I believe in making it very difficult for people to refuse vaccines. There’s enough of the libertarian about me that I wouldn’t actually strap them down and inject them, but I’m fine with school districts making parents write out their conscientious objections to children being immunised or with sports clubs requiring adult proof of immunisation before people can join. What I or you think is, though, beside the point. Much of the US is walking away from cajoling and compulsion and there’s great pressure in Europe for similar change. We can either go on moaning about how we wish the world hadn’t changed or we can respond effectively.

Before the current US Administration began rewriting vaccine recommendations, one in six US parents wasn’t following them. We used to joke that vaccine-preventable diseases in the West had become diseases of children of the over-educated middle classes who shopped at Whole Foods and did naked yoga classes; vaccine refusers now are still more likely to be white, but they skew to being conservative, very religious, and young. Recommendations actually reduced uptake in this group because most have a deep distrust of the Federal Government and its agencies.

Formal vaccine refusals in Poland more than doubled from 2017 to 2022 and reached over 87,000 in 2023, a 1685% increase since 2003; measles cases surged 10x in early 2024 due to falling rates. Ireland, where I live, has the third-lowest childhood vaccine coverage rate in the OECD.

There are bright spots too, Italy for example, and the battle is far from lost. But the mistrust now endemic to the United States is coming to Europe.

High-handed US and European experts

You can understand confusion, if not mistrust. About half of parents in the USA did not vaccinate their children for flu in the past year, compared with 41 percent who said they had done so, a Washington Post / Kaiser Family Fund poll found. Coverage started declining after 2019. In 2016, the US CDC said that the nasal flu vaccine used in children provided “no measurable benefit” (injectable vaccines for adults were, as usual, highly effective). In the same year, Public Health England said that the same vaccine (produced by a British company in a British factory) was 58 percent effective. Canada followed the UK, saying that its population was very different to the USA! It’s very unlikely that both the Americans and the Canadians were right — despite those obvious population differences…. Few journalists covered the story — I suspect because no-one wanted to be accused of promoting vaccine scepticism. The vaccine is now recommended again in the USA.

Few American paediatricians and even fewer nurses would have been able to explain this to parents because no-one ever bothered to give the professionals an explanation. What do we think doctors told parents who asked why a vaccination was recommended then was not and then was again? British parents who did a web search (this was pre-Chat GPT, remember) might have asked why their children were getting an apparently ineffective vaccine and would have met equally bemused stares from their health providers. Did anyone brief social media influencers or health journalists? Of course not, who do they think they are? What impudence…

I know some of those involved and I’m sure that there was no subterfuge and nothing sinister going on; the answer is likely to be dull and involve methodology and surveillance systems.

This is the way we all used to approach treatment discussions 40 years ago — the doctor told you what to do, you thanked him (it was nearly always a him) and you did it. Questions were a sign of disrespect, of even psychological illness. I was recently treated by a Russian dentist, now practising in Ireland, who was shocked and outraged when I questioned his recommendation to use antibiotics prophylactically; if he had been Irish, he would have been completely used to it.

Nonsensical recommendations in developing countries

Vaccine hesitancy looks a bit different in France. Those least likely to have their children vaccinated tend to be more educated, high users of the internet for information and to have lower trust in health authorities. Those who refuse vaccines for themselves tend to be at the lower end of the social hierarchy with less education and fewer financial resources. Many are ​immigrants and descendants of immigrants, and residents of French overseas departments. Both are probably likely to know about the vaccines which Western experts recommend for children in the developing world, including in Francophone countries.

I remember doing a policy interview with the health minister of a large Indian state. I was trying to find out what he might pay for an effective TB vaccine. “But”, he said, “we already have a TB vaccine. Why do I need a new one?” His top civil servant was sitting behind him and frantically gesticulating to me to try to stop me explaining that the BCG vaccine, given to almost every Indian newborn, may do nothing to prevent TB infections and, at best, may make the disease less severe in some of the children who contract it. It is, though, very good at causing severe side effects. No developed economy uses it; almost every poor one does.

