What is the hospitalist’s role in helping to advance the immunization of hospitalized patients? Historically, hospitalization has been seen as an opportunity for vaccinating eligible patients. But could the field be doing better at this responsibility in today’s post-pandemic world, with its greater public uncertainty about the place for vaccines in public health?
Dr. Pyke
“We know that by most measures, immunization in the hospital setting is underutilized,” said O’Neil Joseph Pyke, MD, MBA, SFHM, a hospitalist and physician executive with Jackson North Medical Center in Miami. But hospitals today are instituting protocols, screening patients’ immunization histories, learning more effective communication of vaccine information, and integrating vaccines into “power plans” provided to clinicians through their electronic health record (EHR).
Vaccines are more commonly provided in primary care and clinic settings, although that may fail to happen for any number of reasons. It can be hard these days for many patients to get in to see a primary care provider or get the vaccines they need there. For hospitalized patients, step one in addressing this breakdown is to obtain or confirm their vaccination histories and then offer the opportunity for those who are behind on recommended vaccines to catch up.
Today, the most common vaccines indicated for hospitalized older adults are the yearly autumn influenza vaccine and the pneumococcal vaccine to prevent Streptococcus pneumoniae. Both vaccines are especially recommended for patients who are over age 65 or have chronic conditions like heart or lung disease, diabetes, or a history of smoking. Another vaccine that is now available for patients in these groups protects against pneumonias due to respiratory syncytial virus (RSV), a common and highly contagious virus that can cause severe pneumonia.
Dr. Somani
“People haven’t heard as much about the RSV vaccine, but it is effective for elderly and immunocompromised patients,” said Jyoti Somani, MD, an infectious disease specialist and associate director of infection control and antimicrobial stewardship for Jackson Health Systems in Miami. “We need to introduce this vaccine to hospitalists and explain how effective it is.”
More Challenges on the Adult Side
“I’ll tell you this,” Dr. Pyke said. “I think we’ve done an extraordinary job in this country as it relates to infant, toddler, and childhood vaccines. Our pediatric hospitalists really own that space, and it’s the exception for parents to say no to this.” But the adult side has proven more challenging, he said. “We’ve always needed to convince patients who are in the hospital.”
Over the years, Dr. Pyke was able to persuade the majority of his patients who were getting ready for discharge from the inpatient setting to receive immunizations that were appropriate, as determined by the clinical team. But there was a turning point in practice due to the COVID-19 pandemic in 2020 and the skepticism that emerged surrounding it. That skepticism started to influence flu and pneumococcal vaccine hesitancy, as well.
“In our hospital, our role with COVID-19 was primarily centered around encouragement. We never forced it—we couldn’t do that anyway,” Dr. Pyke said. One of the initial hurdles was getting the hospital systems, physicians, and nurses to remember to offer the vaccine. “We got past some of that with protocols and helpful EHR reminders for the hospital team,” he said.
During the pandemic’s peak, there was a lack of public understanding about it and concerns about how quickly the vaccine had been developed. “I think that some folks who were not in favor of the vaccine, unfortunately, politicized it,” he said. Simultaneously, there was a lack of health literacy around vaccinations, but also a natural, normal, and healthy skepticism that many people have felt toward the healthcare system more broadly.
It may be hard to draw a clear line between these two issues, Dr. Pyke said. “Some patients have clearly articulated to me their concerns about experiments done on Black people back in their parents’ time.” A commonly cited example is the Tuskegee Syphilis Study, conducted by the U.S. Public Health Service to observe the natural progress of untreated syphilis in Black men.1
“There’s been a kind of historical reluctance by some to go down the vaccine path. I would have my patients reference that (history) as a backdrop for why they didn’t want the COVID-19 vaccine,” he said. “When they would say no, I would usually ask them why, and then I’d need to have a proper discussion with them about that why.”
Supporting Immunization
Dr. Wardrop
“Many of us on The Hospitalist’s editorial board feel strongly about supporting vaccines in general,” said Richard Wardrop III, MD, PhD, MACP, FAAP, SFHM, a career med-peds clinician-educator and program director for the internal medicine residency program at the University Hospitals Geauga Medical Center in Chardon, Ohio. “And even though we are not primary care physicians, some of us—like me—are pediatricians as well as adult internists. So immunization in the hospital is not a foreign or new concept to us.
It is something done regularly in pediatrics,” he said.
“We felt like this is something we should talk about with our hospitalists because of vaccine hesitancy and what’s happening nationally around vaccine skepticism,” Dr. Wardrop said. “With the emergence of medical concerns like COVID-19 and RSV, it’s important for hospitalists to be aware of vaccine development broadly and the role of vaccines in preventing disease. This is meant to be a call for awareness and for the efficacy that we would hope hospitalists can have in immunizing adults and children while they are in the hospital.”
Hospitalists, like any physician, have a stake in the health of the patients they take care of in the hospital, Dr. Wardrop said. “And that’s one patient at a time. But we, as a group, also have an impact on the health of populations, especially for the population that’s seen in the hospital. I think we have a unique and important role, and at times, opportunities are missed. It’s another missed opportunity if you don’t have the ability to provide the vaccine on demand or the infrastructure in place, or patient educational materials.”
