how i responded to a vaccine-skeptical parent

Someone in my life recently welcomed their first child into this world.

He called me yesterday, very upset about an encounter at the pediatrician’s office. You vaccinated your kids, he said. Did you notice any changes in them? Are they…different now? Different from other kids?

Well yes, I told him. They’re different in that they’re far superior to all other children. But I don’t think that’s related to the vaccines.

(Relax, I was kidding. I’m sure your kids are great, too.)

She was so rude, he told me. She acted like I was crazy and stupid for having questions.

I want to be clear up front about one thing so that it doesn’t get lost in the shuffle of what I am about to say: Vaccines are a miracle.

They are a major reason I don’t need to birth seven children and pray that one or two make it to adulthood. We are so extremely lucky to have them, and I am very much PRO vaccine.

My children are vaccinated.

I had a mother’s helper after my second child was born, a 14 year old who would play with Violet for a fews hours a week while I nursed the baby. I required that she get vaccinated before spending time with my children.

Vaccines are life saving and essential!

And…I understand why a first-time parent would be hesitant.

There’s a massive asymmetry of information between you and the doctor (unless you are a medical doctor, too, of course). I think many parents are tempted to get overnight medical degrees via frantic 3AM googling after their first child is born. Analyzing images of the various shades of infant poop and reading whatever literature they can find about colic and obligate nose breathing and the functionality of the pediatric esophagus.

You have a tiny life in your care, more responsibility than most people have ever had before, and now you have to make potentially life-altering choices on their behalf. How can you know the right thing to do?

Not just guess and hope, but know, with 100% certainty?

You can’t.

And maybe you’re still slightly traumatized from the moments after your child’s birth when the nurses grabbed him and started pricking his toe and making him scream and giving him a vitamin K shot and smearing goop on his eyes. You’re still slightly reeling from that, uncertain if you should have spoken up, asked more questions, been more protective in that moment. Was that the right thing to do? You’re still not sure. You hope it was, but how can you know?

So you try to research.

There’s so much dis- and misinformation online. Our own government is telling people that Tylenol causes autism, so it’s no wonder parents are scared and confused. I have no judgment toward vaccine hesitant parents.1 The risks feel really high. The stakes are your child’s entire future.

The thing is, though, there are risks on both sides. Not vaccinating might feel like the safe/neutral choice in the moment, but it carries large risks.

And I told this to the parent: There may be some risks in the vaccines. I am not a doctor. If nothing else, it’s certainly documented that vaccines can cause fevers, and fevers can be risky for newborns.

It’s also true that the vaccine schedule has ballooned in recent decades, with far more shots within the first year than ever before. But do you consider the risks of the vaccines to be greater than the risks of measles, mumps, rubella, polio, pertussis, diphtheria, etc.?

Well then why do we get so many more vaccines than other countries? he wanted to know.

I’m not totally sure how different countries come up with their recommended vaccine schedules, I admitted.

The government has a difficult job, setting vaccine guidelines. They need to make a universalizable one-size-fits-all plan to apply nationally. RFK is, if nothing else, shining a light on the deep flaws in that process. If the recommendations can be politicized without regard for the scientific evidence, then it’s hard to have much confidence in them.

The current administration has demonstrated that federal vaccine recommendations can be changed through political leadership, and the result is that the American Academy of Pediatrics now maintains a separate schedule, and specifically does not endorse the CDC schedule.

These are some of the deep fissures being wrought by the corrosive influence of the current administration. Fissures that will take more than a change of leadership to undo. Trust is hard to build, easy to break.

And babies are not one size.

I reminded this parent that the doctors share his goals. Everyone wants his baby to be healthy and cared for.

The thing is, the incentives are slightly different. The government needs to optimize for public health. The parent needs to optimize for the individual health of their child.

These goals are broadly aligned, but not perfectly aligned.

Let’s take an example.