I’m ashamed to say that I did not explain BCG as clearly as I should have to the minister. He was the norm, not the exception, in that series of policymaker interviews: few of those making decisions about TB vaccine policy had ever been given a thorough, honest briefing about the limitations of the vaccines their expert advisers recommended. None of the parents, of course, were ever told about any of these reservations.

There might also be a case for the current practice of giving many children in Africa and Asia a vaccine that sometimes causes polio, instead of preventing it, although I doubt it. The risks of a child contracting polio from the live-attenuated oral vaccine are probably underestimated when they’re presented to politicians and policy influencers. Hardly any parents who bring their children forward for these vaccines are told about the risk or the rationale for continuing to use them, rather than the perfectly safe inactivated vaccine used throughout the rich world.

Is it any wonder that those with insight into the developing world are sceptical? The real wonder is that vaccine confidence is still so high in Africa and Asia. That probably comes from everyday encounters with the tragic consequences of infection by vaccine-preventable illnesses, an experience blessedly denied to most Americans and Europeans.

What we need to do now

The road ahead has been cleared for us. Thirty years ago, I went out with a trainee doctor at the Royal College of Surgeons in Ireland. He was upset one evening because he had been berated by his tutor for telling an older patient that she had cancer — it had been agreed with the family that she would be told that she had a “growth” to avoid upsetting her. At least she found out: King George VI of the United Kingdom sent his daughter, Princess Elizabeth, on a world tour in 1952 because neither he nor she had been told that he had lung cancer and that it was terminal. He never saw her again. These stories shock us now because honesty, realism and communication are taken for granted in what we tell patients who are ill. These principles need to be the new basis for what we tell people who are healthy and want to stay that way.

First we need a change in attitude. Whether to be immunised or not is a decision that people will take — actually, a series of decisions. We don’t need to think about whether we like the concept or not, it is the way things increasingly are. We have to get ordinary people used to making good decisions, just as they do about other life issues such as house buying or insurance or continuing education. Ordinary people are not property experts or risk analysts or trained evaluators of course offerings, but they mostly make reasonable choices. They can do the same thing with vaccines.

Then, we need to communicate much more. Vaccine producers are free to talk to the public about recommended vaccines in many countries; where they are not, they need to be allowed to. Then they need to accept their responsibility to speak often, clearly and loudly. They are the experts on the vaccines they produce and they must tell potential recipients or the parents of recipients about the benefits and disadvantages. Of course, they need to do it in an honest and balanced way. They will be more successful if they communicate in partnership with professional organisations, charities and respected consumer groups. They can be transparent: they have a commercial interest in getting people to accept vaccines but a legal responsibility to set out all the factors in deciding whether to or not. It’s like banks selling mortgages and car dealerships selling warranties.

Researchers and healthcare providers need training in communication and answering questions. They need to be much better at helping policy makers to make decisions about vaccines. Today, too few vaccines are reimbursed and many are offered only to some of those who would benefit from them. In many countries, it is still too hard to get vaccinated and even where rules have changed, practices have not — look at Poland, for example. Politicians and public officials can unleash vaccines so that they can do even more to boost productivity, growth and wealth in society.

Those same scientific and medical experts need to be much better at talking to people who are making decisions about immunisation. Research tells us clearly what helps the right decision, but too few professionals follow the evidence. The most powerful prompt to action is a trusted health professional saying, “I would like you to do this”. Setting a good example works wonders too, but too few health professionals have had all of the vaccines recommended for them.Communication can change all of this.

The vast majority of social media influencers want to give good advice and powerful motivation but no-one talks to them — after all, we want people to follow the guidelines, not think, don’t we? For example, have you seen Dr Mike Varshavski take on 20 vaccine sceptics at once? Thirty million people probably have over various platforms and he’s brilliant. Industry and professionals need to work with influencers who specialise in women’s issues, childhood, workplace effectiveness and, of course, health. Look at this from Dr Ahmed Ezzat — his videos on RSV reduced calls to the emergency services by 25% — and just think what he can do for vaccines.

