The best person to discuss vaccines with is.. your pediatrician

Hmmm... Really?

Increasingly, Americans are pulled in different directions on vaccines. Some are leaning in hard, and think everyone should get the 2024 (#vintage) childhood schedule plus an annual covid and flu shot from age 1 to 100. They think you should get a shingles shot, adding that the Shingles shot also reduces dementia and heart attacks. Maybe tomorrow it will regrow hair!

Others are increasingly skeptical, they question the need for annual covid shots in kids, the need to vaccine pregnant women for covid in 2026, for RSV and much more. The most extreme question vaccines broadly. Hesitancy has spilled to vital and important public health efforts like the MMR shot.

People argue about the causes of this hesitancy as well. Some groups, e.g. Amish, have a longstanding skepticism of vaccination, going back generations, which is hard to trace back to Robert F Kennedy Jr, but not impossible.

Debates on vaccines quickly require quite technical knowledge. Do covid shots increase miscarriage? Do they reduce miscarriage? How do we know? Randomized trials or observational studies? Are there unmeasured confounders in the observational study? Is there immortal time? The randomized trial conducted by Pfizer and on the package leaflet was powered to exclude what increased risk?

On television, the health pundits and vacuous anchors love to say “if you have questions, the best person to ask is your pediatrician”. This is repeated as a sort of legal disclaimer and a mantra.

The best person to discuss vaccines with is the pediatrician.

Of course, this is a data free claim. And there are reasons to doubt it. Are pediatricians really the best people to ask?

Of course, there is no doubt, pediatricians and doctors are fully capable of dispelling some vaccine myths, and answering many questions.

I'm worried this vaccine contains a microchip.

Don't worry, I can assure you it does not. (*correct answer)

That's a really simple question, that any doctor— even Dr. Google— could answer.

But simple questions start easy, but then can become complicated.

I've heard that the covid shot has an 80% rate of miscarriage

I can assure you it does not have an 80% rate. We would have seen that. (**correct answer)

Ahh, got it, so what is the lowest increased rate of miscarriage you can assure me has been excluded? What rate of miscarriage was excluded by the randomized control trial run by Pfizer which was aborted midstream? Was a 5% increased risk excluded?

**Crickets. That’s a Step 2 boards question.

Pediatrics training and practice provides very little information on vaccine regulatory science and evidence. A few follow-up questions can derail a pediatrician, and it isn’t their fault. It is because we never taught them the answers.

I'd prefer to spread these two shots out by a week.

Why do you say that?

I'm worried that giving the shots together will reduce the efficacy and increase the side effects.

Not to worry, we pediatricians know that you can give all the vaccines safely together.

I hear you say that. But don't you think the randomized control trial underlying that claim is severely underpowered, and the lower bound of the confidence interval for non-inferior antibody titers could result in, and is even quite compatible with, substantial clinical inferiority? Also what increased risk of side effects is the trial powered for? Take a look at the package leaflet…

*Crickets That is a Step 3 question.

Not only do I doubt that pediatricians know what is known and not known about vaccine science at the level needed to answer a thoughtful question on interference, I doubt the expert vaccine pediatrician researchers who proudly hop on the television know these details. In fact, their comments suggest to me they do not.

I love pediatricians. If I see a kid with a rash and a fever, I am the first to take their advice. But if I want to understand the evidence base for vaccines, particularly the most controversial areas, I doubt pediatricians are equipped to answer my questions. They have not even been taught the contours of the debate.

An intelligent parent who spends 5 hours reading about the intricacies of a single vaccine question— is maternal RSV vaccination associated with pre-term and lower weight babies?— what is known and unknown— could easily trounce a pediatrician in a conversation.

Should a healthy 29 yo first time pregnant woman get a covid vaccine at week 34 next month, in the year 2026?

Ask your Ob-Gyn

You might as well ask a fortune cookie. What is the risk of illness to a pregnant woman in 2026? What is the risk of hospitalization? What is the absolute risk reduction to mom and baby? What is the risk of AEs? Which is larger? What study is most relevant? What are the pitfalls of the observational studies cited by expert guidelines?

Good doctors are quick to admit what they know and don’t know. They embrace humility, but the average doctor in a busy day can become frustrated. They don’t have time for 50 questions. Given the rules and incentives in some practices a parent can be fired— told to seek care elsewhere.

But I just wanted to know the current hospitalization rate for children younger than 23 months with no known comorbidities, and the statistic you gave did not report the true denominator…. The mother protests, while being escorted out. Tell your baby the only treatment for his otitis media is supportive care, the doctor shouts as the door closes.

Doctor, don’t you think the regression discontinuity study from England, subsumes the Wales analysis for Shingles vaccine and dementia?

Find another doctor.

I don’t want to just pick on pediatricians. All medical fields have these oft-repeated statements that, if you really think about it, are closer to a fable than fact.

In oncology, we lie train fellows to lie.

The best treatment for your cancer is always a clinical trial.

I have heard that a thousand times. I was told to say it. When I struggled to mouth the words, they sent me to Guantanamo bay.

But it is clearly a lie. In some cases, sure, a trial is best, but in many cases the best treatment is the standard of care. Enrolling on a phase II study by a small company bloated with fresh capital proudly stating we have 3/11 stable disease on the trial (no PR or CR)— sweet jesus, that is not a good trial. And yet, our fellows are told, tell them…

The best treatment for your cancer is always a clinical trial.

Ahh, AI supports me claim:

Oh shucks, just when I starting thinking AI was getting smart…

Win some, you lose some.

There is no direct empirical evidence that a pediatrician is the best person to discuss vaccines with. There is plenty of reason to worry that the training has avoided the difficult questions and debates that currently shape modern vaccine hesitancy—can I delay the hep B shot 2 months if the mom’s ultrasensitive Hb assay is neg?— etc. There are reasons to worry there will be countervailing risks— like being fired from the practice. In short, I have my doubts.

My solution would be for medical organizations to curate and host the debates in the space, but that would require humility and political neutrality, which is unlikely to happen anytime soon.

If this post interests you, or outrages you, I ask you to do one thing. Listen to my interview with Reason magazine and ask yourself if there was something about vaccines you didn’t know that you learned. If you are still angry, please leave a comment.