Very good article and well presented groups of vaccine hesitant. Super helpful for those of us in this space. One consideration to add to your rationale is a sober reckoning of where we as clinicians have got it wrong in the past. A little “mea culpa” can go a long way toward winning back the trust of our patients. There’s a big COVID hangover due to some really big misses on the public health side. Owning those helps our patients not throw the baby out with the bath water.
I'm not a physician, just a retired neuropsychologist who sees hundreds of comments about vaccines on social media every day.
It seems to me that most are either bots, nasty people posting disgusting memes, and quite possibly agents of foreign governments and some far-right political groups that want to damage US public health.
Mixed in are a few questions that appear to be from actual humans who fit into the categories you listed.
My occasional responses range from lists of facts with citations to pointed sarcasm. I mention all this because I'm quite worried about what appears to be a decline in public trust in science itself. Thank you for your commendable efforts.
Absolutely! Bots are a huge issue - no doubt about it. But many of the questions and comments do come from humans (as reflected in our exchanges, surveys, interviews, clinician feedback, etc.). Without question, though, we are dealing with external forces that are very intentionally throwing gasoline on the fire...
Yes. Behind many of these "vaccine questions" and rants and delusions - are astroturfers, chaos agents, conspiracy-addled Epoch/OAN/Fox consumers, and overlapping ecosystems intent on grifting and on weaponizing distrust.
Well, the subsides could be from people looking for direct profits: alternative practitioners and perhaps salespersons? Some are true believers in the services and products they sell, some might even be beneficial, however even more people want to capitalize on the current anti-(conventional)-medicine climate, public skeptics, and the 'wellness' industry. We know this industry is many times larger than 'big pharma' and virtually unregulated, with limitless consumers. So, profit seekers benefit from distrust.
I think this is a really important point. A lot of the time, we talk about misinformation as if it's the only reason people make health decisions we disagree with, but I don't think it's always that simple.
People make decisions based on the circumstances they're living in at the time. Knowledge matters, but so do stress, money, family responsibilities, past experiences, and whether someone even has the time and energy to focus on their own health.
I used to give public talks and met many people with real-life problems. For example, I remember a woman who had developed diabetes and was showing signs of early cognitive decline. Earlier in her life, she was in an abusive relationship, and she finally took her two kids and worked multiple jobs to support them. Her focus was on her kids and their education, and not herself. She was not financially able to provide herself with a healthy diet or to find time to exercise (due to multiple jobs). When I talked to her about diet, exercise, and how they are linked to aging and other diseases … she understood exactly what I was saying.
Her response … "I know I didn't always make the healthiest choices, but I was trying to keep a roof over my kids' heads and give them a better life. Given the situation I was in, I'd make the same choices again. I have no regrets."
This was one of the first conversations that changed how I think about health. It's easy for people to advocate for diet, exercise, and other regimens, but so many socioeconomic, intellectual, and family-cultural factors shape how our lives mold us, making us unique in biology and as human beings.
That's why I like the approach described here. Before assuming someone is ignorant or misinformed, it's worth understanding where they're coming from. Sometimes it's misinformation. Sometimes it's fear. Sometimes it's mistrust. And sometimes it's simply the reality of the life they're living.
Health decisions don't happen in a vacuum, and neither do the talks we have about them.
This all very good, but what do you call the parent that has had all of her questions answered but still chooses to risk the life of every immunologically compromised individual.
Trust me, Rebecca - I can feel (and 100% relate to) your frustration. All I can say is that this is the best answer I currently have to getting as many shots in arms as possible, given everything we are dealing with in 2026. In our conversations with these folks you are describing, they *truly* believe that vaccines are harmful or futile... because that is all they know and all they have been told for years and years by people they trust. It is an uphill battle.
I don't think it's fair or appropriate to describe a parent that refuses vaccines for their child as "chooses to risk the life of every immunologically compromised individual". It isn't true and it seems a deliberate choice to enrage those who don't choose to accept every possible vaccines. If a parent decides against the HepB vaccine, their infant will not pose a risk to others.
That framing equates a valid personal choice with responsibility for the health of other people. Every time I drive my car to the grocery store, I am increasing the risk to others by that action. The increase in risk to others is not considered sufficient to justify restrictions on my behavior. Likewise, because it is legal to refuse vaccinations, our society judges any risk to others caused by that decision as insufficient to justify restrictions on their behavior. You don't need to label that behavior separately from the categories given above. Your post comes across as looking for a term to denigrate those people when you have failed at persuading them to make a different choice.
