When the Tank is Empty

The hidden toll of addressing vaccine hesitancy and how to keep going

Recently, I found myself trapped in an airplane next to a seatmate who seemed determined to pass the 2-hour flight in nonstop conversation. After the usual small talk, they asked:

“So, what brought you into town?”

“I was speaking at a conference,” I said.

“What were you speaking about?”

“Um, vaccines and public health communication.”

“Oh, I used to believe in vaccines, but then I started doing some research, and I heard President Trump say…”

I don’t know if I visibly winced, but I was not excited about the direction this conversation suddenly took and very much wanted to go back to my book.

My reluctance to engage further in conversation was more than just a desire to be an introvert after a lot of conference extroverting; it was a small sign of something not discussed enough: conversation fatigue.

It wasn’t that I didn’t care about vaccines. At the moment, I was exhausted by the prospect of another emotionally heavy, values-laden conversation with a stranger when my tank was already running on empty. I suspect that I am not the only one who has had this experience.

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Conversations with random strangers are one thing, but with patients, the stakes are higher. It’s both a heavy conversation and a strain on a therapeutic relationship with serious downstream consequences, including the potential for burnout and moral injury.

When I teach vaccine communication workshops to health professionals, I often get questions like, “Don’t you ever get tired of dealing with wild social media claims?”, “Does any of this actually work?”, or “Don’t you sometimes just want to scream in frustration?” Clinicians, nurses, and other professionals often approach me after talks to share their weariness and fatigue, cynicism, and feelings of defeat from repeatedly and often unsuccessfully addressing vaccine hesitancy.

This isn’t just anecdotal. Pediatricians who regularly engage with vaccine-hesitant parents report higher levels of burnout and decreased job satisfaction. Qualitative work describes clinicians' feelings of being discredited, frustrated, and professionally undermined by these repeated encounters.

Many of us are having the same heavy conversations over and over again, and we are up against an invisible opponent who has hours with patients before we even get five minutes. They aren’t occurring in a vacuum. The explosion of information available on smartphones and social media, the erosion of trust in expertise, and now federal health authorities introducing undue doubt mean we are facing unprecedented headwinds.

What accumulates when we start to question whether the conversation even makes a difference in the face of these headwinds is even more insidious than burnout. Many of us have experienced walking from one room, treating a child with a vaccine-preventable disease, into the next, where vaccination is refused. That gap between what we know can help and what we cannot deliver produces something deeper than burnout: moral injury. This can lead to profound anger, guilt, and ultimately a loss of trust within the therapeutic relationship.

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When clinicians are carrying this level of strain, it shapes the conversations patients and parents experience and the care they receive. Vaccine conversation fatigue, burnout, and moral injury can distort how we see the people we are talking to.

Many people might be tempted to blame parents for these challenges, but they aren’t adversaries. They are also fatigued by conflicting and confusing information and, in some cases, by poor communication from people in science and medicine.

Vaccine-hesitant parents have shared their experiences with me of feeling dismissed, ridiculed, or shamed by a health professional. Just look at the comments section of any “pro-vaccine” post. Every time I post something “pro-vaccine”, I get at least one response that paints vaccine-hesitant parents as the enemy. People are watching and listening, and how we show up in public always feeds a narrative.

I can’t help but wonder how many of these negative interactions happened because providers felt the way I did on the plane—tank already empty and frustrated—resulting in communication that lacks empathy and partnership. And I can’t help but wonder how many times I have been that provider.

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Here is what I have learned, and what I keep reminding myself.

The first move is to reframe the job. The goal is not to win the conversation; it’s to show up as a trusted expert navigator. Not every encounter or conversation will result in a patient saying “yes”. Many will end with a “let me think about it,” and that is a win. Sometimes the win is as simple as having a respectful conversation. Partial progress is still progress, so learn to recognize that. You may have planted a seed that you will never see sprout.

Set limits on where and when you engage. You do not have to respond to every negative claim you hear, every social media comment, every holiday dinner disagreement, or every flight seatmate. Choosing your moments wisely is critical for sustainability.

Name what you are carrying and do not attempt to carry it alone. Sharing your experiences with colleagues, friends, or someone you trust interrupts the buildup that can lead from conversation fatigue to burnout. The burden for addressing vaccine hesitancy does not fall on you alone; it falls on the collective “us”, other clinicians, nurses, community health workers, public health professionals, scientists, community leaders, etc. Everyone has a share of the responsibility in improving health.

Learn to communicate more effectively. Research shows that learning effective communication skills not only improves outcomes but also boosts confidence and self-efficacy. Evidence-based conversation frameworks, empathetic language, and engaging questions can be taught, and I have seen how valuable and empowering it can be to learn these skills.

Finally, and for many, the hardest part: separate your identity from the outcome. A parent declining vaccines or a neighbor not changing their views is not a referendum on your skill, credibility, or worth. You can give the best communication in the world and still hear a resounding “no”. Recognize that most of the outcome is outside your immediate control.

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I ended up having a conversation with my seatmate. They didn’t change their mind or show any signs of shifting their views. But before we went our separate ways, they did thank me for talking with them. Maybe all I did was demonstrate that people with widely differing views can have a respectful, thoughtful conversation. I will take that as a win.

Thanks, as always, for being part of this community.

-David

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Quick Programming Note:

The response to my interview series, The Next Era of Vaccine Governance, has been incredible. I have several interviews lined up and a long list of people who want their voices heard, and I want to honor that. Over the coming months, some will appear here as individual or group interview summary posts, others may find their way to a podcast, and some to other venues. This is clearly meeting a need, and I’m grateful for it. Please reach out if you have ideas or if you are interested in collaborating on this work.

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Community Immunity is written by Dr. David Higgins, MD, MPH, a practicing pediatrician and public health physician whose work focuses on vaccine delivery, health policy, and communication. This newsletter is where he writes about vaccines, public health, and community. When he’s not seeing patients or writing, he’s coaching youth soccer or exploring the outdoors with his family. Find him on LinkedIn, Instagram, Substack Notes, and Bluesky.

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