For years, studies have pointed to one especially powerful influence over whether a person will get a vaccine: a clear recommendation from their doctor. Throughout most of her career, Nola Ernest, a pediatrician in rural southeastern Alabama, could reassure families who were hesitating to vaccinate their kids—in many cases by explaining that she had enthusiastically opted into the same shots for her own sons. In the past few months, though, she’s spoken with several families who, at her recommendation, had previously immunized all of their older kids—and yet are now adamant about not vaccinating their newborn. “I reassure them that I am still the same pediatrician,” Ernest told me. “They say, ‘We still trust you. We just think a lot of the things have been pushed on us for a long time that were not actually necessary, or were harmful.’”
Until recently, doubt about vaccines might have been seeded mainly by cautions from friends and family, or by unreliable information online. Now, though, doubt about vaccines has the weight of the federal government behind it. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, has been telling the public exactly what Ernest’s patients told her: Unnecessary, unsafe vaccines have been forced on you. A recent KFF tracking survey found that about three-fourths of Republicans trust their physician to provide reliable information about vaccines—but about three-fourths trust President Donald Trump and Kennedy to do so as well.
As those sources start to contradict one another, patients’ trust in doctors—which was already eroding—is being pitted directly against trust in government. And in doctors’ offices across the country, the Trump administration’s position is bending conversations about vaccinations—in some cases toward hesitancy, and in others toward haste as people fear that shots will soon be harder to get.
Government advisers and doctors have diverged in their vaccination advice before. In 1989, for instance, the CDC’s Advisory Committee on Immunization Practices, or ACIP, recommended that children receive their second dose of the measles-mumps-rubella vaccine between the ages of 4 and 6, when kids are due for other vaccines; that same year, the American Academy of Pediatrics, following the logic that outbreaks tended to happen in middle school or high school, advised age 11 or 12. The conflicting guidance created enough uncertainty for health professionals and patients that ACIP and the AAP pledged in 1993 to sync their vaccine advice, and in 1995 published the country’s first officially harmonized immunization schedule.
The current vaccine schism between the government and medical professionals, though, is different in kind—not a disagreement over maximizing uptake of data-backed vaccines, but a fight over what evidence to even consider. In May, Kennedy bypassed the CDC—his own department’s agency—and tried to unilaterally remove COVID-vaccine recommendations for children and pregnant people, without providing any evidence of harm. Weeks later, he dismissed all 17 members of ACIP and replaced them with researchers who largely lack expertise in vaccines, including multiple people who are openly antagonistic toward them. At its first meeting last month, that reconstituted group voted to remove recommendations for flu shots, following the advice of an anti-vaccine activist invited to speak at the meeting. (When reached over email for comment, an HHS spokesperson wrote that “HHS continues to support the CDC and the Advisory Committee on Immunization Practices (ACIP) in advancing evidence-based immunization schedules” and that “the Secretary stands by his CDC reforms.”)
These upheavals have prompted a very public fight. Last week, several professional societies—including the AAP, the American College of Physicians, and the Infectious Diseases Society of America—sued Kennedy and HHS, calling recent shifts in vaccine policy “capricious” and arguing that the department’s new leaders were putting the nation’s health at risk. The AAP also boycotted ACIP’s most recent meeting. Shortly after, Martin Kulldorff, the new ACIP chair, criticized the AAP’s loyalty to the unamended immunization schedule as “unscientific.”
The government’s alterations to vaccine guidance so far have been relatively limited. But Kennedy and many of his allies have criticized the immunization schedule, especially for kids, or advocated for paring it back further. And according to nearly a dozen doctors I spoke with, plenty of patients have already picked up on the spirit of these changes: that they should put less stock in vaccination than the government had previously called for. “Families have really been shaken in their confidence in what we’ve been telling them all this time,” Molly O’Shea, a pediatrician in Michigan, told me. “We’re already seeing in my practices a decrease in people taking vaccines on schedule.” In the past, when O’Shea asked, her patients would usually explain their rationale for distrusting a vaccine—something they had read online, a rumor they had heard from a relative. Now, though, many of them don’t want to discuss their choice at all, a response she’s rarely encountered in her three decades of practicing medicine.
