Community Immunity

Does this look familiar?It reads like something from today, but it was written in 1896, printed on postcards, and mailed across Britain by the National Anti-Vaccination League. Here are examples of the originals.Researchers have documented common manipulation tactics, such as cherry-picked data, fake experts, conspiracy theories, emotional appeals, and the exploitation of scientific uncertainty. When I speak about vaccine communication with health professionals, I frequently get questions implying these techniques are new. But the tactics were all there 130 years ago, long before social media. This playbook is not new.So, if the tactics are identical, then what has actually changed?Two things. The first is obvious: the size, scale, and speed at which messages can spread. A postcard in 1896 may have reached dozens of neighborhoods and towns over the course of weeks. A social media post reaches the world in seconds, amplified by an algorithm optimized for outrage, and with no accountability. The information ecosystem today is completely different.However, the second change is the one I keep thinking about, and I don’t think it gets enough attention. In his book Bowling Alone, Robert Putnam discusses the quiet collapse of America’s community life: we are joining fewer civic organizations, knowing fewer neighbors, and attending fewer community gatherings. We have lost what Putnam called social capital—the value of collective social networks that serve one another and build trust.That erosion matters for how health misinformation influences people today. For over a century, misleading claims existed alongside shared institutions that could buffer against extreme messaging. The local church, newspaper, and doctor. Rotary clubs, PTAs, and neighborhood associations. These institutions were far from perfect. They often reflected the biases of their time and were frequently exclusionary toward marginalized communities. Yet, for those within them, they functioned as a collective anchor.Today, many of those institutions still exist, but people no longer show up. Church congregations have declined over recent decades. Local newspapers have closed or been bought out by non-local actors. Civic organizations are dwindling. And physicians—still the most trusted source of vaccine information in survey after survey—are seeing patients for shorter visits, often lack long-term therapeutic relationships, and have increasingly limited availability.Instead of community forming around where we live, work, worship, or play, new substitutes for community are increasingly shaped by partisan political identification or social media algorithms.I want to acknowledge that many past community institutions were often gated and built on exclusion. However, the breakdown of those structures hasn't necessarily led to a more inclusive shared reality. Instead, we traded the old institutions, with all their flaws, for new, digital communities that thrive on fragmentation rather than community-building.The tactics of the Anti-Vaccination League were potent enough in that era to shape policy and influence large groups of people. Today, those same tactics travel to millions instantly, and the institutions that once provided a buffer have eroded. As early as 1896, the Anti-Vaccination League recognized the need for community work. The postcards were more than just propaganda; they came with an invitation to belong. That combination is part of what gave the movement its staying power. And it continues today, only now with tools that scale to millions instantly and far fewer competing sources of trust to push back.The uncomfortable truth is that the anti-vaccination movement has figured out that people need to belong to something. They aren’t just selling people on their set of “facts”; they are calling people into a community. The health and science world often misses this reality. Many believe that people have weighed the evidence on both sides and accepted an alternative set of facts. The reality is, they have decided to accept an invitation to join a community that welcomes them. Evidence needs a community to give it weight. Around vaccines, that work is already happening in small ways.Health care is a team effort, and trust lives not just with physicians but with the medical assistant who rooms the patient, the nurse who answers the portal message, the local pharmacist, family navigators, social workers, and the community health worker. My own work aims at improving how all these people communicate and build trust with families. Trusted voices in faith communities, schools, and neighborhoods still matter too. I was part of a recent science-and-faith gathering that filled me with hope about the possibility of working together on shared messaging. And the work has to extend online too, whether we like it or not, because that's where people are increasingly building community.There is no silver bullet. But we won’t make progress unless we recognize that the work is about more than just correcting misleading claims; it's about rebuilding the connective tissue that makes communities more resilient before the next postcard arrives, in whatever form it takes.I want to hear from you, and I’m curious what you’re seeing. Can you think of a time that a non-medical trusted voice in your community influenced your health decisions? Why did you listen to them?Thanks, as always, for being part of this community.-DavidCommunity Immunity is written by Dr. David Higgins, MD, MPH, a practicing pediatrician and public health physician whose work focuses on vaccine delivery, health policy, and communication. This newsletter is where he writes about vaccines, public health, and community. When he’s not seeing patients or writing, he’s coaching youth soccer or exploring the outdoors with his family. Find him on LinkedIn, Instagram, Substack Notes, and Bluesky.This newsletter is free for everyone. If you want to support the work that goes into it, a paid subscription means a lot. Get full access to Community Immunity at communityimmunity.substack.com/subscribe

