For more parents, ‘vaccine refusal’ is becoming vaccine delay, but it’s no less dangerous

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Dr. Edith Bracho-Sanchez is a primary care pediatrician at Columbia University Irving Medical Center in New York City. She hosts the American Academy of Pediatrics Healthy Children podcast for parents.

Vaccine refusal doesn’t always sound like vaccine refusal in my pediatric office anymore. More and more parents are delaying vaccines and citing logistics, outsourcing the decision to the parent who isn’t in the room or simply wanting more time. I hear countless variations, but the result is often the same: Children leave my office unvaccinated.

“Oh, we’re definitely not anti-vaccine. We’re just waiting for Dad.”

Dad comes to the next visit. “I think Mom should be here when we do them.”

“We are definitely going to vaccinate but we have a birthday party coming up, doctor; wouldn’t want her to be under the weather!”

Another parent agrees to the vaccines, then slips out of the office before the nurse returns with them because the child is “beside himself.” Minutes earlier the kid was happily playing in the exam room.

Vaccination has become so socially and politically loaded that some parents don’t want to identify with either camp. Rather than explicitly refusing, they postpone.

This is a worrisome trend. During the 2025–2026 school year, 92.4% of kindergartners in the United States had completed the recommended measles, mumps and rubella series, down from 95.2% in 2019–2020. A few percentage points may not sound like much, but it meant 280,000 kindergartners attended school without documentation that they had completed the series.

As of early October, the US had recorded 4,080 confirmed cases of measles in 2026 and two deaths, according to the US Centers for Disease Control and Prevention . Compare that with 2,289 cases and three deaths in all of 2025, and only 285 cases and no deaths in 2024.

For me, and many of my pediatric colleagues I speak to regularly, it has led to a realization: If the problem is no longer always explicit refusal, then our interventions can’t be solely designed around convincing self-declared vaccine skeptics. We have to get better at responding to “not today,” and many of us, understanding what is at stake, are working hard to do so.

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When a parent tells me they’ll vaccinate next time, I respect that choice, but I’m also clear with them about what waiting means: Their child is leaving my office without protection against a disease we can prevent.

I also believe when a parent says, “Maybe next time,” their doctor’s office should offer a date and time. “We’ll do it later” is an intention, while “we’ll be back on Tuesday at 3:30 p.m.” is a plan. It’s a way to make it as easy as possible to return to get the child protected without calling the parent out.

Lately, I also talk to parents a lot more about the diseases we are aiming to prevent than I had in the past. Vaccines have been so successful that many of today’s parents and many young pediatricians have never seen what these diseases can do. Most parents have never watched a baby struggle through pertussis or rotavirus or seen a child hospitalized with complications of measles.

When the disease feels theoretical and every alleged vaccine side effect is just one social media search away, how parents calculate risk can become distorted. Recent measles outbreaks are a painful reminder that these diseases did not disappear; we stopped seeing many of them because vaccines worked.

I am also discussing vaccines as a normal part of preventive care, which they are. Instead of asking what parents want to do about vaccines during their child’s visit, I have shifted to the same assumption we bring to the rest of preventive care: “Your child is due for these vaccines today.”

We discuss the risks and benefits that are part of any recommendation we make, and parents can, and should, still ask questions. They still make the ultimate decision. But in a world filled with falsehoods and other noise, clear communication goes a long way.

In nuanced conversations that are far from black and white, I have also found myself tailoring my approach and getting creative. If one parent tells me she needs the other before deciding, we call the other parent together. If both parents truly need more time, then I make sure they leave with reliable information and are part of the next conversation. I have also included grandparents and have even sat through social media videos and group chat posts to answer everyone’s questions.

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We need our health systems to make saying “yes” to vaccines as easy as possible. That means improving access, streamlining workflows, and allowing more time for counseling parents with questions and concerns.

What I see in my exam room makes me wonder whether there may be an emerging group of parents who genuinely support vaccines while actively choosing to delay them. To better understand how to support these parents, researchers need to study that gap, and research requires funding. For pediatricians like me to do our jobs, we need to understand how people actually make decisions about vaccines and how those decisions are changing.

At the end of the day, however, I don’t particularly care whether a parent calls themselves pro- or anti-vaccine. Viruses and bacteria don’t care either. What matters is the protection against measles, mumps, rubella, influenza, chicken pox and more — not the label. For every child to be protected, they need to get their shots, today.