In some cases, families are echoing Kennedy’s concerns, and pressing their doctors to directly address them. Like many pediatricians, O’Shea requires that her patients follow the recommended childhood-immunization schedule to continue to be seen at her practice; at one of her offices, several families have asked recently why she’s maintaining the policy even though Kennedy has described vaccination as a personal decision. Braveen Ragunanthan, a pediatrician in a rural part of the Mississippi Delta, told me that a patient recently expressed concerns about the immunizations recommended for his six-month-old daughter after hearing something on the news. The patient asked, “All this time, has there been something wrong with the shots?” Ragunanthan told me.
Ernest, the pediatrician in Alabama, told me that one family of longtime patients, when declining to vaccinate their newborn, cited the debunked notion that vaccines cause autism, an idea that Kennedy has repeatedly endorsed. Several of Kennedy’s other mistruths about vaccines, including that certain shots contain “aborted-fetus debris” and that the hepatitis B vaccine has been linked to autism, have come up as well. Some of the families she sees have also cast federal vaccine regulators and pharmaceutical companies as untrustworthy—echoing Kennedy’s narrative that the U.S. approach to vaccine policy has been corrupt and is bent on pushing dangerous shots for industry profit.
Families who remain eager to vaccinate are also taking seriously Kennedy’s rhetoric—and the implication that a government that endorses fewer shots will ultimately depress their availability. Gretchen LaSalle, a family-medicine physician in Spokane, Washington, told me that some of her patients have started asking whether they’ll be able to get their fall COVID and flu shots; Jennifer Hamilton, a family-medicine physician in Philadelphia, said she’s heard similar concerns from older adults about shingles and pneumococcal vaccines. Ragunanthan also recently vaccinated a patient against HPV at age 9, the earliest age of eligibility and two years before most pediatricians routinely offer the first dose, at her parents’ request. “They said, ‘I don’t know if they’re going to try to take it away,’” he said.
Several doctors told me that they’re committed to following whatever their professional society—be it the AAP, the American Academy of Family Physicians, or another organization—recommends. But they also acknowledged that doing so may not be practical. Public schools generally look to the national immunization schedule to determine which vaccines to mandate for entry, and when; the government’s official stance on vaccines can also influence the price and availability of shots, and determine what insurers will cover. ACIP also decides which vaccines are covered by the Vaccines for Children Program, which ensures access for kids whose families can’t afford shots.
Certain patients might opt to pay for shots out of pocket; Alanna Levine, a pediatrician in New York, told me that her practice intends to seek grant funding that might help it continue to offer vaccines to all of its patients, regardless of insurance coverage. But some vaccines can cost as much as hundreds of dollars per dose—a price that many families won’t be able to, or want to, pay and that many doctors’ offices won’t want to shoulder to keep shots in stock. “We would definitely lose considerable money if we bought vaccines, paid to store the vaccines, paid to administer the vaccines, and then families couldn’t afford to pay us,” Ernest told me. As much as doctors want to continue to “follow the science”—as nearly all of them put it to me—the power of the government may force their hand. “I can recommend something, but if it’s not paid for, I know my patients aren’t going to get it,” Hamilton told me.
Several doctors told me that they hope insurers end up following the recommendations of professional societies. But in the absence of official harmonization with the government, professional societies might revert to developing their own schedule. Even if they were to agree with one another, the discrepancy between official medical advice and official governmental advice casts doubt on the scientific consensus that vaccines are safe and effective. Sian Jones-Jobst, a pediatrician in Lincoln, Nebraska, told me that some of her patients’ visits are now so dominated by combatting vaccine hesitancy that she runs out of time to discuss other aspects of their health. Uncertainty also makes the work of caring for patients inherently more challenging: Before, doctors trusted that they could simply follow the recommended schedule to keep their patients up-to-date on vaccines, Jason Terk, a pediatrician in Keller, Texas, told me. Now, though, divergence is the norm.
Great Job Katherine J. Wu & the Team @ The Atlantic Source link for sharing this story.