Last week, MedPage Today published a piece I wrote titled “Parents Are Confused. I’m Worried for My Pediatric Patients.” I wrote it after a recent series of conversations in clinic that felt meaningfully different from the questions I usually hear about vaccines.These conversations weren’t driven by misinformation. The parents were disoriented.One parent summed it up well with this question: “What vaccines are recommended now? I’m so confused.”I’ve heard some version of that question several times this week, including from families who previously made confident, routine decisions to vaccinate.That confusion is the predictable outcome of an overnight rewriting of the U.S. childhood vaccine schedule, justified as an effort to “restore” or “rebuild” trust.This rationale deserves far more scrutiny than it has received.The argument appears to go like this: the United States is a negative “outlier” compared to peer nations; routine childhood vaccination is facing a crisis of trust; and recommending fewer routine vaccines will lead parents to trust clinicians more.As someone who studies vaccine delivery and communication, and who sits with families every day, I can say plainly: each of those assumptions is backwards.This week, I want to examine the assumption underlying all of them: that the U.S. being an outlier in childhood vaccination is inherently a problem.Is Being an “Outlier” a Problem?One of the most common justifications for the schedule overhaul is that the U.S. was an “outlier” compared to peer nations, often citing countries like Denmark.Many responses have focused on whether that claim is even accurate, noting correctly that the U.S. schedule is not dramatically different from those of many peer countries and that Denmark is itself an outlier.While these points matter, they skip over the more revealing assumption embedded in the argument: being an outlier is evidence of a problem.Being ahead of peer nations in preventing life-threatening disease, using one of humanity’s greatest achievements, is only a liability if you assume routine vaccination is a problem and we should do less of it. That conclusion is being treated as self-evident without ever being defended.The U.S. has been an outlier in plenty of other domains where “different from peers” is rarely invoked as a warning sign. We have been an outlier in landing humans on the moon, building the internet, and sequencing the human genome. In none of these cases is outlier status taken as evidence that we should pull back to align with peer nations.Difference, on its own, tells us nothing about whether a policy is good or bad. What matters is evidence of harm, risk, or unintended consequences that outweigh the benefits.And this is where the justification falls apart.We’ve been offered no new evidence that broader protection against vaccine-preventable diseases has become a liability rather than a strength. Instead, the vaccine schedule is being rewritten as if that conclusion were already established.I joined the ScienceVs podcast this week to talk through these issues, and one point I tried to make there was this:The fact that we have vaccine coverage for more diseases is not evidence of a problem. That's backward. It's not a competition to see how few diseases we can prevent.Why “Peer Nation” Comparisons Fall ShortSetting aside the unexamined assumption that more vaccines are inherently problematic, the fact that another high-income country does not routinely recommend vaccines reflects different policy trade-offs, not a lack of evidence.Vaccine schedules are shaped by national context, including disease epidemiology, health-system capacity, financing, equity, and the reliability of follow-up care. Those factors matter enormously.Denmark has a smaller population, far less inequality, and universal health coverage. In that setting, policymakers can reasonably assume timely access to care, consistent follow-up, and fewer structural barriers. The U.S. operates under very different conditions.Here, the childhood vaccine schedule must compensate for gaps in access, delayed diagnosis, inconsistent follow-up, and wide variation in healthcare delivery. It functions, in part, as a proactive clinical safety net, one designed to protect children despite those system-level weaknesses.That difference is often overlooked.I recently spoke with a pediatrician who practiced for many years in Denmark before moving to the U.S. He had many positive things to say about the Danish healthcare system, much of which we should aspire to replicate. Yet he viewed Denmark’s more limited vaccine schedule as a weakness, not