Navigating Vaccine Schedules and Hesitancy in a Changing Policy Environment

Clinicians need both reliable sources of current vaccine guidance and effective ways to address hesitancy in a fast-changing environment.

Why vaccine guidance feels harder to navigate now

Health and Human Services (HHS) influences vaccines at every level, including research, approvals, post-market monitoring, national schedules, insurance coverage, and school requirements. In the past year, rapid changes within HHS have made this landscape difficult to follow. These changes have included leadership gaps, staff losses, changes to the Advisory Committee on Immunization Practices (ACIP), withholding of studies on the continued effectiveness and safety of COVID-19 and shingles vaccines, and shifts in research methodology and priorities. At the same time, misinformation has become widespread, including from senior public figures.

One way to monitor rapid developments in public health is through trusted sources such as the Center for Infectious Disease Research and Policy (CIDRAP) (https://www.cidrap.umn.edu/); the Children’s Hospital of Philadelphia (CHOP) Vaccine Education Center (https://www.chop.edu/vaccine-education-center); Your Local Epidemiologist (https://www.yourlocalepidemiologist.co/); and the Center for Unbiased Science and Health (https://www.unbiasedscience.org/).

Two major lawsuits have challenged HHS and HHS Secretary Robert F. Kennedy Jr. over changes made to ACIP and the immunization schedule since May 2025. In Academy of Pediatrics [AAP] et al. v. Kennedy et al., the plaintiffs argued that downgrading certain vaccines on the official childhood schedule and abruptly replacing members of the Advisory Committee on Immunization Practices (ACIP) was done without proper scientific justification. They specifically highlight unilateral changes made to COVID-19 vaccine recommendations.¹ In State of Arizona, Josh Shapiro et al. v. Kennedy et al., the states are suing because federal immunization schedules directly dictate state-level school entry requirements, Medicaid funding, and insurance mandates under the Affordable Care Act (ACA). This lawsuit mirrors the AAP case regarding the ACIP restructuring but focuses heavily on recent administration rollbacks regarding the Hepatitis B vaccine.²

Under the ACA, private insurance companies are legally required to cover any vaccine recommended by the ACIP with zero out-of-pocket costs for patients. By altering the ACIP membership and downgrading vaccines on the formal schedule, the administration effectively removes that mandatory insurance coverage. Both cases argue that doing this without a transparent, peer-reviewed scientific record will trigger severe real-world consequences: spiking out-of-pocket costs for parents, driving down national vaccination rates, and increasing the spread of preventable childhood diseases.

Where can clinicians find the current vaccine schedule?

In this environment, it is essential to distinguish scientific consensus from policy change. The CDC schedule changes made since May 2025 were policy decisions rather than evidence-based updates, while the scientific support for universal hepatitis B vaccination within 24 hours of birth, COVID-19 vaccination for young children, and Tdap during every pregnancy remains in place. The current recommendation is to use medical society immunization schedules, which are aligned. Pennsylvania Governor’s Executive Order 2025-02³ ensures that pharmacists and insurers cover immunizations as recommended by the AAP, the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG):

• AAP Recommended Child and Adolescent Immunization Schedule: United States, 2026.  https://www.aap.org/
• AAFP immunization Schedules https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html
• ACOG https://www.acog.org/news/news-releases/2026/02/acog-releases-updated-guidance-maternal-immunizations

How can clinicians and patients make informed decisions using the best available evidence?

Misinformation and disinformation are now widespread globally. According to a recent trust and health survey, many respondents reported declining trust in both the healthcare system and the media as sources of accurate health information.⁴ Physicians now compete with AI tools, peer networks, and other information sources that shape personal health decisions. The encouraging news is that physicians remain the most trusted messengers on health issues and protection of public health (80%). They are seen as both local and expert voices.

Vaccines remain one of the greatest achievements in biomedical science and public health and one of the most cost-effective public health tools available. According to the World Health Organization (WHO), vaccination prevents 2-3 million deaths each year. At the same time, the success of vaccines has reduced public familiarity with many vaccine-preventable diseases, lowering perceived disease risk while increasing attention to perceived vaccine risk. WHO has identified vaccine hesitancy as one of the top global health threats.

What is vaccine hesitancy?

Vaccine hesitancy is defined by the WHO as a motivational state of being conflicted about, or opposed to, getting vaccinated. It includes intention and willingness. It is complex and context-specific, varying across time, place, and vaccine. It encompasses a spectrum of feelings from refusal of all vaccinations to receipt of all recommended vaccinations while still having concerns about vaccinations.

