Vaccine hesitancy: Doctors and health systems face more skepticism, and they need new strategies

Dr. Brandon Smith says he has seen more people skeptical or resistant to vaccines in recent years.

Smith, the associate medical director of the Harriet Lane Clinic at Johns Hopkins Children’s Center, says he has seen more vaccine hesitancy since the COVID-19 pandemic. But now, he’s seeing it more frequently.

“Definitely over the past year, I feel like, anecdotally, in our clinic, we've had more conversations,” Smith tells Chief Healthcare Executive®. “We've had more conversations, but also longer conversations too. I do want to say these conversations for providers aren't easy, and they do take longer time in the room to have.”

Vaccine hesitancy has been a growing concern of doctors, healthcare leaders and infectious disease experts, and it’s only magnified at the start of another school year. Doctors have been troubled by the uptick in families opting against vaccines, including typical childhood vaccines, as well as vaccines for Covid and the flu.

KFF has compiled troubling figures on declines in vaccination. In the 2024-25 school year, 39 states had MMR vaccination rates below the target of 95%, a significant change from five years earlier, when 28 states fell below that benchmark. Last year, 16 states had MMR vaccination rates below 90%.

Dr. Gary Price, president of The Physicians Foundation, says the rising reluctance to get vaccinated is alarming, and healthcare leaders need to rethink their strategies of reaching patients.

“We've seen a tremendous erosion in vaccination rates, just as a simple matter of public health metric,” Price tells Chief Healthcare Executive®. “That's very clear, and it's unprecedented. We now take for granted the diseases we had declared had been eradicated just a decade ago, we're now having outbreaks of them. So something clearly has changed.”

• Read more: Addressing vaccine skepticism, without alienating patients

More misinformation

Doctors say they are encountering more misinformation - and disinformation - from patients. Six out of 10 doctors (61%) say they met with patients who were influenced by misinformation or disinformation, according to a survey released last week by The Physicians Foundation.

Most doctors say they feel well-equipped to overcome misinformation from patients, but Price says some of that confidence may be misplaced.

“If we feel so confident in our ability to deal with this,” he asks, “why have vaccination rates eroded?”

Providers need to understand where patients are and engage patients in a constructive way, Smith says.

“For every parent who comes in, they might fall on a spectrum of accepting to hesitancy, to refusing vaccines,” Smith says. “And I think for us as providers, understanding where they are in that can really help us to then navigate some of these conversations and fully dig into really what some of the concerns may be, and to speak directly to misinformation.”

Doctors need to remember that virtually all parents want what is best for their kids. Some parents may not be going to reliable sources of medical information, but the fact that they’re looking for guidance anywhere is an indicator of how much parents are invested in the welfare of their children.

Physicians need to recognize that in their conversations with their patients, and their families.

“Even for families who are accepting of vaccines, I also want to say that there are legitimate questions about vaccines that can give a healthy conversation ... And we as healthcare providers are educators to families, so we should be sharing about why the timing of vaccines are this way, or the importance of certain vaccines at this point in the child's life," Smith says.

Aiming to fill the void

Healthcare leaders say the federal government’s changes in vaccine guidance aren’t helping matters. With Robert F. Kennedy Jr., a longtime vaccine skeptic, leading the U.S. Department of Health & Human Services, critics say he’s creating more confusion and skepticism.

Kennedy has said on multiple occasions that he wants vaccines available for all who want them, but he wants to be sure they are safe.

But Kennedy has also changed guidance on the coronavirus vaccine. The government is no longer advising pregnant women and healthy children to get the coronavirus vaccine, and healthcare groups have sharply criticized that change. The CDC says healthy kids can get vaccinated after a consultation with a doctor.

Dr. Georges Benjamin, executive director of the American Public Health Association, says Kennedy has fallen short of providing unambiguous support of the measles vaccine, even with the biggest measles outbreak in decades.

“If you look at the measles outbreak as one example, eventually he finally said, ‘Yeah, you should get vaccinated,’” Benjamin says. But he says Kennedy undercut that message by still advising people to talk to their doctors about whether it’s needed.

“He gave a degree of hesitancy about whether or not you should accept those recommendations,” Benjamin says. “And so that's created a great deal of confusion.”

Physicians and healthcare organizations also expressed alarm when the Centers for Disease Control and Prevention announced plans for new research to see if any tie exists between vaccines and autism.

The Center for Infectious Disease Research and Policy at the University of Minnesota is working to try and reduce confusion. Dr. Michael Osterholm, the center’s director, is leading an initiative known as the Vaccine Integrity Project.

The center held a webinar last week affirming the safety and effectiveness of the flu, RSV, and COVID-19 vaccines. In its review, 24 experts examined nearly 600 papers over recent years.

Osterholm told Chief Healthcare Executive® earlier this month that the center is looking to provide medical societies and payers with reliable data.

“We're doing the hard lift of understanding all the data that has been generated in the last several years,” he says.

The American Academy of Pediatrics also issued recommendations on COVID-19 vaccines that differ from federal guidance. The academy advises that all children 6-23 months get the COVID-19 vaccine, along with kids between 2 and 18 years if they have certain risk factors. The group also says all parents and guardians who want their children to have the COVID-19 vaccine should have access to it.

The academy has published its own vaccine schedule recommendations and is urging insurers to cover those vaccines.

Reaching people

Still, healthcare leaders acknowledge that they need to try different approaches to reach Americans who aren’t getting their information from reliable news sources. And most members of the public aren’t reading medical journals.

Osterholm says everyone in the healthcare ecosystem is wrestling with how to reach people.

“I think that the collective medical community and public health communities need to come together and strategize about what can be done,” he says.

Hospitals and health systems need to take different approaches to reach people in their communities. Price suggests hospitals can use social media to post information, but more importantly, establish a relationship with those in their communities, including some who may not be engaging with the health system.

“I think we need to understand that the fundamental way to communicate this information has changed if we want to be effective,” Price says. “And I think that same idea has to be applied to our public health messaging and communications. And I think doctors in their offices need help with resources like that.”

Health systems and public health agencies may need to look at helping offer guidance to the public on healthy social media viewing, and advice on how they can check AI-generated answers with reliable sources of information, Smith suggests.

Johns Hopkins is partnering with community groups and schools to do more proactive outreach. The system is also developing magnets for parents of newborns, he says. The magnets will spell out the recommended vaccine schedule for the child’s first four years.

“We’re finding new ways to be proactive about misinformation and specifically about vaccines,” Smith says.

Podcast: Check out our conversation about misinformation with Dr. Gary Price, president of The Physicians Foundation, in the latest episode of “Healthy Bottom Line,” a podcast by Chief Healthcare Executive®.