Dr. Edith Bracho-Sanchez is a primary care pediatrician at Columbia University Irving Medical Center in New York. She hosts the American Academy of Pediatrics’ Healthy Children podcast for parents.
Vaccine refusal no longer always looks like vaccine refusal in my pediatric practice. More and more parents are delaying vaccination and citing logistics, leaving the decision to the parent who is not in the room or simply wanting more time. I hear countless variations, but the result is often the same: children leave my office without being vaccinated.
“Oh, we’re definitely not anti-vaccine. We’re just waiting for Dad.”
Dad is coming for the next visit. “I think mom should be here when we make them.”
“We’ll definitely vaccinate but we have a birthday party coming up, doctor; I wouldn’t want her to be sick!”
Another parent accepts vaccinations, then runs out of the office before the nurse returns with them because the child is “out of it.” A few minutes earlier, the child was playing happily in the exam room.
Vaccination has become so socially and politically charged that some parents don’t want to identify with either side. Rather than explicitly refusing, they postpone the decision.
This is a worrying trend. In the 2025-2026 school year, 92.4% of kindergartners in the United States completed the recommended measles, mumps, and rubella series, compared to 95.2% in 2019-2020. A few percentage points may not seem like much, but that means 280,000 kindergartners attended school without proof that they had completed the series.
As of early October, the United States had recorded 4,080 confirmed measles cases in 2026 and two deaths, according to the U.S. Centers for Disease Control and Prevention. Compare that with 2,289 cases and three deaths in all of 2025, and just 285 cases and no deaths in 2024.
For me, as well as many of my pediatrician colleagues with whom I speak regularly, this led me to a realization: If the problem is no longer always explicit refusal, then our interventions cannot be designed solely around self-declared staunch vaccine skeptics. We need to do a better job of responding to “not today,” and many of us, understanding what is at stake, are working hard to make it happen.
When a parent tells me they’ll get vaccinated next time, I respect that choice, but I’m also clear with them about what it means to wait: Their child is leaving my office without protection against a disease we can prevent.
I also believe that when a parent says, “Maybe next time,” their doctor’s office should offer a date and time. “We will do it later” is an intention, while “we will be back Tuesday at 3:30 p.m.” is a plan. This is a way to make the return as easy as possible to have the child protected without calling the parent.
Lately, I’ve also been talking to parents a lot more about the illnesses we want to prevent than in the past. Vaccines have been so successful that many of today’s parents and many young pediatricians have never seen the consequences of these diseases. Most parents have never seen a baby struggle with whooping cough or rotavirus or seen a child hospitalized for measles-related complications.
When the disease seems theoretical and every suspected side effect of a vaccine is just a social media search away, the way parents calculate risk can be distorted. Recent measles outbreaks are a painful reminder that these diseases have not disappeared; we stopped seeing a lot of them because the vaccines worked.
I also talk about vaccines being an integral part of preventative care, which they are. Instead of asking parents what they want to do about vaccines during their child’s visit, I adopted the same assumption we apply to the rest of preventative care: “Your child should receive these vaccines today.” »
We discuss the risks and benefits that are part of any recommendation we make, and parents can and should always ask questions. They always make the final decision. But in a world filled with lies and other noise, clear communication goes a long way.
In nuanced conversations that are far from black and white, I’ve also found myself adapting my approach and getting creative. If one parent tells me they need the other parent before making a decision, we bring the other parent together. If both parents really need more time, I make sure they leave with reliable information and participate in the next conversation. I also included grandparents and even watched social media videos and group chat posts to answer everyone’s questions.
We need our health systems to make it as easy as possible to say “yes” to vaccines. This means improving access, streamlining workflows and allowing more time to advise parents with questions and concerns.
What I see in my exam room makes me wonder if there might 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 this 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 evolve.
Ultimately, though, I don’t particularly care whether a parent calls themselves pro- or anti-vaccine. Viruses and bacteria don’t care either. What matters is protection against measles, mumps, rubella, flu, chickenpox and more, not the label. For every child to be protected, they must get vaccinated today.
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