Baby A is born in November in New York City, at the start of cold and flu season. He has two older siblings—one in preschool and one in elementary school. Both parents work full time, and Baby A will be starting at daycare when he is 3 months old. They have family coming to visit for Christmas, arriving on planes from around the country. Baby A was born healthy, and is eating and sleeping well and growing fast. He regularly goes to the public park and library with his older siblings, riding in a stroller and taking public transit. They are indoors a lot for play groups, since the weather is getting cold. The family is planning an international trip for spring break in a few months.

Baby B is born in May in rural Montana, an only child. He’s a little bit on the small side, and loses some weight in the first week after birth, but is generally healthy and growing. Mom is not planning to go back to work, and will stay home with Baby B full time. Most of their family is local, and they are not taking any trips any time soon. Mom takes Baby B on walks, and since it’s getting into summer most of their socializing is done outside—hikes, picnics, cookouts, outdoor play groups, etc.

These two babies have the same recommended vaccine schedule. The American Academy of Pediatrics has made a plan that the scientific consensus agrees will apply equally well to these two babies. And that’s fine! No one has done anything wrong. It is not my intention to criticize the recommendations.

I cannot emphasize enough the extent to which I am not a doctor.

However, it is completely sane and reasonable for the parents of Baby A to look at their child and think Oh man, there are a lot of potential disease vectors entering this house, not least from the older siblings. We’d better get this kid vaccinated as soon as possible and hit him with everything the doctor recommends. Let’s do as many shots as we can in one visit, too, because coordinating childcare and time off work for multiple doctor visits is a surefire way to guarantee we get behind in the vaccine schedule.

That is an extremely reasonable approach that accounts for the risks and concerns of this family, and this baby. The parents may even talk to the pediatrician about getting Baby A some of his shots ahead of schedule, to make sure he’s fully vaccinated before starting at daycare, or before getting on that international plane. The pediatrician might look at his size and his health and agree that yes, some doses can safely be given on an accelerated schedule before daycare or international travel.

Meanwhile, the parents of Baby B say, You know what? Baby B is small. It’s summer. We’re not exposing him to anything, so we’re going to delay his first shots a few months. They talk to their doctor. They understand that this isn't the schedule their pediatrician recommends, and that delaying leaves him unprotected for longer. The pediatrician tells them that there are annual outbreaks of pertussis in their region, getting worse every year, and that they should really consider doing the DTaP shot as soon as they’re able. They agree, and get the vaccine. There are three other vaccines that Baby B is eligible to take at this appointment. They decide to wait. They’ll see how Baby B reacts to this vaccine before adding others to the mix. Since Mom does not work, she is able to schedule an appointment every two weeks. It’s not a big deal for her to come back somewhat frequently in order to space out the shots—she does not need to organize childcare or take time off work in order to do it, and it will be covered by insurance. The pediatrician is supportive of this approach, and happy to accommodate their preferences and answer any questions.

By age 2, Baby A and Baby B are both fully vaccinated. Both babies are healthy and happy. The end.

In my opinion, no one here did anything wrong.

The parents of Baby B were vaccine hesitant, and chose to do things on their own schedule according to their comfort level and what they considered best for their child.

Baby B’s parents aren’t necessarily making the medically optimal choice. They’re making a suboptimal-but-understandable choice that still ends with a vaccinated child. And a pediatrician who keeps them engaged rather than humiliating them may be the reason it ends that way.

That’s one of the hardest parts of parenthood and adulthood: The realization that there are no objectively correct answers to anything. There are just choices, made with good intentions and imperfect data.

No one can ever have perfect information before making a decision. That is due to the nature of time moving in a linear fashion (at least according to our limited human perceptual faculties!).

And when it comes to vaccines, there are two important propositions competing with each other:

A. Based on the evidence we have, following the recommended vaccine schedule has the better expected risk/benefit profile for the overwhelming majority of children.

B. Therefore, following the vaccine schedule is a risk-free choice whose outcome is guaranteed to be better for this particular individual child.

B does not follow from A.