Interesting Times
Dr. Herrle
“We live in interesting times,” noted Elizabeth Herrle, MD, FACP, SFHM, a hospitalist and physician leader with MaineHealth in Portland, Maine. “I think we’re dealing with a lot of issues, such as vaccination rates declining for various reasons. Some of that is inpatient factors, payer factors, or lack of access to care in the populations we care for in the hospital.” Some hospitalists have worked in ambulatory care settings more than others and are more practiced in discussing primary prevention and vaccine risks and benefits. But for others, this may be a less familiar skill set, Dr. Herrle said.
Meanwhile, the nature of COVID-19 has evolved, becoming less virulent, with more immunity in the community. “There is less of a sense of urgency around COVID-19 vaccination now. It’s shifted to be more in line with how we perceive the flu vaccination. It’s a good thing to do every year, but it’s not necessarily something that we need to push because it’s an emergency,” she explained.
“At my institution, that’s really led to more of a focus on immunizing people for COVID-19 in the community rather than in the hospital. So the role of the hospitalist becomes more about making recommendations and encouraging folks to follow up in the community for their vaccination,” she said. But many hospitalized patients don’t have the opportunity to connect with primary care.
Hospitalists can do right by their patients by making sure they are as protected as possible from preventable diseases. “That’s an easy intervention with a lot of payoff, which honestly isn’t something we get to do every day as hospitalists. And if you’re approaching them just as their doctor in the hospital, with curiosity and care for their health, that can go a long way toward diffusing any tensions that exist around what has sometimes been a challenging conversation,” Dr. Herrle said.
Influenza vaccination has been a target for reporting inpatient vaccination rates during flu season to the Centers for Medicare and Medicaid Services through the National Healthcare Safety Network, a program managed by the Centers for Disease Control and Prevention.2 “So that’s probably the one that hospitalists are going to see most often,” Dr. Herrle said. Many hospitals have built processes around screening inpatients and administering influenza vaccines through nurse-driven protocols. While hospitalists may not be directly involved in the day-to-day work of those protocols, they can support the quality efforts in their institutions.
The Benefits of Child Vaccinations
Anika Kumar, MD, FAAP, FHM, staff physician in the division of pediatric hospital medicine at Cleveland Clinic Children’s Hospital in Cleveland, said childhood immunizations are instrumental to primary care and crucial to pediatric hospital medicine. Vaccines have eliminated a lot of childhood infections.
Dr. Kumar
Many childhood illnesses are rarely seen anymore because of widespread immunizations, but some, like measles, eradicated in the U.S. in 2000, are now making a comeback, Dr. Kumar said. Whether a child is fully immunized or not often influences the choice of antibiotic therapy for common illnesses like meningitis and community-acquired pneumonia. “For me to go to the front lines to practice, I need to know the child’s vaccination status,” she said.
“For all of us who work in pediatric hospital medicine, one of the things we do when we admit a patient is to review their childhood immunizations,” said Dr. Kumar, who described a recent admission of a 4-year-old patient for an asthma exacerbation. According to the hospital records, the patient had not received any vaccines since six months of age and had missed several vaccine milestones.
“I went and talked to the mom and asked when [was] the last time her daughter got shots. And the mom said, ‘It’s been a really long time, Dr. Kumar.’ And I said that’s okay,” she related. “I said, ‘Our job is to make sure your daughter is well cared for, and we want to catch your child up on her vaccines. Is that something you would like us to provide while she’s hospitalized? Because we can start the catch-up now,’” she related.
“My job is to educate families, whether they want the immunization or not. I strongly encourage them to get it. And in my documentation, I also document if the vaccine was offered and the family declined, because I think that’s important,” Dr. Kumar said. The pediatrician can pick up on it when the patient is discharged back to the community.
“What I teach our medical trainees is that we are privileged to have the time to work on these issues. It’s part of the medical history of this patient. I say to families: ‘This is about me providing the best care I can for your child, and knowing their vaccination status will allow me to do that best. Vaccines are there to help your child and to prevent childhood illnesses.’”
Because vaccinations have been so crucial, they are built into clinical practice guidelines from the American Academy of Pediatrics, the Infectious Disease Society of America, the American College of Physicians, and others. Chapter 3 of the Centers for Disease Prevention and Control’s annual pink book, “Epidemiology and Prevention of Vaccine-Preventable Diseases,” also includes recommendations for hospitals.3
Acknowledging Uncertainty
The world of vaccines has been shaken up by a new administration in Washington, D.C., with new appointees to federal boards that oversee various preventative health and immunization guidelines, such as the Advisory Committee on Immunization Practices. “Unfortunately, they are changing, potentially in the wrong direction,” Dr. Somani said. “I think there’s just a lot of concern right now among physicians about the misinformation. And now you have people in those seats who raised this misinformation. It’s hard to dispel those messages. And there’s been a whole movement saying expertise doesn’t matter.”