a strength, particularly given how well the U.S. program has prevented disease across a far more complex system.Calling the U.S. schedule an “outlier” was never evidence that it was wrong. In many cases, it meant we were setting the pace.In fact, peer nations often move toward the U.S. over time. The United Kingdom’s recent adoption of routine varicella (aka chickenpox) vaccination is one example. And even Denmark recently added the RSV vaccine during pregnancy, following the U.S. lead.Here’s the irony that isn’t being widely acknowledged: The U.S. is now becoming an outlier in the opposite direction, and we are narrowing protections while other countries expand them.Do you like this newsletter?Community Immunity is free for everyone. If you find it valuable, please subscribe below and help spread the word!Subscribe for free to receive new posts and support my work.You can also follow me on LinkedIn, Instagram, Substack Notes, and Bluesky. Get full access to Community Immunity at communityimmunity.substack.com/subscribe

Hi community!It’s been another whirlwind week for vaccines and public health. Here are some of the biggest vaccine and public health headlines from this week:* NIH Abruptly Pulled Funding for Vaccine Confidence Research: Despite surging measles cases, record flu rates, and rampant vaccine misinformation, the NIH has abruptly defunded research on vaccine confidence—an indefensible decision with life-or-death consequences. * Measles Outbreak Update: The Southwest’s deadly measles outbreak continues to grow, with nearly 300 cases now across multiple states, including Texas, New Mexico, and Oklahoma. This week, we also learned that newborns, their parents, and families were exposed in a hospital in Lubbock, Texas. * A Small Win for the CDC: Just before his scheduled confirmation hearing this week, the Trump administration abruptly withdrew Dave Weldon’s nomination for CDC director. If there was any doubt about his stance on vaccines, his four-page statement—riddled with falsehoods and misleading claims—made it clear. * U.S. FDA Bypasses Advisory Committee in Flu Vaccine Strain Selection. The FDA has selected flu vaccine strains for the 2025-2026 season, ensuring timely availability and aligning with WHO recommendations, as it normally does. However, instead of the usual open public hearing with VRBPAC input, the decision was made behind closed doors after the committee meeting was canceled. Public trust in vaccines depends on transparent decision-making. Cutting out independent oversight risks fueling skepticism at a time when trust is already fragile.* Misinformation with a Side of Fries: The nation’s top health leader downplayed ongoing measles outbreaks, spread misinformation about vaccines, and promoted vitamin A as a measles treatment—essentially a vaccine alternative—during a bizarre interview at a Steak ‘n Shake, where he ate french fries cooked in beef tallow. If it hasn’t happened already, someone will surely start selling vitamin A-infused fries cooked in beef tallow for measles prevention—and cash in on the chaos.Now, here’s what is on my mind this week…When to Call Out, When to Call In: Talking About Vaccines the Right WayThis week, I went straight from a news interview—where I made it crystal clear that messaging from health leaders promoting alternatives to vaccination is harmful—to seeing patients in clinic and having conversations with parents hesitant to vaccinate their children.My vaccine communication posture in these two settings was very different.When I talk about vaccines, my approach depends on who I’m speaking with. This isn’t about inconsistency—it’s about meeting the moment with the right stance.When addressing leaders and policymakers or when speaking publicly about their actions, I don’t pull any punches. Those in power—whether in government, public health, or media—shape the systems that influence vaccine access, trust, and uptake. Their words and decisions have real consequences, and when they promote misinformation or enact harmful policies, those actions must be called out. I expect more from them, as we all should because they have the ability—and the responsibility—to make a difference at scale.But when I’m talking with the public—patients, families, friends, and communities—the posture is entirely different. These conversations aren’t about calling out but calling in. They are built on partnership, empathy, and curiosity. More often than not, I listen more than I speak. I don’t dismiss concerns; I try to understand them. Vaccine hesitancy often isn’t about a lack of knowledge—it’s about trust, values, and lived experiences.Both approaches matter. Accountability for those in power. Compassion for those making personal choices. One without the other fails the bigger picture. If I only criticized harmful policies but ignored individual concerns, I’d miss the chance to build trust. If I only engaged empathetically with individuals but stayed silent on systemic failures, I’d let harmful policies go unchecked.The goal, always, is a healthier, better-informed society. And that means knowing when to challenge and when to connect.It can do more harm than good when health providers, public health professionals, and science communicators conflate these different postures. I wrote about this in The New York Times several months ago: amid eroding