The CDC says there is a “very remote chance” of vaccination causing a severe allergic reaction, other serious injury, or death, and there are specific known rare adverse events—for example, CDC estimates the additional risk of intussusception after rotavirus vaccination at roughly 1 in 20,000 to 1 in 100,000 vaccinated infants.

Those numbers are tiny, but they are still nonzero.

Even if the risk is one in a million, somebody’s child is the one. A parent cannot know with certainty that the one in a million won’t be theirs.

Let’s not pretend otherwise. Let’s not treat vaccine hesitant parents with disdain and revulsion. They are not stupid. They are not ignoring scientific evidence.

They may be incorrectly weighting the relative risks, but that is psychologically valid even if not scientifically sound.

I’m sure I could craft a scenario for Baby C, who lives in a high risk area with regular measles outbreaks, who attends daycare full time and whose parents choose not to vaccinate. Baby C has older siblings in school (also unvaccinated) and goes to the senior center every weekend while his mom volunteers.

Those parents are, in my view, making unsafe choices not just for themselves but for their community. The risks they are taking would be, for me, unacceptable. But that’s not my choice to make! The choices in this scenario belong to the daycare (which should require vaccines) and to the senior center (which should require that their volunteers be vaccinated). My kids will not be having playdates with their kids, though I’ll have little power to influence whether they’re playing together at the library or park or school.

This is the delicate task of balancing competing interests and risk tolerances in a complex society.

So what did I tell this panicked parent on the phone?

Well first an foremost, I advised him to find a new pediatrician. Someone who was willing to engage with his questions and develop a plan that he felt comfortable with. There are different brands of vaccines, for instance. Different formulations can contain different ingredients, and a pediatrician can help a parent understand what is actually in each vaccine and whether an alternative formulation is available.

A pediatrician talking down to a parent and dismissing their concerns is not helping, even if they believe themselves to be promoting larger public health goals.

Secondly, I recommended that he make it clear when scheduling his next appointment that he has questions, and would like to book a longer appointment time in order to talk things through with the doctor. He felt that the pediatrician was attempting to rush them through to limit their time to a 15 minute slot. This is not a way to inspire confidence in a new parent.

Thirdly, I reassured him that the doctors ultimately share his goal that his child be healthy. I told him that there are risks to everything a person does—not vaccinating carries, in my opinion, far greater risks than vaccinating. But there are no objectively correct or perfect choices, and all he can do is make the choice that feels best for his circumstances. Which he should look at clearly. Will this kid be in environments where he’s likely to be exposed to illness? Or do they have the luxury of fully controlling his environment until they decide it’s safe to vaccinate?

There is no perfect defense against communicable diseases.

There is no perfect knowledge that your kid won’t be the one in a million.

There is no guarantee that you won’t get hit by a truck on your way to the pediatrician’s office.

Life is scary.

I articulated that he has permission to modify the recommended schedule to suit the unique considerations of his family and his child. The recommendations are made for a population level, and he can tailor those recommendations for his comfort.

Well for one thing I don’t necessarily believe that. But for another, I don’t believe that approach to be effective.

For this particular person—and for many others!—that kind of attitude would be likely to inspire defensiveness, protectiveness, rebellion, and a complete rejection of all vaccines. It is my belief that my words will produce at least some vaccines, and some is better than none! Maybe he won’t get the flu shot, or the covid vaccine, but if that baby gets DTaP and MMR then I will consider that a success.

Let’s not let perfect be the enemy of good.

Vaccinating on schedule is the medically preferable choice. AND: Vaccine-hesitant parents are not stupid or evil. Doctors should answer their questions seriously, and treat them with respect.

Delaying vaccines carries a real risk. And if an incremental path is the only path by which a particular parent can get from fear to vaccination, keeping them walking down that path is more useful than screaming at them for not already being at the destination.

So before we all leap to criticizing parents for making choices that differ from our own, let’s try to remember that we are all doing our best, balancing different risk profiles and tolerances in different circumstances.

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