Yet, on an individual level, she said, patients still do listen to their physicians. “So physicians still have a role to be very positive and very professional and not condescending, but to really explain that vaccines are safe, they’ve been used for years, and they are beneficial. I think hospitalists can and should do that, hard as it is,” Dr. Somani said.
“I think as a physician, or even as a person, you want to work with those you can possibly convince. And if there’s someone who’s flat out against it, you don’t want to get in a fight. But you can just say, ‘Look, let me leave you with this information. Let me at least tell you this. In the end, it’s still your decision.’”
Dr. Somani said, “As part of our antimicrobial stewardship efforts, especially, we do what I call ‘road-shows’, where we try to meet with the hospitalists and let them know current best practices in antibiotics. That also leads to a discussion about vaccines. With the hospitalists, we try to interface and just say these are the things that you need to be aware of,” she said.
“I would say that we are at a point where we have to acknowledge that there is a lot of vaccine hesitancy. And the reasons for that are often more social and political than they are medical,” said Dr. Somani. “But we also need to recognize and acknowledge that one of the issues with the flu shot, as well as the COVID-19 shot, is that they don’t necessarily prevent all vaccinated patients from getting the infection. The flu vaccine makes you less likely to need to be hospitalized or to get very sick from it.”
The efficacy rate for the seasonal flu vaccine was 56% in 2024-2025.4 “So I think we have to be very clear about our messaging. Not overselling it is going to help enhance trust with patients, while still reminding them that these are highly safe, tested on millions of people around the world. There are side effects, but nothing compared to what would make you very sick (from the disease),” she said.
Explaining vaccine choices has to be done with assent and agreement, Dr. Wardrop added. “We don’t just jab people in the arm. That’s on an individual patient level. But from the standpoint of physicians as scientists and as role models, part of overcoming the geopolitical inertia is to be healthy, to role-model good behavior, including getting immunized myself.”
Dr. Wardrop said he respects patient autonomy highly. “I’ve never been a paternalist, or at least I hope I haven’t. But at the same time, I have a PhD in immunology, and I’ve taught evidence-based medicine, and I consider myself a good user and a contributor to the evidence base whenever possible,” he said. “I have seen patients die of vaccine-preventable diseases. I’ve also seen patients die of diseases that they got vaccines for, or develop Guillain-Barré syndrome secondary to a vaccination.”
Explaining the Why
Along with the usual vaccines described above, there are other circumstances where immunizations are absolutely indicated. If somebody comes into the hospital and has their spleen taken out, it’s important to make sure they have proper immunizations as part of their care plan,” Dr. Wardrop said.
The hepatitis B vaccine is the only available treatment to prevent hepatitis B, which has complications, including liver cancer. So that is one of the few vaccines that protects against cancer. Haemophilus influenzae type b is a bacterium that causes serious infections in young children, and the vaccine is highly effective and recommended for those under age five.
Dr. Pyke said he tries to work with Jackson’s hospitalist workforce, supporting them to get the information they need to answer the questions patients have. “Let’s be honest. There are physicians who are able to explain things like this in a way that you can understand, and there are other physicians who struggle with it,” he said.
“I recognized that there was not a blanket competence among rank-and-file hospitalists, related to their ability to explain something that’s really complex in simple enough terms to get the patient to say yes. Hospitals need to educate them on how to do it—to reach a deep enough understanding to be able to explain the why of vaccines.”
Larry Beresford is an Oakland, Calif.-based freelance medical journalist.
References
1. Tobin MJ. Fiftieth anniversary of uncovering the Tuskegee syphilis study: the story and timeless lessons. Am J Respir Crit Care Med. 2022;205(10):1145-1158. doi: 10.1164/rccm.202201-0136SO.
2. National Healthcare Safety Network. HCP influenza summary reporting FAQs. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/faqs/vaccination/faq-influenza-vaccination-summary-reporting.html. Updated December 4, 2024. Accessed September 1, 2025.
3. Bjork A, Morelli, V. Chapter 3: immunization strategies for healthcare practices and providers. In: Hall E, et al., eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th ed. Washington, D.C.: Centers for Disease Control and Prevention Public Health Foundation; 2021. Available at: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-3-immunization-strategies.html. Accessed September 1, 2025.
4. Centers for Disease Control and Prevention. CDC Seasonal Flu Vaccine Effectiveness Studies. CDC website. https://www.cdc.gov/flu-vaccines-work/php/effectiveness-studies/index.html. Published May 30, 2025. Accessed September 1, 2025.
I had the privilege of working with a brilliant physician, who frequently “schooled” me on the erroneous practice of administering the influenza vaccine in the acute care setting, where I worked as a hospitalist. His position was that this population may have a greater risk of an adverse event(s) and that the reaction has the potential of being overlooked during the acute phase of a patient’s illness(es), when most are unstable. His opinion makes sense if one conducts a comprehensive review of the influenza vaccine’s effectiveness rates (which range from 30-54% depending upon age, flu strain, etc-CDC) over the past 16 years, in conjunction with a review of other available literature, and always considering the benefit vs the risk. In my humble opinion, albeit not a popular one, I believe that the influenza vaccine should be restricted to the outpatient setting. Thank you for the opportunity to add this post.
I look forward to any opposing comments.