trust in public health and a surge of misinformation, the response from many in health, medicine, and science has been to yell and call out the public—often louder and louder. But that approach doesn’t work. In fact, it often backfires.How health leaders communicate with the public is as critical as what they say. When people feel genuinely supported, valued, and understood—when approached as partners rather than opponents—they become far more open to considering scientific evidence.Fire Doesn’t Put Out FireHolding leaders accountable and upholding scientific integrity does not require dismissiveness, condescension, or combativeness.I know that if I gave extreme answers to reporters, launched direct attacks on those whose policies I believe are making America less healthy, or resorted to outrage and vitriol, I’d get more likes, shares, and attention. But that’s not my goal.I want our communities to thrive. And maybe that makes me naïve, but I believe the best way to achieve it isn’t by fighting fire with fire—it’s by modeling something better. Strength and clarity, yes, but also hope, compassion, and a commitment to the people we serve.Measles Outbreak Grows—And So Do Questions About ProtectionThe deadly measles outbreak in the Southwest continues to grow, with nearly 300 cases now reported across multiple states, including Texas, New Mexico, and Oklahoma. At this rate, I predict that 2025 will be the year the U.S. loses its measles elimination status—a designation we’ve held for 25 years, defined as the absence of endemic (ongoing) transmission for a year or more.This week, we also learned that multiple newborns, their parents, and families were exposed to measles after a woman gave birth in a hospital in Lubbock, Texas. Unlike older children and adults, newborns aren’t eligible for measles vaccination after exposure. Instead, they can receive measles immune globulin—a concentrated dose of measles antibodies administered by injection. This is called passive immunization, where antibodies provide immediate but short-term protection. While I’m grateful this tool exists—and it’s very safe—no parent wants their newborn to need it. And the truth is, these exposures were preventable. Every single case of measles could have been avoided with vaccination.With the outbreak growing, I’ve been flooded with questions from family, friends, colleagues, and the public:• Should my child get an early MMR vaccine?• Should I check my measles titers?• I’m traveling soon—do I need another dose?I get why people are confused! The recommendations depend on a mix of immunology, evolving epidemiology, and individual risk factors. It’s complicated—but that doesn’t mean the information should be hard to access.Fortunately, Katelyn Jetelina at Your Local Epidemiologist put together this fantastic FAQ that answers many of these questions in a clear, digestible way. I highly recommend checking it out and sharing it—I helped review it myself. As measles spreads, accurate information is more important than ever! The NIH Abandoned Vaccine Acceptance Research. We Won’t.As measles continues to spread—overwhelmingly among unvaccinated communities—the NIH’s decision to cut funding for vaccine confidence research is not just baffling; it’s dangerous. Earlier this week, I shared my frustrations and concerns. As the days passed, the damage reports kept coming in. Many outstanding researchers—both well-established and those just beginning promising careers—saw their work on improving vaccine uptake canceled overnight.The frustration, anger, and sense of defeat are real. But so is the resilience.One thing is clear: we will not wait… Get full access to Community Immunity at communityimmunity.substack.com/subscribe

Hi community, Something different for a short midweek post—something that’s been weighing on my mind, and likely on yours too. Thanks for reading Community Immunity! Subscribe for free to receive new posts and my weekly newsletter.Last week, I wrote an Opinion Letter in The New York Times to shed light on the human cost of reckless federal funding freezes and indiscriminate cuts across the nonprofit, science, academic, and health sectors. These actions don’t just harm vital programs and the people who rely on them—they inflict deep and lasting damage on the dedicated professionals who make these programs possible: teachers, nurses, nonprofit leaders, community health providers, social workers, researchers, public health professionals, disaster relief workers, and many more. Abrupt cuts don’t just disrupt services; they inflict moral injury on some of the most selfless individuals in our society—the very backbone of our communities.Colleagues and friends have asked why I wrote this letter. My answer? For me, silence was no longer an option.In a recent JAMA viewpoint article, Dr. Steven Woolf reflects on the shockwaves sent through the scientific, medical, and public health communities by the administration’s early executive actions. In response, some institutions will remain silent to appear nonpartisan, while others will attempt to find bipartisan solutions on issues like opioid addiction and chronic disease. Some programs are avoiding controversy by removing sensitive language or reframing initiatives in ways that align with political realities—strategies that, in some cases, may be necessary and even effective.But