I have to try to reach out to you when you say that an infant not vaccinated against Hep B (via parental choice) “will not pose a risk to others”. On what do you base this, because the FIRST risk is to the child itself, the risks to others may come later?
Why would an infant unvaccinated for HepB pose a risk to others? Later, when they are older, they might contract the disease and pose a risk to others. As does everyone who has Hep B. Do you think that people with Hep B are a serious risk to others?
Regarding the risk to the child itself, that risk is dependent on many individual factors. It's up to the parents to decide which risk they think is larger for their child, the disease or the vaccine.
I already raised that possibility and agree that can occur, but the far greater risk, which you haven’t addressed, is the potential for an unvaccinated infant to contract Hep B in its first year of life from an (unknowingly) infected contact, which is known to significantly increase the infant’s risk of chronic Hep B infection, with all its known risks, including chronic liver disease and liver cancer. Are you aware of those risks? So the major threat is to the infant, not the rest of the community in the first instance. Can we discuss that perspective?
I agree that the major threat is to the infant, not to the rest of the community. I was responding to the poster that claimed that parents who choose not to vaccinate are risking the life of every immunologically compromised individual and simply used Hep B as an example of why that isn't a true statement, but one that is designed to outrage readers.
I assume you agree with me that an unvaccinated for Hep B infant does not pose a risk to others. We can certainly discuss the perspective of the risk to the infant if you like.
The probability of the infant contracting Hep B in it's first year is quite low if the parents do not have the disease. IMO, the risks from the vaccination are underestimated. That would need to be included in the evaluation that parents make when choosing what to do and thus in our discussion as well.
I’m glad that you appreciate that “the major threat is to the infant”, yet you then downplay that risk later based on both parents being uninfected, as well as stating your belief that the risks of the vaccine are “underestimated”. Are you aware of the rate of under-recognition of Hep B diagnosis, and the decades of data on the safety of the Hep B vaccine? I am concerned to know why you would that its risks are not fully recognised. USA in particular has very good data from the time when the birth dose was NOT given, vs that since, and the reduction in infections in infants and children declined dramatically, which will translate to fewer later complications. I guess this vaccine, like many others in the childhood schedule, is becoming a potential victim of its own success.
HBV spread from an infected baby is low risk for others, but not zero. Is the child in daycare? Do family change diapers without PPE? A larger pool of susceptible children, who grow into susceptible adults will create a riskier future. Clearly the greatest risk is to a susceptible baby who if exposed will likely become a chronic carrier, and then possibly spread HBV to others in contact with their blood and body fluids. I remember a time that this was a significant infection control problem for the occasional infected child. Praying we do not return to that era.
The obvious example is not hepatitis B vaccine but MMR, particularly the measles part, providing 95% of a population are vaccinated then the 5% that are unvaccinated, for whatever reason, are protected through community immunity. Although the vaccine protects the individual there can be wider implications for the wider community depending on the disease.
If the poster I was responding to had specified the MMR, then the Hep B vaccine would not have been a counterexample to her claim. However, since she didn't but instead generalized to all vaccines, it was.
The Confused being your fastest-growing group is the part that stopped me. That feels less like people turning against vaccines and more like people drowning in guidance that keeps changing on them. It also means the same person might look like a "no" one month and a "maybe" the next, depending on what they just read.
Makes me think these labels are more of a moving snapshot than a fixed type. Really useful framework, especially the reminder that most people are a blend.
Perhaps another category to consider for Version 2.0 would be individuals who aren’t necessarily anti-vax but ‘anti-poke’. I’m talking about individuals who have a phobia of needles or who have a hard time watching their child or baby experience pain from a needle poke. I know people who don’t believe that the long-term benefits of a vaccine are worth the pain or trauma that comes with a series of pokes. For parents of anxious or neurodivergent kiddos, this seems to be a fairly common concern.
I am absolutely terrified of needles but I believe in vaccinations (as well as donating blood - here in Australia it’s voluntary and you don’t get paid to donate) so I always stay up to date on getting them but I have to make sure I don’t see the needle! I tell this to the nurses and doctors and they are always so lovely about that!
And thanks to the team for a wonderful article which I found super useful. 🙏
I have always been mindful when administering a vaccine to younger clients, I don't want to be a "bad memory". I have occasionally observed I am trying to manage the guardian more than the recipient.
The Confused being your fastest-growing group is the part that stopped me.
That feels less like people turning against vaccines and more like people drowning in guidance that keeps changing on them. It also means the same person might look like a "no" one month and a "maybe" the next, depending on what they just read.
Makes me think these labels are more of a moving snapshot than a fixed type. Really useful framework, especially the reminder that most people are a blend.
