In an age of vaccine skepticism, parents trust pediatricians most

ENTERPRISE, Ala. — As one of the few pediatricians in town, Dr. Nola Jean Ernest was used to fielding questions about vaccine ingredients. But even this was a new one: Could heavy metals in a hepatitis B shot give a 2-month-old boy autism? His parents saw videos on TikTok falsely claiming they could.

Ernest earned their trust after years caring for their 6-year-old and didn’t want to squander it. She pulled up the periodic table on her laptop and pointed to aluminum, she recalled. It was indeed an ingredient in the vaccine — added to boost the immune system’s response. The amount is not dangerous, she told them, and no credible evidence links it to autism. Hepatitis B, however, can scar the liver and cause cancer.

Pediatricians such as Ernest are the most trusted source of vaccine information for parents, according to a Washington Post-KFF poll, and they now play an essential role in combating rising vaccine skepticism in the United States.

Eighty-five percent of parents said they trust their child’s pediatrician on vaccines — a level of confidence that cuts across political divides, including among Republicans who support President Donald Trump’s “Make America Great Again” movement and parents who support Health and Human Services Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” agenda.

The poll found that 1 in 6 parents have delayed or skipped some vaccines for their children, excluding for coronavirus or flu. Confidence in pediatricians is a strong predictor of vaccination.

Among parents who do not trust pediatricians much or at all, 41% skipped or delayed a vaccine, compared with 12% of parents who trust them a great deal or fair amount.

About 6 in 10 parents with little trust in pediatricians believe childhood vaccines do not undergo enough safety testing, compared with 3 in 10 parents who do trust pediatricians.

While pediatricians are well-regarded, American Academy of Pediatrics President Susan Kressly said that their role is being undermined by competition from critics of childhood vaccines gaining influence on social media and in state and federal governments.

“It’s increasingly difficult to have the trusted factual voice be heard in the loud throng of everyone’s social media sound bites,” Kressly said.

Ernest, a 46-year-old mother of three, revels in caring for patients from birth to college, seeing their fun moments in life and guiding them through their challenges. She fears for a patient heading into cold and flu season without protection against other diseases, such as Hib meningitis, a bacterial infection that can kill young children within days or leave them with lifelong disabilities. She said she feels it is her responsibility to help parents understand what is at stake when they receive misinformation about vaccines.

“Will they trust me? And if they don’t trust me, what is going to happen to their child?” Ernest said. “It’s just a very heavy moment.”

Earning trust

As a small-town doctor, Ernest wins much of her patients’ trust outside the exam room.

Once a week, she volunteers with the youth at her church.

On a recent Tuesday, she stopped by a girls’ flag football game at the local high school to root for a patient. Wearing black jeans, a black sleeveless turtleneck and sneakers, “Dr. E,” as she is known, cheered on the girl while chatting with her mother.

Several parents sitting in the late afternoon sun under umbrellas waved to Ernest. A man walked over to share the news that he and his wife — who have a teenager the same age as Ernest’s youngest boy — were back together and expecting a baby.

Enterprise, population about 30,000, is one of the major cities in a rural southeastern corner of Alabama known as the Wiregrass, for the wiry grass once abundant in the sandy soils. It boasts a statue dedicated to the boll weevil, a pest that upended the South’s cotton economy and forced it to diversify. The Enterprise Pediatric Clinic, where Ernest is one of two full-time pediatricians, is on Boll Weevil Circle, the main thoroughfare lined with fast-food outlets.

The region does not have enough pediatricians to support the community’s needs, said Ernest, who has been practicing here for more than a decade. There are no children’s hospitals and no interstates. Her clinic serves patients from eight surrounding counties and several in the Florida Panhandle.

Access to pediatricians varies widely. Nearly 4 million children live in counties with no doctor certified by the American Board of Pediatrics, according to its most recent data.

In her office, Ernest sports earrings and pins featuring fruits, vegetables, insects and Disney characters. Children need something fun to look at when she is up close and peering into their ears and mouths, she explained, a starting point for a conversation and deeper relationship.

She stocks her office with copies of board books and Lego kits to give away during well visits.

For years, Andrews Barranco and Johanna Vargas-Barranco’s 6-year-old daughter, Scarlet, received books and stickers. When it came time to vaccinate their 2-month-old boy, Gael, they felt reassured after Ernest took time to answer all their questions about metals in the one vaccine.

Still, Johanna anticipates anxiety when Gael is due for his first MMR dose in a year.

“It’s because I hear a lot of things about the-” she began.

“Autism,” her husband interjected.

“Oh yeah,” Johanna nodded. “Autism.”

Who else parents do and don’t trust

On social media, the Barrancos had been seeing posts in Spanish and English that it was too early to give a hepatitis B shot to a newborn. A Latina media personality’s Facebook post that questioned the safety of that vaccine and connected the rise of recommended immunizations to autism was typical of their news diet.

Ernest maintains her own social media presence, which she doesn’t always enjoy, by posting as AlabamaKidDoc on TikTok and Instagram. Her most popular posts share what she is seeing in her office, such as hand, foot and mouth disease surging in the summer and football injuries when students go back to school.

