Permanent labels like “anti-vaccine” in medical records may harm trust and hinder long-term public health goals, argues a family medicine specialist.
I HESITATED before writing this. Not because the issue of vaccination is any less important, but because emotions around it have begun to cool. That distance matters. It allows reflection rather than reaction.
Let me be clear from the outset: This is not a dismissal of the very real frustration faced by healthcare workers when engaging patients who refuse vaccination. I work in the same clinics, face the same conversations and carry the same fatigue. I understand how emotionally draining these encounters can be.
What I question, however, is the practice of placing permanent labels such as “anti-vaccine” or “vaccine refusal” in patients’ clinical records.
I do not believe this practice serves patients, clinicians or public health.
Clinics are not social media
A clinical consultation is fundamentally different from a public debate. In the consultation room, we are not there to win arguments, shame patients or enforce compliance. Our responsibility is to offer the best available medical advice while respecting patient autonomy.
Permanent labels subtly but powerfully change the tone of care. They shape expectations before a word is spoken. Over time, they influence patience, empathy and even clinical judgement. The encounter risks shifting from care to confrontation.
Once that happens, the therapeutic relationship begins to erode.
Vaccine hesitancy is dynamic, not fixed
Behavioural science has repeatedly shown that vaccine acceptance exists on a spectrum, not as a binary choice. People move along this spectrum over time.
A patient may reject one vaccine but accept another. Someone who refuses today may accept months or years later after a life event, a trusted conversation or simply the passage of time.
Permanent labels deny this reality. They freeze patients at their most hesitant moment and follow them long after their views may have evolved. In doing so, we risk turning a temporary stance into a permanent identity.
This is not only inaccurate but counterproductive.
Trust is the end goal
The ultimate goal of vaccination counselling is not to force acceptance. It is to build trust strong enough that, when patients are ready to reconsider, they return to us.
Trust is fragile. Once patients feel judged, boxed in or written off, they disengage. When that happens, the opportunity for influence is lost entirely.
Yes, this work is exhausting. Yes, it demands patience that sometimes feels unfair. But healthcare has always carried an ethical burden that goes beyond efficiency. Strategy matters as much as stamina.
Closing doors may feel satisfying in the moment, but it rarely serves long-term public health.
A necessary distinction
Some ask why healthcare professionals reject labelling in clinics but use terms like “anti-vaccine” in public discourse.
The answer lies in context.
In the public sphere, there exists a small but influential group of vocal vaccine deniers who:
- reject overwhelming scientific evidence;
- actively persuade others to refuse vaccination; and
- spread misinformation or manipulate facts to incite fear.These actors influence population behaviour far beyond individual consultations. Warning the public about such misinformation is a matter of societal protection.
However, managing organised disinformation is not the responsibility of individual clinicians at the bedside.
Where policy must step in
When healthcare workers are left to confront both hesitant patients and organised misinformation without clear institutional backing, burnout is inevitable.
Without firm policy support, frustration spills into clinical encounters. Patients sense this. The result is a vicious cycle: mistrust fuels refusal, refusal fuels frustration and frustration deepens mistrust.
Public health authorities must lead decisively in infectious disease communication. Regulatory bodies must take a proactive role in curbing health misinformation. When silence comes from the top, narratives are filled from elsewhere.
Clinicians should not be expected to act simultaneously as caregivers, educators and enforcement agents.
A more humane alternative
If documentation is necessary, it should be temporary, transparent and revisable, not permanent. Patients should be informed that their decisions can change at any time, and that the door remains open.
In our own work training healthcare providers in vaccine communication, we have seen measurable reductions in vaccine refusal when trust-based, behaviour-informed strategies are applied consistently.
Change is possible. But only if space for change is preserved.
Closing the door helps no one
Labels may simplify systems today but they risk closing doors tomorrow.
Public health does not thrive on coercion or categorisation. It thrives on relationships built patiently over time. If we lose that, no amount of data, enforcement or messaging will bring it back.
Dr Amirul Amzar is a family medicine specialist and vaccine communication trainer. The views expressed are his own. Comments: letters@thesundaily.com
The Sun Malaysia