Vaccine hesitancy and vaccine mandates are not new.

Vaccine hesitancy started with the smallpox vaccine in 1796, with the first vaccine mandates issued in 1809. In 1905, the Supreme Court upheld a state’s right to mandate vaccines. Rapid change in government, communication, technology, science, and the quest for self-autonomy have increased vaccine hesitancy, although most people still feel that vaccines are safe and important.

What drives vaccine uptake?

A strong clinician recommendation remains the single most important driver of vaccine uptake. Perceived disease risk, confidence in vaccine safety and effectiveness, and social norms also influence whether patients accept recommended vaccines. Practical factors matter as well, including access, availability, affordability, service quality, and whether patients feel respected by healthcare workers. Decisions about vaccination are shaped by context, including trust in messengers, media, politics, religion, culture, and accessibility; by individual and group influences such as beliefs, attitudes, and knowledge; and by vaccine-specific issues such as schedule, cost, risk, benefit, and the strength and clarity of the clinician’s recommendation.

How can clinicians respond to vaccine hesitancy?

No single strategy works for every patient. The most effective approach combines a strong recommendation, respectful communication, and tailored follow-up based on the patient’s concerns, values, and readiness to vaccinate.

• Start with a strong, consistent recommendation. Use a presumptive format such as, “You are due for…” and a clear recommendation such as, “I highly recommend….” Make sure everyone on the care team communicates the same message.
• Tailor your approach for hesitant patients. What you say, how you say it, and how you interact with the patient or caregiver can strongly influence vaccine acceptance. Avoid arguing, repeating myths, providing unrequested facts, emphasizing danger in a way that feels coercive, or using dismissive language.
• Use motivational interviewing techniques. Start from shared values, ask open-ended questions, listen carefully, reflect on what you hear, affirm strengths, and validate concerns. Ask permission before offering information, then provide clear facts and check understanding.
• Use positive social norms and reframing. Patients are often influenced by intuitive risk perceptions, emotions, and the beliefs of people around them. It can help to emphasize that vaccination remains common and to frame the conversation in ways that align with the patient’s values.
• Maintain honesty, patience, and trust. Tell the truth, preserve the relationship, and recognize that behavior change often takes more than one conversation. Repeated, tailored communication is often necessary.

How can practices and communities increase vaccination?

• Be a knowledgeable vaccine advocate and ensure your team is well-informed.
• Make vaccines available in your clinic, office, or through nearby referral options.
• Prioritize immunization review at every visit.
• Use standing orders when appropriate.
• Contact patients who are due or overdue for vaccines.
• Identify a vaccine champion in each office.
• Reduce practical barriers to vaccination.
• Promote vaccines as safe, effective, and essential.
• Participate in community outreach when possible.

Clinicians play a critical role in helping patients navigate a complex and rapidly changing environment.

Their influence on health outcomes depends on knowing their audience, building trust, and using tailored, easy-to-understand communication. Effective vaccine conversations require humility, respect, and avoidance of argument. They also often require patience, repeated communication, and sensitivity to a patient’s concerns, beliefs, and practical constraints.

Vaccinations save lives, and clear, trusted clinician communication remains essential.

Additional training and communication tools can strengthen these conversations. Consider the free course on Infodemiology (https://www.infodemiology.com/training-resources/#trainings). Resources on addressing rumors and misinformation include The Debunking Handbook 2020 (https://climatecommunication.gmu.edu/wp-content/uploads/2023/09/DebunkingHandbook2020.pdf) and the Practical Playbook for Addressing Health Rumors (https://centerforhealthsecurity.org/sites/default/files/2024-07/24-07-cdc-misinfo-playbook-v2.pdf).

References

1. https://litigationtracker.law.georgetown.edu/litigation/american-academy-of-pediatrics-et-al-v-robert-f-kennedy-jr-et-al/
2. https://litigationtracker.law.georgetown.edu/litigation/state-of-arizona-et-al-v-kennedy-et-al/.
3. https://www.pa.gov/content/dam/copapwp-pagov/en/governor/documents/Executive%20Order%202025%2002%20Governor%20Shapiro%20Vaccines%20Access.pdf
4. https://www.edelman.com/sites/g/files/aatuss191/files/2026-04/2026 Edelman Trust Barometer Special Report Trust and Health_Final.pdf