A hero with a PR problem
A 2024 Lancet modelling study reconstructed 50 years of the WHO’s Expanded Program on Immunization across 194 countries and 14 pathogens. The finding: 154 million deaths averted, not cases, deaths! By almost any measure, vaccines are the single most successful public health intervention of the modern era, arguably behind only clean water.
So why do intensivists still spend so much of their day negotiating vaccine hesitancy at the bedside? Prof. Lenora Saxinger, an infectious diseases physician at the University of Alberta and long-time science communicator (@AntibioticDoc), joined Peter Brindley and Leon Byker on this episode of The Critical Care Commute to work through that paradox: vaccines have become victims of their own success. When they work, the disease disappears, the threat becomes invisible, and the intervention starts to look optional.
Measles: the clearest case study
Measles is, in Saxinger’s words, close to a gold-standard vaccine in terms of the durable immunity it produces. It’s also one of the most transmissible pathogens in medicine: a susceptible person entering a room up to two hours after an infectious case has left can still be infected, with attack rates approaching 90%. Beyond acute severity, measles infection can cause a period of post-infection immune amnesia, leaving children more vulnerable to unrelated infections for months afterward. As vaccination rates have dipped, the disease’s near-total disappearance from clinical memory has made its return harder for both the public and some clinicians to take seriously.
The hospital’s own blind spot
The conversation didn’t stay in the community. Saxinger pushed back directly on a common ICU and ward reflex: deferring vaccination because “the patient is too sick right now.” Provided a patient isn’t floridly septic or on significant immunosuppression, seroconversion rates for standard vaccines remain good. Deferring to outpatient follow-up means 50 to 70 percent of patients never receive the vaccine at all. Hospital admission, she argued, is a moment of captive attention that health systems routinely waste by treating vaccination as an optional add-on instead of standard of care.
Why misinformation keeps winning
Anti-vaccine content generates roughly 3.7 times more engagement than pro-vaccine content online, and misinformation typically peaks within hours, long before fact-checkers can respond. The mechanism, Saxinger explained, is emotional and hardly ever factual: outrage is the currency of online engagement, and calm reassurance simply doesn’t provoke the same reaction as a vivid anecdote about harm.
What actually changes minds
The most practical part of the conversation was also the simplest. Saxinger’s approach starts by receiving every question neutrally, without assuming bad faith, then pivoting from arguing the fact to naming the problem: “I can see why that concerns you, the problem is there’s a lot of low-quality information out there.” The single most powerful tool, though, is a direct, personalized recommendation. She draws a parallel to smoking cessation counselling, where a physician’s clear recommendation to quit is associated with a 50 to 66 percent increase in the likelihood of quitting. The same principle, delivered with sympathy and conviction, applies to vaccination.
It’s a conversation for anyone who has stood at a bedside, in a family meeting, or in a discharge conversation and felt out of tools.
Listen to the full episode of The Critical Care Commute wherever you get your podcasts.
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