I think the only group missed, and somewhat alluded to in several comments, are the knowingly lying and grifting. The folks who have figured out that there is money and/or notoriety to be had by touting anti-vaccine nonsense. They are not acting in good faith, and thus really aren't part of the universe you are describing with your ten types, but rather preying on those people. Which raises a question - for those who are medically trained at the MD/DO/Biomedial Ph.D. level, what is your experience regarding those who are firmly planted in the anti-vax camp and making names (and perhaps money) for themselves?
This is excellent. Now I just need another 10 minutes per visit 😉
Adding it all up, I’ve spent years of my life talking about vaccines in primary care. Thanks for your work out there behind the scenes, too.
Just like we see in most elections, and most cynically in 2024, fear is a powerful tool. It is much easier to scare people than to reassure and then inspire them.
What a wonderful piece; it’s a framework that would probably work for any politically charged topic, whether we call it “health-related” or not. We still have risks, benefits and barriers to work through.
Excellent article. I teach in higher ed and recognize concerns from all of these categories.
One additional category may be individuals who are accepting of ‘traditional’ vaccines but highly opposed to COVID-19 vaccines and other potential mRNA vaccines.
I’ve heard concerns that the COVID-19 vaccine was developed ‘too quickly’. Others seem very concerned about the ‘politics’ of the COVID-19 vaccine. I’ve also heard many people express a fear that mRNA vaccines can change or ‘mess up’ a person’s DNA. I recently encountered a woman who needed a blood transfusion but refused it because she was so concerned that it could have come from a donor who received the COVID-19 vaccine.
PS: I love the virtual escape rooms you’ve developed :)
If you truly are unbiased, then spend some time actually I vestigating the cases where children have been harmed by vaccines rather that honing your approach to convince people they are safe and should be adopted. I suggest there is undeniable evidence of harm that noone wants to touch. Especially medical professionals.
Primary Care doc of 40 yrs and strong vaccine advocate even before that was necessary ; thanks for this Jess. It is spot on . Explanations and suggestions are excellent
Very good article and well presented groups of vaccine hesitant. Super helpful for those of us in this space. One consideration to add to your rationale is a sober reckoning of where we as clinicians have got it wrong in the past. A little “mea culpa” can go a long way toward winning back the trust of our patients. There’s a big COVID hangover due to some really big misses on the public health side. Owning those helps our patients not throw the baby out with the bath water.
I'm not a physician, just a retired neuropsychologist who sees hundreds of comments about vaccines on social media every day.
It seems to me that most are either bots, nasty people posting disgusting memes, and quite possibly agents of foreign governments and some far-right political groups that want to damage US public health.
Mixed in are a few questions that appear to be from actual humans who fit into the categories you listed.
My occasional responses range from lists of facts with citations to pointed sarcasm. I mention all this because I'm quite worried about what appears to be a decline in public trust in science itself. Thank you for your commendable efforts.
Absolutely! Bots are a huge issue - no doubt about it. But many of the questions and comments do come from humans (as reflected in our exchanges, surveys, interviews, clinician feedback, etc.). Without question, though, we are dealing with external forces that are very intentionally throwing gasoline on the fire...
Yes. Behind many of these "vaccine questions" and rants and delusions - are astroturfers, chaos agents, conspiracy-addled Epoch/OAN/Fox consumers, and overlapping ecosystems intent on grifting and on weaponizing distrust.
Apart from the delusional ranters, can you suggest who or what you think might be subsidizing the peculiar comments?
Well, the subsides could be from people looking for direct profits: alternative practitioners and perhaps salespersons? Some are true believers in the services and products they sell, some might even be beneficial, however even more people want to capitalize on the current anti-(conventional)-medicine climate, public skeptics, and the 'wellness' industry. We know this industry is many times larger than 'big pharma' and virtually unregulated, with limitless consumers. So, profit seekers benefit from distrust.
Makes sense.
I think this is a really important point. A lot of the time, we talk about misinformation as if it's the only reason people make health decisions we disagree with, but I don't think it's always that simple.
People make decisions based on the circumstances they're living in at the time. Knowledge matters, but so do stress, money, family responsibilities, past experiences, and whether someone even has the time and energy to focus on their own health.
I used to give public talks and met many people with real-life problems. For example, I remember a woman who had developed diabetes and was showing signs of early cognitive decline. Earlier in her life, she was in an abusive relationship, and she finally took her two kids and worked multiple jobs to support them. Her focus was on her kids and their education, and not herself. She was not financially able to provide herself with a healthy diet or to find time to exercise (due to multiple jobs). When I talked to her about diet, exercise, and how they are linked to aging and other diseases … she understood exactly what I was saying.