While pediatricians have raised concerns about vaccine misinformation on social media, the Post-KFF poll suggests that this has not undermined their standing with parents. Trust in health and wellness influencers for reliable vaccine information ranked lowest after many other sources: government agencies, friends and family, a child’s school or day care, and pharmaceutical companies. About 1 in 7 (14%) of parents express trust in health and wellness influencers for vaccine information, and just 2% say they trust them “a great deal.”

Pediatricians often relied on the Centers for Disease Control and Prevention and other federal health agencies for vaccine information. But that is starting to change after Trump elevated Kennedy, a longtime anti-vaccine activist, to serve as his top health official. Kennedy has launched efforts to overhaul the childhood immunization schedule and tapped critics of vaccine policies to craft federal vaccine guidance.

The poll found that most parents view Kennedy with skepticism. More than 6 in 10 parents say they do not trust Kennedy much or at all to provide reliable information about vaccines.

More than a third (36%) of parents say they trust him Kennedy a fair amount or great deal to do so. That is higher among Republicans (54%) and parents who skipped or delayed vaccines except for coronavirus and flu (47%).

Wary of relying on federal guidance that has been shaped by Kennedy, the American Academy of Pediatrics in Itasca, coalitions of Democratic-run states and other medical groups recently took the extraordinary step of issuing competing vaccine recommendations.

Kennedy has accused pediatricians who promote vaccines of putting commercial interests ahead of public health, even though pediatricians say vaccines are not a lucrative source of income.

Under Kennedy, “nonexpert voices have a loud megaphone to promote mis- and disinformation that is contrary to what child health experts know to be true,” said Kressly, president of the AAP.

At the association’s recent annual conference, Kressly led attendees in a primal scream to vent their frustration at chaos and confusion unleashed by the federal government’s actions on vaccines and “a troubling campaign against pediatricians.”

‘How do we overcome that?’

Pediatricians across the country have gone to great lengths to preserve their credibility.

Eric Ball, in Orange County, California, sets out copies of his childhood vaccination records and those of his children in his exam rooms. In the Cleveland area, Shelly Senders visits his patients in the hospital after they are born.

Amber Lemasters, a nurse at a nonprofit pediatric clinic in northeastern Ohio, asks children to tell her their favorite and least favorite subjects in school and what they do for fun. Sometimes she will make a note of their favorite activities in their patient charts.

As Lemasters opened a box of measles vaccines on a recent day at the Shipley Child Health Clinic, she recalled worrying about her patients as the nation’s worst measles outbreak in more than three decades reached her state in the spring. She called about a half-dozen of the parents she remembered had not vaccinated their children. She asked if they would reconsider getting a shot now that cases of the highly contagious virus were growing. All but one said yes.

That same day, Amy Lakritz, a pediatrician who volunteers at the clinic once a week, glanced at the vaccine schedule posted on a wall. The majority of patients are up-to-date on their shots. But there is something gnawing at her about those who aren’t.

The parents trust her to write a prescription for an antibiotic. To diagnose an ailment. But for vaccination, they trust someone else.

Lakritz paused and turned to Lemasters, who was seated at her computer. “How do we overcome that, Amber?”

“I feel like a lot of it has to do just with how comfortable they are with the provider,” Lemasters replied.

The nonprofit clinic has been a staple in the community for more than half a century, long enough for multiple generations to cycle through its doors. A few mothers who brought their children for a visit that day said they had gone to the clinic themselves as kids.

Some patients still have concerns about the vaccination schedule, such as a mother of three who brought her 20-day-old baby into the clinic. The mother, who spoke on the condition of anonymity because she did not want her family’s medical information publicized, said she had some reservations about her children getting multiple shots at once.

It’s not that she doesn’t trust the providers at Shipley. But maybe they don’t know everything, she said, as she cradled her sleeping baby. “I know they’re really skilled in what they do, but I don’t know,” she said. “I just feel like maybe they’re missing something.”

Limits of trust

Even though trust in pediatricians is widespread, according to the poll, substantial minorities of parents still harbor doubts about vaccine safety. Forty-one percent believe children are healthier if they don’t receive multiple shots at once.

Ernest hopes her expertise can overcome those doubts.

She often cites her undergraduate degree in biochemistry and doctorate in neurobiology to show she understands how vaccine ingredients interact with the body and how a child’s brain develops.

She is considering adding those diplomas to her exam rooms, to signal that she grasps the science in a way others do not.

Unlike some pediatricians who require their patients to be vaccinated, Ernest does not in order to keep a line of communication open.

When families who are hesitant about vaccines go to Ernest, they often tell her they don’t want to disappoint her because they know she will disagree with their decisions. Two of those families recently left her practice.

The Post-KFF poll found that 25% of parents who skipped or delayed vaccines tried to change their child’s medical provider due to their views on vaccines.

Those departures from Ernest’s clinic reflect the challenges and sometimes exhausting work she faces to show parents she is on their side.

She worries that the country is moving into a time where families are going to refuse more frequent routine preventative care.

“While the work that pediatricians do in disease prevention is not sexy — not as sexy as curing cancer or removing an appendix,” she said, “it is very important work and that means that we are going to see the reemergence of disease.”

• Emily Guskin and Caitlin Gilbert contributed to this report.