Getting Another Shot: Physicians Combat Post-COVID Vaccine Hesitancy
By Sean Price Texas Medicine July 2022

Thousands of Texas children are getting back-to-school vaccinations before starting the new academic year.

As they do, Texas physicians see evidence that for some patients, skepticism about the COVID-19 vaccines has turned into skepticism about all types of vaccines. 

“There are a lot more people who have questions about vaccine safety, and there’s more vaccine hesitancy post-pandemic than there was prepandemic. And there was already an issue [with vaccine hesitancy] prepandemic,” said Austin pediatric infectious disease specialist Donald Murphey, MD, who sits on the Texas Medical Association’s COVID-19 Task Force and is immediate past chair of the Council on Science and Public Health.  

Keller pediatrician Jason Terk, MD, sees that increased hesitancy as a kind of “parallel contagion” in which skepticism about COVID vaccines has infected once healthy public perceptions about childhood vaccines.  

“We’re seeing that quite a bit among established families with … children who previously accepted vaccines readily,” said Dr. Terk, chair of the Texas Public Health Coalition, which includes TMA. “We’re spending a lot more time addressing questions and concerns about vaccines among families who once accepted them without much hesitancy at all.” 

Between 2019 and 2020, childhood vaccination rates in Texas dropped by 47% among 5-month-olds, 58% among 16-month-olds, and 5% among 24-month-olds, according to a June 8, 2021, study published in Vaccine. Vaccinations given at birth remained steady, the study says.  

The drop-off in childhood vaccination occurred in large part because families stopped bringing children to in-person physician appointments in the months after COVID emerged in the U.S. in March 2020. Few people – even medical professionals – had adequate personal protective equipment, and there was great uncertainty about how easily COVID could spread. 

 In the absence of real-time data on current childhood vaccination rates, physicians contacted for this story say those rates appear to have rebounded to near – but below – prepandemic levels as medical offices have resumed more normal operations.  

They also say the trend toward greater skepticism about childhood vaccines is unmistakable in their practices. 

“I’ve had a couple of kids who were vaccinated as infants come back and be due for their 4-year-old vaccines for starting school, and parents were either not wanting to vaccinate or were very hesitant and had lots of questions about vaccination,” said Tyler pediatrician Valerie Smith, MD, chair of the Council on Science and Public Health and a member of TMA’s COVID-19 Task Force.  

Dr. Terk says he and other physicians address those concerns respectfully. (See “Countering Controversy,” page 42.) But as they do, physicians have heard other warning signs about increased vaccine hesitancy. For instance, “for early childhood vaccinations, we’re seeing a lot more families who want to get them in a more spaced-out fashion,” he said. 

Skepticism about COVID vaccines is not a foolproof sign that someone will show hesitancy about childhood vaccines, Dr. Terk says. However, those who are newly skeptical about childhood vaccines also tend to be skeptical about COVID vaccines. 

Childhood vaccines have a longer track record of success, and people have more faith in them, Dr. Murphey says. But attacks on all types of vaccines on social media, in the press, and by some public figures have made people question them, and he is concerned that could lead to a long-term decline in vaccinations that have protected children for generations. 

“Faith [in childhood vaccines] is at risk, and I think there has been erosion of faith in public health too,” he said.  

The good news: Physicians are still a trusted source of information on vaccines for young patients and their families, says Pasadena pediatrician Lindy Upton McGee, MD, an assistant professor at Baylor College of Medicine. And not all childhood vaccines face the same level of scrutiny.  

Addressing the skeptics 

“About a year ago, I remember I had a patient who came in for [an 11-year-old well-child visit] and had gotten all their vaccines [previously] and now were refusing all the 11-year-old vaccines,” said Dr. McGee. “I thought, ‘Oh, no. This a bad omen of things to come.’ But it really hasn’t turned out that way. Fortunately, most people, even if they refuse the COVID vaccine, are still getting [most of] the routine childhood immunizations.” 

However, she and her colleagues have seen the most pushback with the flu vaccine. “We’ve had some patients who have every year gotten flu vaccine and are now refusing both the flu and the COVID vaccine.” 

Other physicians report an uptick in refusals for adolescent vaccines, specifically the one for human papillomavirus.  

“I’m seeing hesitancy around that one, partly because it’s not required for school attendance,” Dr. Smith said. “It’s easier for patients to decline it or push back on it.” 

Many parents are willing and even eager to talk about their objections, Dr. Terk says. However, others put up barriers that make discussion impossible. For instance, many parents blame their spouse – who is not present – for objecting to a vaccine.  

“You don’t really have access to the stakeholder who is refusing the vaccine in the room,” he said. “You say, ‘I’d be glad to speak with your husband or your wife about what their concerns are and be sure to send me a message,’ and we don’t hear back from anybody.” 

Parents who do discuss their objections usually have two major points in mind, Dr. Smith says. 

“There’s skepticism around the science of vaccines and the safety of vaccines, and that is a place where physicians are well-armed with data and personal experience to fight back,” she said. “There’s also skepticism of the government requiring anything of someone. And that one’s really hard because that’s not where a physician’s role really lines up.” 

Increased skepticism about childhood vaccines has been encouraged by anti-vaccine forces, says Dr. McGee, who serves on the board of The Immunization Partnership, a Houston-area organization that promotes vaccines through education and advocacy. She fears it will be used to convince lawmakers during the session of the Texas Legislature that begins in January 2023 to weaken requirements that schoolchildren be vaccinated. 

“The fact that you need these vaccines for school helps [overcome the objections of] the vaccine-hesitant parent,” she said. If those requirements wane, “our job would become so much more difficult. We would really be looking at measles outbreaks in Texas.” 

In fiscal year 2021, a total of 115,675 Texans requested a conscientious exemption from at least one vaccine requirement for child care facilities and elementary or secondary schools, according to the Texas Department of State Health Services (DSHS). That is a 50.5% increase over 2020, and it represents a 79% increase since 2017.  

Physicians can best address the increased vaccine skepticism caused by COVID in part by continuing what they’re doing – calmly and thoroughly addressing parent questions in the exam room, Dr. McGee says. 

“A Kaiser Family Foundation poll asked people who they trust the most, and people trust their child’s pediatrician the most when discussing vaccines,” she said (tma.tips/KFFVaccinePoll2021).