Her response … "I know I didn't always make the healthiest choices, but I was trying to keep a roof over my kids' heads and give them a better life. Given the situation I was in, I'd make the same choices again. I have no regrets."
This was one of the first conversations that changed how I think about health. It's easy for people to advocate for diet, exercise, and other regimens, but so many socioeconomic, intellectual, and family-cultural factors shape how our lives mold us, making us unique in biology and as human beings.
That's why I like the approach described here. Before assuming someone is ignorant or misinformed, it's worth understanding where they're coming from. Sometimes it's misinformation. Sometimes it's fear. Sometimes it's mistrust. And sometimes it's simply the reality of the life they're living.
Health decisions don't happen in a vacuum, and neither do the talks we have about them.
This all very good, but what do you call the parent that has had all of her questions answered but still chooses to risk the life of every immunologically compromised individual.
Trust me, Rebecca - I can feel (and 100% relate to) your frustration. All I can say is that this is the best answer I currently have to getting as many shots in arms as possible, given everything we are dealing with in 2026. In our conversations with these folks you are describing, they *truly* believe that vaccines are harmful or futile... because that is all they know and all they have been told for years and years by people they trust. It is an uphill battle.
I don't think it's fair or appropriate to describe a parent that refuses vaccines for their child as "chooses to risk the life of every immunologically compromised individual". It isn't true and it seems a deliberate choice to enrage those who don't choose to accept every possible vaccines. If a parent decides against the HepB vaccine, their infant will not pose a risk to others.
That framing equates a valid personal choice with responsibility for the health of other people. Every time I drive my car to the grocery store, I am increasing the risk to others by that action. The increase in risk to others is not considered sufficient to justify restrictions on my behavior. Likewise, because it is legal to refuse vaccinations, our society judges any risk to others caused by that decision as insufficient to justify restrictions on their behavior. You don't need to label that behavior separately from the categories given above. Your post comes across as looking for a term to denigrate those people when you have failed at persuading them to make a different choice.
I have to try to reach out to you when you say that an infant not vaccinated against Hep B (via parental choice) “will not pose a risk to others”. On what do you base this, because the FIRST risk is to the child itself, the risks to others may come later?
Why would an infant unvaccinated for HepB pose a risk to others? Later, when they are older, they might contract the disease and pose a risk to others. As does everyone who has Hep B. Do you think that people with Hep B are a serious risk to others?
Regarding the risk to the child itself, that risk is dependent on many individual factors. It's up to the parents to decide which risk they think is larger for their child, the disease or the vaccine.
I already raised that possibility and agree that can occur, but the far greater risk, which you haven’t addressed, is the potential for an unvaccinated infant to contract Hep B in its first year of life from an (unknowingly) infected contact, which is known to significantly increase the infant’s risk of chronic Hep B infection, with all its known risks, including chronic liver disease and liver cancer. Are you aware of those risks? So the major threat is to the infant, not the rest of the community in the first instance. Can we discuss that perspective?
I agree that the major threat is to the infant, not to the rest of the community. I was responding to the poster that claimed that parents who choose not to vaccinate are risking the life of every immunologically compromised individual and simply used Hep B as an example of why that isn't a true statement, but one that is designed to outrage readers.
I assume you agree with me that an unvaccinated for Hep B infant does not pose a risk to others. We can certainly discuss the perspective of the risk to the infant if you like.
The probability of the infant contracting Hep B in it's first year is quite low if the parents do not have the disease. IMO, the risks from the vaccination are underestimated. That would need to be included in the evaluation that parents make when choosing what to do and thus in our discussion as well.
I’m glad that you appreciate that “the major threat is to the infant”, yet you then downplay that risk later based on both parents being uninfected, as well as stating your belief that the risks of the vaccine are “underestimated”. Are you aware of the rate of under-recognition of Hep B diagnosis, and the decades of data on the safety of the Hep B vaccine? I am concerned to know why you would that its risks are not fully recognised. USA in particular has very good data from the time when the birth dose was NOT given, vs that since, and the reduction in infections in infants and children declined dramatically, which will translate to fewer later complications. I guess this vaccine, like many others in the childhood schedule, is becoming a potential victim of its own success.
HBV spread from an infected baby is low risk for others, but not zero. Is the child in daycare? Do family change diapers without PPE? A larger pool of susceptible children, who grow into susceptible adults will create a riskier future. Clearly the greatest risk is to a susceptible baby who if exposed will likely become a chronic carrier, and then possibly spread HBV to others in contact with their blood and body fluids. I remember a time that this was a significant infection control problem for the occasional infected child. Praying we do not return to that era.