Journalists are discouraged from writing pieces about vaccine decisions — “just tell people to follow expert recommendations”. Many, consequently, avoid writing about vaccines. We need to treat these journalists as powerful allies in helping lay people to make important decisions with lifelong implications for their risk of developing chronic illnesses. It’s the way that property developers treat journalists who write about houses,

Honestly, I still think it would be simpler and still ethically correct to just nudge almost everyone into getting immunised but that is not an option in many places now and, given the global market in ideas, won’t be one anywhere soon.

Parents get things right

Asia should encourage us. Many parents save and spend to get their children the best vaccines. The state often provides old tech or nothing, so middle-class parents take their children to private clinics for the best protection and pay full price for it. Of course, it’s not fair to poorer children and it is crazy public policy given that population sizes will plunge across Asia over the next 30 years so every child, whether middle class or not, is a precious national resource. Still, it shows that individual families can and do make better decisions than health policy makers when the routes of communication are open and used well.

The post We Have to Earn Better Vaccine Coverage Rates appeared first on Medika Life.

“First 100 days,” said Means, a former consultant to Big Pharma who uses the social platform X to focus attention on chronic disease. “What should be done to reform the FDA?”

The question was more than rhetorical. Means is among a cadre of health business leaders and nonmainstream doctors who are influencing President Donald Trump’s focus on health policy.

Trump’s return to the White House has given Means and others in this space significant clout in shaping the nascent health policies of the new administration and its federal agencies. It’s also giving newfound momentum to “Make America Healthy Again,” or MAHA, a controversial movement that challenges prevailing thinking on public health and chronic disease.

Its followers couch their ideals in phrases like “health freedom” and “true health.” Their stated causes are as diverse as revamping certain agricultural subsidies, firing National Institutes of Health employees, rethinking childhood vaccination schedules, and banning marketing of ultra-processed foods to children on TV.

Public health leaders say the emerging Trump administration’s interest in elevating the sometimes unorthodox concepts could be catastrophic, eroding decades of scientific progress while spurring a rise in preventable disease. They worry the administration’s support could weaken trust in public health agencies.

Georges Benjamin, executive director of the American Public Health Association, said he welcomes broad intellectual scientific discussion but is concerned that Trump will parrot untested and unproven public health ideas he hears as if they are fact.

Experience has shown that people with unproven ideas will have his ear and his “very large bully pulpit,” he said. “Because he’s president, people will believe he won’t say things that aren’t true. This president, he will.”

But those in the MAHA camp have a very different take. They say they have been maligned as dangerous for questioning the status quo. The election has given them an enormous opportunity to shape politics and policies, and they say they won’t undermine public health. Instead, they say, they will restore trust in federal health agencies that lost public support during the pandemic.

“It may be a brilliant strategy by the right,” said Peter McCullough, a cardiologist who has come under fire for saying covid-19 vaccines are unsafe. He was describing some of the election-season messaging that mainstreamed their perspectives. “The right was saying we care about medical and environmental issues. The left was pursuing abortion rights and a negative campaign on Trump. But everyone should care about health. Health should be apolitical.”

The movement is largely anti-regulatory and anti-big government, whether concerning raw milk or drug approvals, although implementing changes would require more regulation. Many of its concepts cross over to include ideas that have also been championed by some on the far left.

Robert F. Kennedy Jr., an anti-vaccine activist Trump has nominated to run the Department of Health and Human Services, has called for firing hundreds of people at the National Institutes of Health, removing fluoride from water, boosting federal support for psychedelic therapy, and loosening restrictions on raw milk, consumption of which can expose consumers to foodborne illness. Its sale has prompted federal raids on farms for not complying with food safety regulations.

Means has called for top-down changes at the U.S. Department of Agriculture, which he says has been co-opted by the food industry.

Though he himself is not trained in science or medicine, he has said people had almost no chance of dying of covid-19 if they were “metabolically healthy,” referring to eating, sleeping, exercise, and stress management habits, and has said that about 85% of deaths and health care costs in the U.S. are tied to preventable foodborne metabolic conditions.

