vaccine is not possible.

Vaccine-hesitant patients who come to you with concerns are being open. It is best not to dismiss those concerns. One way to ensure that patients feel heard is by mirroring.

Provider: “I hear that you are concerned about getting the flu from this vaccine. That is a concern I’ve had other people ask me about as well. I understand your worry, but this is an inactivated vaccine, so it can’t infect you. Most people experience only a sore shoulder after a flu shot. Some may feel achy or develop a low-grade fever. Your sister’s coughing episode sounds more like she caught a cold coincidentally around the time of the shot. The vaccine we would give you is inactivated and cannot cause a cold.”

Richard: “You may be right about that; she goes to a lot of club meetings and group lunches, so she could have caught a cold.”

Finally, I like to personalize my vaccine recommendations even further by discussing why I encourage my own family members to vaccinate.

Provider: “My family gets the flu shot every year for 2 main reasons: first, to protect ourselves from influenza, and second, to reduce the chance of spreading it to others if we were to get sick. I know how excited you are about your newborn granddaughter—she is too young to receive the vaccine. Would you consider getting vaccinated to help protect her?”

Richard: “Yes, I cherish her, she’s my first granddaughter. And I would hate to miss the cruise or end up in a nursing home. Go ahead and give me the enhanced one; I want the better flu vaccine.”

Your Thoughts
What are some other common vaccine counseling scenarios where the techniques discussed above may be applicable? Leave a comment to join the discussion!