One recent morning, I found myself reading a book to my toddler about two young bears who go to the doctor to get their booster shots. One of the bears is nervous and asks the bear doctor why he needs the shot when he isn’t even sick. The doctor explains the science behind vaccination and the young bear agrees to the booster. A crowd has gathered in the waiting room to witness his bravery; they applaud.
This is a children’s story about three bears who talk. That’s not the only way the story differs from our reality.
The future of vaccine policy is uncertain under Robert F. Kennedy Jr., the secretary of health and human services, given his history of criticizing vaccines and his desire to change the childhood vaccine schedule. This week, many doctors watched nervously as his handpicked Centers for Disease Control and Prevention vaccine advisory panel met to debate multiple vaccines.
The results were confusing and the process chaotic, but things largely turned out better than expected. The committee voted against recommending the combined measles, mumps, rubella and varicella vaccine for children under 4 (though kids can still get the M.M.R. and chickenpox vaccines separately). It also postponed a planned vote on the hepatitis B vaccine for newborns, despite plenty of debate among several members that revealed a deep skepticism about the vaccine. Members raised exaggerated fears about harm from the Covid-19 vaccine but still narrowly rejected a resolution that would have urged states to require prescriptions for the shots.
There’s a lot of uncertainty and confusion for public health in America, and it will mostly fall to individual doctors to help people understand which vaccines they need to get and when. The advisory panel, for instance, voted to rescind federal recommendations for Covid vaccines in favor of shared clinical decision-making, putting the onus on doctors to decide about the shots. I spoke with doctors from multiple states who are trying to understand how best to advise their patients now.
Some states, like Massachusetts and California, are entering new health alliances with neighboring states to generate the scientific recommendations that used to be a federal responsibility. But what does that mean for physicians in states like Florida, where anti-vaccine sentiment has resulted in a complete dismissal of science and recommendations are following political leanings rather than data?
Despite a measles outbreak in a Florida suburb last year, the state’s surgeon general recently announced that he wants it to end all vaccine mandates for schoolchildren. (It’s unclear if that will happen.) This is not just about Covid but also about vaccines that have saved countless kids. How does a doctor square those two realities during the limited time allotted in an office visit? In many cases, it is simply not possible. “Many of us are scrambling to get clear information” about what’s to come for the state’s vaccine access, said Dr. Cynthia Rivera, an infectious disease specialist in Miami.
Dr. Rivera is grappling with how to be diplomatic and clear with patients. She wants them to trust high-quality science, which shows childhood vaccinations are essential and safe. In a better system, no layperson would have to parse the data on her own.
“They’re politicizing medicine to the point that they’re putting doctors against the wall,” said Dr. Lizy Paniagua, also an infectious disease specialist in Miami. Dr. Paniagua remembered a young woman she saw recently who had a new diagnosis of H.I.V. Despite her compromised immune system, the patient simply refused to get vaccinated. There were no words that Dr. Paniagua could use to change the patient’s mind. Despite scheduling follow-ups, the patient never returned to the clinic.
In the hospital where Dr. Paniagua practices, doctors have decided that anyone who comes in with a fever and a rash will be placed immediately under airborne precautions with concern for measles. “It’s a scary time,” she said.
This isn’t just a question of vaccine acceptability. Doctors are also worried that patients are going to face challenges with vaccine access. Even if people want vaccines, such as for Covid-19, will they be able to get them? This is what worries Dr. Grace Lee, a pediatrician in California who served as the chair of the C.D.C.’s vaccine advisory panel during the Covid-19 pandemic. Dr. Lee is fielding questions from patients about whether they can get vaccines at her hospital, because pharmacy access is so uncertain and varies from state to state and pharmacy to pharmacy.
If nothing else, the pandemic taught us that we are all interconnected. Any disease that affects some of us will ultimately affect all of us, through the very air that we breathe. Which means that the counseling that a doctor in Miami offers for a patient in the office will ultimately affect us all. “There is no income bracket for which you don’t get measles if herd immunity falls through,” said Dr. Rivera.
After I finished reading the children’s book to my daughter, I looked at what year it was published: 1981. Four decades ago, and we seemed to have a clearer understanding of vaccination and evidence then than we do now. If we look ahead to the future, perhaps we can envision a return to that time. But I worry how many more preventable deaths we will need to see before we change our course.
Daniela J. Lamas, a contributing Opinion writer, is a pulmonary and critical care physician at Brigham and Women’s Hospital in Boston.
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