Woolf poses a critical question:“Is there a bridge too far—a point where it is no longer appropriate for medicine and public health to accede? How do we know where to draw the line, and when it is time to resist?”I’ve been thinking about this a lot lately, as I’m sure many of you have as well. When must I stand my ground and vocally oppose policies or misinformation that threaten community health? This is not a question I take lightly. I deeply respect diverse viewpoints and value partnership. I also recognize that speaking up—especially in today’s climate—can come at great personal and professional risk. But as a physician, I also have a moral and ethical duty to speak out when policies jeopardize the well-being of my patients and communities.To condone policies that I believe will compromise health—or to remain silent and look away—is to be complicit in putting our community’s health at risk. Policymakers may ignore our voice and expertise, but that does not excuse us from the duty to warn against actions and policies with the potential to harm.Speaking up can be confident without being combative—rooted in respect, nuance, and an openness to diverse perspectives. Advocacy is most effective when tailored to the right audience, delivered with tact, and grounded in shared values, no matter how small. The goal isn’t just to highlight problems but to find meaningful solutions.So, where is the line?For me, it’s when the most vulnerable—such as children, who cannot advocate for themselves—are put at risk. When those with little agency to defend themselves are harmed, such as the millions of children and families facing the real possibility of losing comprehensive healthcare coverage, that is where I draw the line.And, as Dr. Woolf emphasizes, science must be the guiding principle—not blind allegiance to the term, but a commitment to rigorous, peer-reviewed, evidence-based research. When the evidence clearly shows that a policy threatens public health—such as the disruption of vaccination services and the intentional, unfounded erosion of vaccine confidence from health leaders—that is where I draw the line.The line may be different for each of us, but when it is crossed, silence is not an option.Below is my letter to The New York Times."Sweeping federal funding freezes and indiscriminate cuts that affect schools, community health clinics, research centers, nonprofits and other public service organizations have grave consequences — not just for those they serve but also for the dedicated individuals within them.Beyond job loss and uncertainty, these actions inflict moral injury by stripping people of their ability to serve their communities and leaving them feeling anxious, exhausted and helpless.As a community health researcher and a nonprofit leader, I have seen this distress firsthand. As a pediatrician, I've experienced the same moral injury, sometimes unable to provide the care that my patients and families need because of factors outside my control.For many, this work is often more than just a job; it is a calling they've pursued, often at great personal cost. When that calling is unjustly taken away, burnout, cynicism and despair follow.To address this problem, our nation's leaders must recognize and acknowledge how brash and chaotic actions can affect those at the front lines — some of the most altruistic and dedicated individuals in our communities, who are critical to the fabric of our society.Necessary reforms, such as reducing redundancies and inefficiencies in federal programs and contracts, must be thoughtful and targeted, ensuring that these individuals and their vital work are valued and protected.While funding can be restored and organizations rebuilt, the distress suffered by people who serve our communities may take generations to heal."The challenges facing nonprofit, public health, science, healthcare, and academic organizations are greater than ever. Where do you draw the line? When is it necessary to speak out, and when is it best to step away? I’d love to hear your thoughts.Community Immunity is a newsletter dedicated to vaccines, policy, and public health, offering clear science and meaningful conversations for health professionals, science communicators, policymakers, and anyone who wants to stay informed. This newsletter is free for everyone, and I want it to be a conversation, not just a broadcast. I’d love to hear your feedback, questions, and topic suggestions—let me know what’s on your mind! And if you find this valuable, please help spread the word!Thanks for reading Community Immunity! Subscribe for free to receive new posts and support my work. Get full access to Community Immunity at communityimmunity.substack.com/subscribe

This week in public health and vaccins, a canceled FDA meeting, a measles-related child death, and controversy over a flawed COVID-19 vaccine study made headlines, alongside concerns about HHS transparency and NIH website outages. A CDC statement on vitamin A for measles treatment sparked debate over potential misinterpretation, with experts emphasizing that it should never be seen as a vaccine alternative. Meanwhile, vaccine misinformation continues to spread—even into veterinary medicine—raising concerns about its impact on both human and animal health. Get full access to Community Immunity at communityimmunity.substack.com/subscribe