Do pediatricians contribute to declining vaccination rates?

Over the past five years, MMR (measles, mumps, and rubella) vaccination rates have declined in 80% of U.S. counties, and measles cases are rising. Pertussis (whooping cough) infections have surged by 1,500% since 2021, and tragically, deaths are also increasing.

Many of us in the pediatric community fear this is the beginning of a tsunami of vaccine-preventable infections, hospitalizations, complications, and, as we are already witnessing, fatalities.

There’s plenty of blame to go around.

Blame Robert F. Kennedy Jr.’s dangerous, nonscientific rhetoric about vaccines, which despite his promises, he has only amplified since he became secretary of the U.S. Department of Health and Human Services. On Monday, he sacked all 17 vaccine experts on the CDC’s advisory panel, claiming without evidence that they had conflicts of interest.

Blame the COVID-19 vaccine mandates that fomented distrust in the medical establishment. Blame a long, painful history of racism and medical experimentation in marginalized communities. Blame social media algorithms that feed families misinformation instead of science.

But is the pediatric community also contributing, even unintentionally, through well-meaning policies that exclude unvaccinated children from their medical practices?

In 2005, the American Academy of Pediatrics (AAP) advised that pediatricians “should avoid discharging patients from their practice solely because a parent refuses to immunize his or her child.” But in 2016, the AAP shifted its stance, stating that “a pediatrician may consider dismissal of families who refuse vaccination as an acceptable option,” while also urging that such decisions be made with care and respect for family beliefs.

That opened a door I never thought I’d see open in my career: pediatric practices turning families away.

Not long ago, a woman came to my practice with her 4-month-old baby. She was a single mother of three, breastfeeding while preparing to return to work the following week. Her baby had gained minimal weight, and I asked if she’d like to see our lactation consultant — she said yes. I also arranged transportation for her next visit. As she began nursing again, I gently brought up the vaccines her baby was due for. Her expression shifted.

As physicians, we are guided by the Hippocratic Oath: Primum non nocere — first, do no harm. That means doing what’s in the best interest of both the individual and the community. It means traveling alongside our patients, offering expert guidance rooted in current science, and helping them achieve their health goals with compassion and respect.

Health does not exist in a vacuum. We must account for multiple factors that influence health outcomes: the patient’s health literacy, the provider’s implicit biases, the historical trauma of marginalized communities, and the family’s autonomy in making health decisions.

Vaccines in the U.S. are among the most thoroughly tested and monitored medical interventions. They are safe, effective, and lifesaving. Pediatric providers strongly support the current immunization schedule recommended by the AAP, which is developed and continually refined by expert panels. We do not endorse or follow “alternative” vaccine schedules that seek to spread out vaccines over a longer period of time, knowing that these can result in missed appointments and potentially deadly illnesses.

But we also know many patients don’t agree with or understand these precepts. So at our practice, we strive to meet them where they are. We use tools like shared decision-making, motivational interviewing, plain language, language of choice, and above all, empathy. We advocate for a comprehensive, accessible, team-based, and patient-centered medical home.

Yet, over half of pediatric practices nationwide now have policies excluding families who decline vaccines. Where will these families go? Will exclusion further erode trust in medicine and vaccines? Could it lead to missed checkups, missed diagnoses and declines in the health of children?

Vaccine exclusion policies stir passionate debate. On one side: concern about waiting room safety and the worry that if families ignore vaccine recommendations, they may disregard other medical advice. On the other: the ethical dilemma of denying care to a child because of a parent’s decision. Evidence shows that simply having a policy does not motivate parents to vaccinate their children. Instead, it can hinder our ability to build trust and work with families over time to protect children and communities from vaccine-preventable diseases.

» READ MORE: In Camden, anti-vaccine rhetoric threatens community health | Expert Opinion

Helping vaccine-hesitant families is a fundamental skill pediatricians learn during training. Building trust is the cornerstone of effective care — it strengthens the provider-family relationship and improves adherence to medical guidance, including vaccines, when families feel heard and ready. Naturally, families that do vaccinate their children might worry about being among unvaccinated kids, especially if they have babies too young to get their shots. Check with your doctor to ask about protective measures.

At the end of my visit with that 4-month-old baby, after addressing the mother’s concerns with care and respect, she chose to vaccinate. I followed up with her the next day. “She was a little irritable,” the mother said of her daughter after her shots, “but doing fine.” I could hear her baby cooing in the background — safe, protected, and loved.

Daniel R. Taylor is an associate professor at Drexel University School of Medicine and pediatrician at St. Christopher’s Hospital for Children.