A co-founder of Truemed, a company that helps consumers use pretax savings and reimbursement programs on supplements, sleep aids, and exercise equipment, Means says he has had conversations behind closed doors with dozens of members of Congress. He said he also helped bring RFK Jr. and Trump together. RFK Jr. endorsed Trump in August after ending his independent presidential campaign.

“I had this vision for a year, actually. It sounds very woo-woo, but I was in a sweat tent with him in Austin at a campaign event six months before, and I just had this strong vision of him standing with Trump,” Means said recently on the Joe Rogan Experience podcast.

The former self-described never-Trumper said that, after Trump’s first assassination attempt, he felt it was a powerful moment. Means called RFK Jr. and worked with conservative political commentator Tucker Carlson to connect him to the former president. Trump and RFK Jr. then had weeks of conversations about topics such as child obesity and causes of infertility, Means said.

“I really felt, and he felt, like this could be a realignment of American politics,” Means said.

He is joined in the effort by his sister, Casey Means, a Stanford University-trained doctor and co-author with her brother of “Good Energy,” a book about improving metabolic health. The duo has blamed Big Pharma and the agriculture industry for increasing rates of obesity, depression, and chronic health conditions in the country. They have also raised questions about vaccines.

“Yeah, I bet that one vaccine probably isn’t causing autism, but what about the 20 that they are getting before 18 months,” Casey Means said in the Joe Rogan podcast episode with her brother.

The movement, which challenges what its adherents call “the cult of science,” gained significant traction during the pandemic, fueled by a backlash against vaccine and mask mandates that flourished during the Biden administration. Many of its supporters say they gained followers who believed they had been misled on the effectiveness of covid-19 vaccines.

In July 2022, Deborah Birx, covid-19 response coordinator in Trump’s first administration, said on Fox News that “we overplayed the vaccines,” although she noted that they do work.

Anthony Fauci, who advised Trump during the pandemic, in December 2020 called the vaccines a game changer that could diminish covid-19 the way the polio vaccine did for that disease.

Eventually, though, it became evident that the shots don’t necessarily prevent transmission and the effectiveness of the booster wanes with time, which some conservatives say led to disillusionment that has driven interest in the health freedom movement.

Federal health officials say the rollout of the covid vaccine was a turning point in the pandemic and that the shots lessen the severity of the disease by teaching the immune system to recognize and fight the virus that causes it.

Postelection, some Trump allies such as Elon Musk have called for Fauci to be prosecuted. Fauci declined to comment.

Joe Grogan, a former director of the White House’s Domestic Policy Council and assistant to Trump, said conservatives have been trying to articulate why government control of health care is troublesome.

“Two things have happened. The government went totally overboard and lied about many things during covid and showed no compassion about people’s needs outside of covid,” he said. “RFK Jr. came along and articulated very simply that government control of health care can’t be trusted, and we’re spending money, and it isn’t making anyone healthier. In some instances, it may be making people sicker.”

The MAHA movement capitalizes on many of the nonconventional health concepts that have been darlings of the left, such as promoting organic foods and food as medicine. But in an environment of polarized politics, the growing prominence of leaders who challenge what they call the cult of science could lead to more public confusion and division, some health analysts say.

Jeffrey Singer, a surgeon and senior fellow at the Cato Institute, a libertarian public policy research group, said in a statement that he agrees with RFK Jr.’s focus on reevaluating the public health system. But he said it comes with risks.

“I am concerned that many of RFK Jr.’s claims about vaccine safety, environmental toxins, and food additives lack evidence, have stoked public fears, and contributed to a decline in childhood vaccination rates,” he said.

Measles vaccination among kindergartners in the U.S. dropped to 92.7% in the 2023-24 school year from 95.2% in the 2019-20 school year, according to the Centers for Disease Control and Prevention. The agency said that has left about 280,000 kindergartners at risk.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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