The obvious example is not hepatitis B vaccine but MMR, particularly the measles part, providing 95% of a population are vaccinated then the 5% that are unvaccinated, for whatever reason, are protected through community immunity. Although the vaccine protects the individual there can be wider implications for the wider community depending on the disease.
If the poster I was responding to had specified the MMR, then the Hep B vaccine would not have been a counterexample to her claim. However, since she didn't but instead generalized to all vaccines, it was.
The Confused being your fastest-growing group is the part that stopped me. That feels less like people turning against vaccines and more like people drowning in guidance that keeps changing on them. It also means the same person might look like a "no" one month and a "maybe" the next, depending on what they just read.
Makes me think these labels are more of a moving snapshot than a fixed type. Really useful framework, especially the reminder that most people are a blend.
Perhaps another category to consider for Version 2.0 would be individuals who aren’t necessarily anti-vax but ‘anti-poke’. I’m talking about individuals who have a phobia of needles or who have a hard time watching their child or baby experience pain from a needle poke. I know people who don’t believe that the long-term benefits of a vaccine are worth the pain or trauma that comes with a series of pokes. For parents of anxious or neurodivergent kiddos, this seems to be a fairly common concern.
I am absolutely terrified of needles but I believe in vaccinations (as well as donating blood - here in Australia it’s voluntary and you don’t get paid to donate) so I always stay up to date on getting them but I have to make sure I don’t see the needle! I tell this to the nurses and doctors and they are always so lovely about that!
And thanks to the team for a wonderful article which I found super useful. 🙏
I have always been mindful when administering a vaccine to younger clients, I don't want to be a "bad memory". I have occasionally observed I am trying to manage the guardian more than the recipient.
The Confused being your fastest-growing group is the part that stopped me.
That feels less like people turning against vaccines and more like people drowning in guidance that keeps changing on them. It also means the same person might look like a "no" one month and a "maybe" the next, depending on what they just read.
Makes me think these labels are more of a moving snapshot than a fixed type. Really useful framework, especially the reminder that most people are a blend.
This is a great piece with practical implications. Thank you for your work!!
I think the only group missed, and somewhat alluded to in several comments, are the knowingly lying and grifting. The folks who have figured out that there is money and/or notoriety to be had by touting anti-vaccine nonsense. They are not acting in good faith, and thus really aren't part of the universe you are describing with your ten types, but rather preying on those people. Which raises a question - for those who are medically trained at the MD/DO/Biomedial Ph.D. level, what is your experience regarding those who are firmly planted in the anti-vax camp and making names (and perhaps money) for themselves?
This is excellent. Now I just need another 10 minutes per visit 😉
Adding it all up, I’ve spent years of my life talking about vaccines in primary care. Thanks for your work out there behind the scenes, too.
Just like we see in most elections, and most cynically in 2024, fear is a powerful tool. It is much easier to scare people than to reassure and then inspire them.
What a wonderful piece; it’s a framework that would probably work for any politically charged topic, whether we call it “health-related” or not. We still have risks, benefits and barriers to work through.
If we could somehow take parents back a hundred years, they could see the ravages of childhood diseases and mortality.
Excellent article. I teach in higher ed and recognize concerns from all of these categories.
One additional category may be individuals who are accepting of ‘traditional’ vaccines but highly opposed to COVID-19 vaccines and other potential mRNA vaccines.
I’ve heard concerns that the COVID-19 vaccine was developed ‘too quickly’. Others seem very concerned about the ‘politics’ of the COVID-19 vaccine. I’ve also heard many people express a fear that mRNA vaccines can change or ‘mess up’ a person’s DNA. I recently encountered a woman who needed a blood transfusion but refused it because she was so concerned that it could have come from a donor who received the COVID-19 vaccine.
PS: I love the virtual escape rooms you’ve developed :)
Great point. We hear a lot from people who have different perspectives depending upon the vaccine. Something we should clarify.
If you truly are unbiased, then spend some time actually I vestigating the cases where children have been harmed by vaccines rather that honing your approach to convince people they are safe and should be adopted. I suggest there is undeniable evidence of harm that noone wants to touch. Especially medical professionals.
Primary Care doc of 40 yrs and strong vaccine advocate even before that was necessary ; thanks for this Jess. It is spot on . Explanations and suggestions are excellent
More power to you if you can summon the inner strength to break through to these lost souls.