“Explain a time you faced vaccine hesitancy and how you handled it.” As a fourth-year medical student applying for pediatric residency, this question came up often in interviews. It is an experience that almost every medical professional has encountered, even early in training. The first story that came to mind was from my newborn nursery rotation during my third year of medical school.
I met a first-time mother who had just delivered a bright-eyed, healthy baby boy. Only a couple of hours after his birth, my team of two residents, an attending, and me had the privilege of being among the first people to welcome this new human into the world. He was swaddled so securely in a decorated blanket that only a locksmith could unravel. He rested peacefully during arguably the most vulnerable stage of our lives. In their first months, neonates have weakened immune functions, immature nervous systems, and even lack the strength to hold up their funky-shaped heads.
As the pediatric team, our job was to ensure this baby had every chance to grow into a healthy child. With that goal in mind, our first two recommendations were what we call “eyes and thighs”: erythromycin eye ointment and a vitamin K shot. Our challenge arose with the third recommendation, the hepatitis B vaccine. Mom didn’t want her baby receiving any vaccines at this time. Although this is common in pediatrics, it was my first time confronting the dilemma directly. The room shifted from relaxed and celebratory to tense and uneasy.
Without even the slightest hesitation, our attending looked at the mother and gently said, “Well, why don’t we talk about it?” She slowly and intentionally unearthed all of Mom’s fears and reasoning without judgment or frustration. She responded with comfort and recognition, recognition that this mother was advocating for her baby with the knowledge she had. Only after did she offer evidence-based information that addressed each concern. By the end of the conversation, we left the room with permission to administer the hepatitis B vaccine. Reflecting back, I don’t think knowledge alone led to that outcome. It was giving Mom the space to speak and tailoring our education to her specific concerns. This was my first encounter with vaccine hesitancy, but far from my last.
The American Academy of Pediatrics was among the first U.S. organizations to recommend routine vaccination starting in 1934. For as long as vaccines have existed, so have anti-vaccine movements. Concerns such as patient autonomy, risk-benefit calculations, and fear of “foreign ingredients” developed in genuine skepticism, the same skepticism that pushes science to uphold high standards. But unlike in the past, we now live in an era where information is instantly accessible, and the loudest voices often drown out the most accurate ones.
Recently, newly appointed advisory panel members at the Centers for Disease Control voted to overturn the longstanding recommendation to administer the hepatitis B vaccine at birth for infants born to mothers who test negative, guidelines that have stood for 30 years. Since introducing the birth dose, neonatal hepatitis B cases have decreased from 20,000 to 20 annually. This virus is particularly dangerous because about 90 percent of infected infants develop chronic disease. This decision has alarmed many medical organizations, including the American Academy of Pediatrics, and has prompted reflection among future physicians like myself, especially those pursuing pediatrics.
The new recommendation does not change the fact that the hepatitis B vaccine has always been a choice, but it does introduce confusion and fear. In this landscape, several qualities have become essential to practicing pediatrics and addressing vaccine hesitancy productively.
First, we must recognize and uphold patient autonomy. Pediatrics is best when practiced as a team sport. Like in any team, team members must learn each other’s stories to fuel bonds rooted in trust and mutual respect. I was fortunate to work with pediatricians who enter a room and immediately establish that they are part of a team, one that includes the patient, parents, caregivers, and anyone else involved in the child’s well-being.
Second, we cannot ignore the growing spread of misinformation. Most medical professionals are firm in their stance on vaccines and public health, but our opinions matter most when speaking with the general public. We have a responsibility to understand the sources our patients are exposed to so we can meet their concerns with context, empathy, and facts.
Lastly, we must broaden our advocacy beyond medical settings. Physicians spend only a small fraction of time with each patient in the grand scheme. So much of life happens beyond hospital and clinic walls. We must use our education to influence policies that shape health, from preventive medicine to nutrition and SNAP benefits to firearm safety. It all matters.
As I finish my residency interviews, I am reminded that the role of a pediatrician is now more important than it has ever been. These new challenges may complicate our work, but I believe they will only ignite the passion of the next generation of pediatricians. Our goal is not to win arguments or silence opposing voices. Our goal is to work alongside families to make the most informed decisions for their children. It is that commitment to something larger than ourselves that will ultimately prevail, even amid the setbacks we face today.
Adam Zbib is a medical student.
