rewrite this title When it comes to vaccines, how are pediatricians restoring trust?

NPR’s Pien Huang speaks with pediatrician Alexandra Cvijanovich and Professor Jason L. Schwartz about trying to shore up trust about vaccines.

PIEN HUANG, HOST:

There is a lot going on in the vaccine world right now. The Centers for Disease Control and Prevention, under Health and Human Services Secretary Robert F. Kennedy Jr. is walking back longstanding vaccine recommendations, including the one recommending universal COVID vaccines for kids and pregnant women. Kennedy says these moves are designed to restore public trust in vaccines, but doctors’ groups say they undermine it. That puts a lot of folks in a confusing situation to navigate. To help us better understand what’s going on and where we go from here, we’ve called pediatrician Dr. Alexandra Cvijanovich and Professor Jason L. Schwartz from the Yale School of Public Health. Thank you both for joining us.

JASON L SCHWARTZ: Great to be with you.

ALEXANDRA CVIJANOVICH: Thank you for having us.

HUANG: Sounds like there’s a lot that is still up in the air – Jason, what are some of the biggest changes that you’ve seen recently when it comes to vaccines?

SCHWARTZ: You know, what we’ve seen really since the inauguration back in January is, week after week, new announcements, new personnel changes, new decisions, new messages that call into question how the federal government views the safety and effectiveness of vaccines. And we’ve seen it most recently with the expert advisers to the CDC, that Advisory Committee on Immunization Practices that met recently, that’s for 60 years been really the gold-standard source for shaping national vaccination policy. The entire membership of the committee was dismissed several weeks ago by the secretary of Health and Human Services, replaced with a new group of members who are deeply skeptical, deeply doubting of the evidence supporting the safety and effectiveness of vaccines. They made that loud and clear at their initial meeting, and they’ve signaled an agenda that will continue to emphasize their views regarding the value and benefits of vaccines that they appear to think have been overstated and the harms of vaccines that they appear to think have been understated. So I think we’re getting a signal of a major shift in how we talk about and hear about vaccines from our federal government continuing in the months ahead.

HUANG: Dr. Cvijanovich, has anything actually changed so far in terms of what kids and adults have access to in this moment?

CVIJANOVICH: No, it has not changed on a street level at this point.

HUANG: There’s definitely a lot of uncertainty right now around where the policies of vaccines are going. But the actual CDC recommendation for kids and pregnant women to get COVID vaccines has gone from a universal recommendation – you know, everyone should be getting it – to – I believe it’s changed to, like, a shared decision-making recommendation. Is that your understanding of it?

CVIJANOVICH: Yes, that is my understanding. That is correct.

HUANG: Can you talk a little bit about shared decision-making? Like, how is that different than the recommendation for just everyone to get it?

CVIJANOVICH: The shared decision-making is a trend which in some cases, it is – I think it’s an important thing to do. As a pediatrician, I talk to my families about the need for vaccines, and they ultimately have the final decision. But when the recommendation is not a universal recommendation that every child and all pregnant women should get the vaccine, it does allow for more discussion in terms of, is it truly safe? Like, why is this no longer a universal recommendation? Why are we being told that not everybody has to get this? So I think the shared decision-making option ends up sowing doubt in terms of the need for vaccines for these patient populations. So I think it further complicates the picture.

HUANG: Jason, you’ve studied how public trust in vaccines has gone up and down in the past, and I’m wondering, from those past experiences, what has improved it and are things heading in that direction right now?

SCHWARTZ: Sure. I think what we’ve seen when individuals have doubts or concerns or questions or a lack of trust in public health recommendations or vaccines in particular, what moves the needle is not a public service announcement or a snazzy website from a public health organization, but it really is the kinds of recommendations and clarity and empathy from a health care provider, a pediatrician or another physician, for example, who a family knows, can relate to, can talk to, can try and seek clarity. So I think, you know, that will – if there is a path to overcome all of this turbulence that we’ve been speaking about, it will really come from the frontline health care providers who can sit down and can try and help sort through the noise, help see what the evidence points to and can help little by little try and reverse, I think, the confusion that we’re seeing here. But that is a long and challenging hill, particularly in the face of so much attention being given in many cases to – it’s either long refuted or discredited vaccine safety hypotheses or inaccuracies regarding the benefits of vaccines. There’s a megaphone coming that is amplifying, I think, questions about vaccines that it will be very challenging to undermine, but I think it will begin with those frontline health care providers.

HUANG: Dr. Cvijanovich, I’m wondering if you can describe a situation with a patient who is confused. How would you direct them in this particular time and place?

CVIJANOVICH: Yes, I can bring up a specific conversation I had with a family just a couple of weeks ago where this is a family who has not been immunizing their now toddler. And at the 12-month well child check, we generally do a few vaccines. And one of the vaccines we traditionally do at this checkup is the measles vaccine. And I know this family, and I said, you know, I understand that you haven’t been vaccinating your child until now, but I do think that I would like you to consider the measles vaccine very seriously because we are seeing measles in our community, and it is an extremely dangerous disease that can cause long-term effects. And we know that the vaccine is effective, and it has been around a long time. And I would really appreciate it if you considered protecting your child against the measles virus.

And the parent said, well, I absolutely do not want that vaccine because I don’t want any mRNA vaccines. And I explained that currently the COVID vaccine is the only mRNA vaccine that we use and that the measles vaccine is not an mRNA type vaccine. And the father said, that’s not true. That’s not what I’ve read. And you don’t know that they haven’t changed the measles vaccine into an mRNA vaccine. And so I am battling this type of information, and it is a very challenging thing.

HUANG: Jason, what do you make of Dr. Cvijanovich’s example? Do you think that this is, you know, what you’re talking about in terms of how trust can be restored?

SCHWARTZ: Exactly – that often, you know, we think that folks who have doubts or questions of vaccines may be sort of really committed opponents or critics, the kinds of folks that we sometimes see on the news or protesting vaccines. And while those represent a portion of individuals who have reservations around vaccines, it’s far more common for individuals like the family we just heard about who have questions or concerns. Maybe there’s some confusion. Maybe there’s some factual misunderstanding. And by and large, we know from research that families who have reservations around vaccines overwhelmingly are trying to figure out what to do for their children, how to best take care of their children. And providing a venue where hopefully doubts and questions and concerns can be clarified is exactly the kind of setting that can address concerns, maybe not all the time but certainly sometimes.

CVIJANOVICH: I do feel like when I talk to my families who are hesitant about vaccines, the best part of my job is watching their child grow up and be a healthy, successful person. And there is so much information out there. And one of my jobs that I take extremely seriously is making sure that I am always current on vaccines and current safety profiles of all the vaccines. And I do stress with these families that, you know, you trust me to take care of your child when they’re sick and at their most vulnerable. I take that trust very seriously. So when I tell a family that I believe that this vaccine is safe for your child to take, that is not a sentence I say lightly. I feel responsible because they are placing their most treasured possession in my hands literally and figuratively.

HUANG: That’s pediatrician Dr. Alexandra Cvijanovich in Albuquerque, New Mexico, and Professor Jason L. Schwartz from the Yale School of Public Health. Thank you both for joining us.

CVIJANOVICH: Thank you.

SCHWARTZ: Thank you.

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