As federal vaccine policies and messaging shift under the Trump administration, pediatricians across Pennsylvania are working to maintain proven standards of care.
Doctors told Spotlight PA they’re speaking often and openly with parents who are increasingly anxious about the safety of vaccines — including COVID-19 shots, which the Trump administration has changed CDC guidance for.
“You have to listen to the concerns, you have to address the concerns, you have to be fully informed about everything that's going on, including the negative stuff that's on the internet,” said Joseph Aracri, chair of pediatrics at Allegheny Health Network.
Kate Tigue, president of the American Academy of Pediatrics’ Pennsylvania chapter, said families at her Scranton-area practice worry about losing access to immunizations that protect against deadly diseases like measles.
Tigue shares the concern, and said her colleagues are just as distressed. “We feel like the government is in our exam room,” she said.
Some of those fears are fueled by changes at the federal Advisory Committee on Immunization Practices, which underwent a complete staffing upheaval earlier this year led by top health official and vaccine skeptic Robert F. Kennedy Jr.
The powerful group studies vaccine research and advises the federal government on how immunizations should be administered. Critics contend that under Kennedy, the group has become politicized and unscientific.
To counter “confusion and risk” created by the federal changes, Gov. Josh Shapiro signed an executive order mandating that Pennsylvania's vaccine recommendations follow those of national medical groups, including the AAP, rather than the federal government.
The order also directs the state Department of Health to ensure that children who are currently eligible for no-cost shots through the federal Vaccines for Children program maintain access to those immunizations, even if the federal government removes vaccines from the list.
There have already been some disruptions to pediatric access to this year’s COVID vaccine. Jonathan Weinkle, chief medical officer at Squirrel Hill Health Center in Pittsburgh, said his clinic just recently got its doses. He finds this wait especially troubling for his youngest patients.
“Their antibody levels are going to be quite low,” he said. “They don't have the repeated exposures that those of us in the older childhood, young adult, middle adulthood period have, where we can sort of rely on preexisting immunity a little bit.”
The delay is tied to ACIP’s new recommendation that people consult with their physicians about the benefits of the shot. The CDC formally adopted the recommendation, making it federal policy.
This shift breaks from leading medical associations that maintain that anyone older than six months should get the initial vaccine series, and that people who are immunocompromised and kids under two receive the updated COVID shot to boost their immunity.
The coronavirus spreads and evolves throughout the year, and the effectiveness of the vaccine starts to wane after four to six months. So some caregivers might opt for older kids to get the vaccine to protect vulnerable members of the household, or decide to time the shot to ensure maximum protection during the holiday season or a vacation. Or they might skip it.
Lori Handy, associate director of the Vaccine Education Center at Children's Hospital of Philadelphia, said these choices are all OK, provided people have gotten the initial jabs and aren’t at high risk of complications from COVID.
"Vaccines still are a medical intervention," she said. "We do want to make sure everybody receiving it is getting some personal benefit from being vaccinated."
Handy thinks all kids older than six months should get the influenza vaccine, which the AAP and CDC both advise. The virus virtually disappears in the summer, so an annual shot keeps people protected when it peaks during the colder months, greatly reducing the odds of hospitalization and death.
Last year, 280 children in the U.S. died from the flu. The CDC reports that’s the highest number since the agency began tracking pediatric deaths from the flu in 2004 — with the exception of the 2009-10 season, which is when the H1N1 pandemic occurred.
Nearly 90% of kids who died last year were not fully vaccinated, according to the CDC. Handy cited federal data showing about half of these children had no underlying medical conditions, “which is really terrifying.”
To prevent unnecessary harm and illness, doctors are eager to have conversations about the risks and benefits of medical care, said Katherine E. Shedlock, a pediatrician at Penn State Health Children’s Hospital.
The most common question Shedlock fields is whether families should go with an alternative vaccine schedule. Parents ask this because they worry about their child getting too many vaccines at once.
Shedlock never advises that. The order and cadence of childhood immunizations are highly researched and scrutinized for safety and effectiveness. She said that deviating from the schedule can lead to mistakes, such as missed doses. And spacing vaccines past the recommended schedule increases the risk of exposure to a virus or bacteria.
She acknowledged that her work has become more charged lately, but declined to comment on the national politics heightening the tension.
“I don’t want to get political,” she said, "but it's something that is very frustrating for pediatricians.”
She prefers to focus on how she cares for kids and builds collaborative, trusting relationships with families, a sentiment expressed by many of the physicians Spotlight PA spoke with.
One pediatrician worries ACIP’s decision on the COVID vaccine could herald more significant changes to federal policy.
Tigue, of the Scranton area, is particularly worried about the hepatitis B vaccine, as ACIP recently discussed changing recommendations and it may vote on whether to do so in the future. It’s given to newborns because they’re particularly susceptible to the virus, which causes lifelong health complications and is the leading cause of liver cancer. Kennedy has recently questioned the safety of the shot, and last month President Donald Trump said “there’s no reason” to administer it to babies.
In some ways, vaccines are “victims of their own success,” state Secretary of Health Debra Bogen, who is a pediatrician, told Spotlight PA via email: “People no longer see the diseases, like polio, that the vaccines prevent. So, when parents make their individual decisions, it is hard for them to apply the risks of the disease into their own risk-benefit determination.”
As the two pediatric deaths from this year’s measles’ outbreak show, diseases can and will come back. Because the consequences of forgoing vaccines are sometimes dire, physicians can get frustrated when parents choose to skip shots.
Weinkle, of Pittsburgh, recalled that he used to have “impassioned” discussions with parents who refused vaccines for their kids. But he’s realized that confrontational approach hurt his relationships with families.
He now tries to be more cooperative, he said. The physician would rather see hesitant parents go home and consider their options than feel unheard. In his experience, some might say no to a vaccine for years and then change their minds.
He recalled one family doing just that following a measles outbreak from a few years ago. “They were very concerned when they heard about it and decided that they were going to change tack.”
So they vaccinated their child, and trusted Weinkle to provide that care.