In the 20 years I’ve spent researching vaccine decisions, I have spoken to plenty of parents who reject shots for their children. Some say vaccines are never safe or necessary or that polio went away on its own and the vaccine wrongly got credit. I’ve heard comparisons of vaccines to snake venom. In reality, however, the number of people who reject all vaccines is quite small — so small that they are unlikely to compromise public health.
The greater issue, the one we don’t discuss often enough, is the many parents who don’t identify as being opposed to vaccines but don’t always consent to them.
Even before the Covid-19 pandemic, one-quarter to one-third of American parents were delaying vaccines or picking and choosing them cafeteria-style, deciding certain vaccines weren’t relevant to their family because they believed the risk for the disease was low. Some parents design their own vaccine schedules, often customizing for each child based on their perceptions of risk, benefit and how they believe their child will handle it.
Often, these families don’t consider themselves anti-vaccine. They just trust their own judgment more than expert recommendations. But the outcome is the same: Their children are not immunized at the ages when they’re most vulnerable to the worst outcomes of infection and can spread disease to others.
The growth of vaccine hesitance in America may feel inexplicable, ignorant or irrational to those who feel confident in their decisions to vaccinate. Yet my research suggests that this approach to vaccines is entirely logical in a culture that insists that health is the result of hard work and informed consumer decisions and too often sees illness as a personal failure.
In many ways, especially now, parents who reject vaccines are following expert advice. Myriad parenting books and specialists have encouraged women, starting during pregnancy, to see themselves as experts on their children and to trust their instincts. This matches public health messaging, which over the past several decades moved away from collective aims like improving the quality of air and water toward a focus on behavior modifications, like diet and exercise. It also echoes the recommendations of the health and human services secretary, Robert F. Kennedy Jr., whose Make America Healthy Again campaign insists Americans can take control of their own health with wider use of wearable technology and more focus on nutrition.
Flanked by leaders of the nation’s health institutions, including Mr. Kennedy, President Trump recently told parents to space out vaccines and to delay the hepatitis B vaccine until their children are at least age 12. This highlights just how mainstream it has become to postpone or personalize vaccinations, even though such an approach is at odds with the realities of infectious disease.
In a world that feels increasingly uncertain and unsafe for children, it’s no wonder that parents generally and mothers, in particular, have embraced the ethos that they know best. Mothers’ willingness to work hard to ensure their children’s health is why the government’s announcement that women should avoid Tylenol during pregnancy and tough it out has caused so much turmoil. Although there is little clear evidence that typical acetaminophen use in pregnancy causes autism, many mothers of children with autism have new reasons to feel guilty or to question their behaviors.
Parents who refuse vaccines don’t necessarily deny the seriousness of some vaccine-preventable diseases. Polio, they know, was a serious disease but hasn’t spread in the United States since 1979. Chickenpox they remember as uncomfortable, but most recall recovering without incident. Vaccines, they reason, should feel relevant to their lives — and when they don’t, universal recommendations and mandates for school attendance can feel unnecessary or even oppressive. The impact of their vaccine choices on others is not necessarily part of their calculation. And why should it be? There are few other arenas in which parents are asked to consider the effects of their choices on other children.
But collective investments make personal choice possible. High-quality food is possible because of public investment in food inspection and testing. Crosswalks and traffic rules, maintained and enforced collectively, make it possible for kids to walk safely to school. Vaccines are often taken for granted, and their widespread use has prevented countless miscarriages, serious illnesses and child deaths.
Take hepatitis B. It is spread through bodily fluids and can be transmitted through unprotected sex, making it seem like a vaccine for people whose behaviors place them at risk. But it can also be passed from mother to baby during childbirth or between people sharing personal items like toothbrushes and earrings. America previously limited the hepatitis B vaccine to groups it viewed as most likely to contract the virus, but that strategy proved unsuccessful, with one-third of affected people having no identifiable risk. The country moved to universal vaccination of infants in 1991 and virtually eliminated the disease in people under 18 years old.
Across all vaccine decisions, parents share the desire for healthy children and healthy communities. The real solution is better public investments and clearer information that can make parents feel confident in their choices. Instead, parents are left to figure out on their own whether the ingredients in their cleaning supplies are safe, whether their food supply can be trusted and now whether giving their child Tylenol is wise. Against that backdrop, deciding whether to vaccinate a healthy child against a hypothetical future risk feels increasingly high stakes, especially when official advice is so confusing.
Most parents choose to vaccinate their children. Yet the growing unease with vaccines reflects how many parents now feel they must trust their own judgment rather than expert advice that feels generic, impersonal or politicized. What leaders should be communicating is that while a healthy lifestyle and good parenting are important, they are not adequate protection against infectious disease. This was made tragically clear when one unvaccinated child died of measles this year while her siblings in the same house recovered.
The current administration is unlikely to offer clarity here. But other health leaders — including individual doctors, researchers and health care organizations — should. Americans have a long history of facing challenges together. Vaccine science, often paid for by the people for the people, is part of that story. Rather than leave parents to mitigate risks beyond their control, real leadership would remind us that we need one another to ensure all our children are safe and healthy.
Jennifer Reich is a professor of sociology at the University of Colorado, Denver. She is the author of “Calling the Shots: Why Parents Reject Vaccines” and “Fixing Families: Parents, Power, and the Child Welfare System.”
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