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伊迪丝·布拉乔-桑切斯博士是纽约市哥伦比亚大学欧文医学中心的儿科初级保健医生。她主持美国儿科学会面向家长的“健康儿童”播客节目。

在我的儿科诊室里，现在听到的“拒绝接种疫苗”听起来并不总是像真正的拒绝接种疫苗。越来越多的家长以各种理由拖延疫苗接种，比如把决定权交给不在场的另一位家长，或者仅仅是想多花点时间。我听到过各种各样的理由，但结果往往都一样：孩子们离开诊室时仍然没有接种疫苗。

“哦，我们绝对不是反对疫苗。我们只是在等爸爸。”

爸爸下次来的时候也来了。“我觉得妈妈应该在场。”

“我们肯定会给她接种疫苗，但是医生，我们马上要办生日派对了；我们可不想让她生病！”

另一位家长同意给孩子接种疫苗，但在护士把疫苗带回来之前，就悄悄离开了诊室，因为孩子“情绪非常激动”。几分钟前，这孩子还在诊室里开心地玩耍。

疫苗接种已经变得如此具有社会和政治色彩，以至于一些家长不愿认同任何一方的观点。他们没有明确拒绝，而是选择推迟接种。

这是一个令人担忧的趋势。在2025-2026学年，美国幼儿园儿童完成麻疹、腮腺炎和风疹疫苗接种的比例为92.4%，低于2019-2020学年的95.2%。几个百分点的差距听起来似乎不大，但这却意味着有28万名幼儿园儿童在没有接种疫苗证明的情况下入学。

据美国疾病控制与预防中心的数据，截至10月初，美国2026年已确诊4080例麻疹病例，死亡2例。相比之下，2025年全年确诊病例2289例，死亡3例；2024年确诊病例仅285例，无死亡病例。

对我以及我经常交流的许多儿科同事来说，这让我们意识到：如果问题不再总是出在明确拒绝上，那么我们的干预措施就不能仅仅围绕着说服那些自称对疫苗持怀疑态度的人。我们必须更好地应对“今天不行”这种说法，而且我们中的许多人，都明白其中的利害关系，正在为此努力。

丽贝卡·布莱克威尔/美联社

呼吸道病毒流行季已至。以下是关于今年秋季流感、新冠肺炎和呼吸道合胞病毒疫苗需要了解的信息。

当家长告诉我他们下次会给孩子接种疫苗时，我尊重他们的选择，但我也会明确地告诉他们等待意味着什么：他们的孩子离开我的诊室时，将无法获得针对一种我们可以预防的疾病的保护。

我也认为，当家长说“也许下次吧”时，医生诊所应该提供具体的日期和时间。“我们稍后再做”只是个大概的打算，而“我们周二下午3:30再来”则是一个具体的计划。这样既能让家长更方便地带孩子回来接受保护，又不会打扰到家长。

最近，我跟家长们谈起我们试图预防的疾病的次数比以前多了很多。疫苗如此成功，以至于如今很多家长和年轻的儿科医生都从未亲眼见过这些疾病的危害。大多数家长从未目睹过婴儿在百日咳或轮状病毒感染中挣扎，也从未见过孩子因麻疹并发症住院。

当疾病似乎只是理论上的，而所有所谓的疫苗副作用都只需在社交媒体上搜索一下就能找到时，父母对风险的评估就可能出现偏差。近期麻疹疫情的爆发令人痛心地提醒我们，这些疾病并没有消失；我们不再见到其中许多疾病，是因为疫苗发挥了作用。

我还将疫苗接种作为预防保健的常规组成部分进行讨论，而它们本来就是。我不再询问家长在孩子就诊时对疫苗接种有何想法，而是采用了与预防保健其他方面相同的假设：“您的孩子今天应该接种这些疫苗。”

我们会讨论我们提出的每一项建议所涉及的风险和益处，家长可以而且应该继续提出问题。最终的决定权仍然在他们手中。但在一个充斥着谎言和其他干扰的世界里，清晰的沟通至关重要。

在那些远非非黑即白、充满微妙之处的对话中，我发现自己也在不断调整方法，并发挥创意。如果一方家长告诉我她需要另一方家长的意见才能做决定，我们会一起给另一方家长打电话。如果双方家长确实都需要更多时间，我会确保他们带着可靠的信息离开，并参与到下一次的对话中。我还邀请了祖父母参与，甚至认真观看社交媒体视频和群聊帖子，解答大家的疑问。

CNN记者米歇尔·古斯塔夫森报道

在数十年来最严重的麻疹疫情爆发之际，一家诊所依靠多年来建立的来之不易的信任，保障弱势群体的安全。

我们需要让医疗系统尽可能简化疫苗接种流程，使人们更容易接受疫苗。这意味着要改善接种途径，简化流程，并留出更多时间解答家长的疑问和担忧。

我在诊室里看到的景象让我不禁思考，是否真的存在这样一群家长：他们真心支持疫苗，却又主动选择推迟接种。为了更好地了解如何支持这些家长，研究人员需要深入研究这一认知差距，而这项研究需要资金支持。对于像我这样的儿科医生来说，为了更好地履行职责，我们需要了解人们究竟是如何做出疫苗接种决定的，以及这些决定正在发生怎样的变化。

但说到底，我并不特别在意家长自称支持疫苗还是反对疫苗。病毒和细菌也不在乎这些。重要的是疫苗对麻疹、腮腺炎、风疹、流感、水痘等疾病的保护作用，而不是标签。为了保护每个孩子，他们今天就需要接种疫苗。

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