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An SSM Health employee in Wisconsin who was fully immunized contracted measles on a commercial flight earlier this year, resulting in a significant exposure that involved both health care workers and community members.

"So she became the second case, and the concentric circles of exposure just kept getting bigger and bigger," said Dr. Shephali Wulff, the system's director of infectious diseases and prevention. "Fortunately, there were no secondary cases from that exposure, which was really lucky, but we had some work to do as a health system."

SSM Health coordinated with local public health departments and set up an incident command that met daily until immune globulin and vaccines were available to those who were exposed.

Across the board, the work for health systems continues as officials report that more people are hesitant to get vaccinated for measles, COVID-19, influenza and other contagious illnesses. Researchers and health care providers point to politics, vaccine fatigue because of the COVID pandemic, and the spread of misinformation as reasons patients are questioning the need for vaccines or avoiding them altogether.

The issue extends beyond measles, which was officially eliminated from the United States in 2000, but reemerged during outbreaks in unvaccinated communities in New York and New York City in 2019. From January 2020 through March 2024, a total of 338 cases were reported, according to the Centers for Disease Control and Prevention. Nearly one-third of those cases occurred in the first quarter of 2024.

A recent Gallup poll found that the number of Americans who consider childhood vaccines important is plummeting, with 40% saying it is "extremely important" for parents to have their children vaccinated, down from 58% in 2019 and 64% in 2001. Some of that change tracks with politics, with the declining belief in importance nearly confined to Republicans and Republican-leaning independents and little change in views among Democrats and Democratic-leaning independents.

Another study showed a "spillover" effect of vaccine attitudes post-pandemic, with liberals having more positive attitudes toward non-COVID vaccines like those for flu, measles, mumps, rubella, human papillomavirus, and chicken pox, and conservatives' attitudes becoming more negative.

Gaps in COVID-19 vaccination rates across racial and ethnic groups nearly disappeared in 2021, according to a KFF research project, but large gaps remained by partisanship, education level, age, and health insurance status.

"Vaccine hesitancy is real, and it's disappointing to those of us in health care, but especially those of us who have a background in infectious diseases," said Dr. Douglas Waite, chief medical officer of Covenant Health, based in Andover, Massachusetts. "If you fail to prevent vaccine-preventable diseases, that's a societal failure. That's not to point blame or fingers at people, but to frame the problem in a bigger perspective."

He compared the problem of somebody failing to get vaccinated for influenza and ending up intubated or dead to somebody not wearing a seat belt and dying in an accident while traveling at 45 mph.

"And it's frustrating, because we can prevent these things from happening," he said.

Wulff, of SSM Health, said that vaccine fatigue plays a part in lower immunization rates for COVID. "People don't get as sick today as they did in 2021, and I think people are tired of COVID," she said. "They're tired of hearing about COVID. They don't want to think about the vaccine. They don't want to think about this virus that caused such havoc for a couple of years."

'Faith in one-on-one conversations'
Dr. Jericho Bell specializes in both internal medicine and pediatrics outside Jackson, Mississippi, for St. Dominic Medical Associates, part of the Franciscan Missionaries of Our Lady Health System. Vaccine uptake in Mississippi was among the lowest in the country during the COVID pandemic.

The system makes pamphlets about vaccination schedules available for patients and gets vaccine messaging out through its communications channels and the media.

Bell often sees children for well-child visits, when most vaccinations occur. She believes personal conversations are one of the most effective ways to discuss vaccines with families.

"I'm a hopeful person," she said. "I really have faith in one-on-one conversations with people, and I feel like God gave me that as a superpower — that if I can get one-on-one with someone, then I can get through to them. They may still decide not to do what I'm hoping they'll do, but I think I can at least make the impression that the reason I am talking to them about this is because I care about them."

If a conversation about vaccines turns political, Wulff, of SSM Health, said she tries to refocus. "I try really, really hard to stay out of the politics and repurpose the conversation into science," she said. "I listen to where they're coming from. What are you afraid of? What's keeping you from getting the vaccine? And then I steer them back into the science."

Waite, of Covenant Health, said his conversations with hesitant patients aren't usually political. "My conversations are usually along the lines of, 'Really, do I need it? I mean, it's not that bad of an illness.'"

His response? "Maybe not, but it could be, and the latest strain that might emerge might be much more pathologic and could cause more problems."

Proactivity and planning
Waite is the chair of what Covenant Health calls the "Flu Cru," a group of about 50 system leaders including infection preventionists, nursing and medical staff leaders, human resources leaders, and employee and occupational health leaders. They have met several times a year for four years to talk about the previous flu season and to make plans for the coming year.

“I try really, really hard to stay out of the politics and repurpose the conversation into science. I listen to where they’re coming from. ... And then I steer them back into the science.” — Dr. Shephali Wulff

"We talk about planning our seasonal influenza vaccination programs," said Waite. "What does it look like for vaccines? What do we hear from our suppliers? Do we expect any shortages?"

The Flu Cru also annually revisits Covenant Health's employee vaccination policy, which, like many systems', mandates the influenza vaccine as a condition of employment.

"Staffing during the flu season is always a challenge, but if you have a highly vaccinated staff at 98%, you can have less absenteeism, and appropriate staffing is always good for patient care," Waite said.

What helps Covenant Health, he said, is that the state of Maine requires vaccines for health care workers and has done away with religious exemptions.

The Flu Cru also puts messages in employee newsletters, adding a fun spin to the communications with a cape-wearing cartoon mascot.

Compassionate messaging
Covenant Health's St. Joseph Hospital in Nashua, New Hampshire, has a radio campaign that emphasizes how getting vaccinations shows compassion for others, especially the most vulnerable. "Our compassionate team is ready to help you schedule vaccinations for your family, so you can have peace of mind knowing your loved ones are protected," says a female announcer.

That compassion extends into the examination room. Wulff of SSM Health said: "As physicians, we actually have tremendous power in making sure that we protect the public health, because patients listen to us. That physician-patient relationship is sacred. And so when we take the time to have a meaningful conversation with our patients about the value of these vaccines, they do listen. And so then, as a physician, you're not just impacting that one person. You're actually protecting the greater good."

» Covenant Health's St. Joseph Hospital has a radio campaign promoting vaccines. Listen to a message from the campaign here.