The U.S. Centers for Disease Control and Prevention’s recent reversal in its former position that vaccines do not cause autism is another example of the continued erosion of our public health infrastructure. This shift will have long-lasting, deleterious effects on public health with disproportionate impacts on our children in South Side communities.
Prior to the announcement late last month, reports indicated that the measles vaccination rate in the Chicago Public Schools system is 93%, falling short of the herd immunity threshold and impacting many South Side schools that serve children from marginalized communities.
These low vaccination rates among our most vulnerable community members are the outcome of deliberate actions by an administration that has dismissed vaccine experts, politicized childhood immunization schedules and undermined agencies responsible for our children’s health.
While there has been intense focus on the financial implications, the shift of childhood disease epidemiology and barriers to vaccine access as a result of the current Department of Health and Human Services’ vaccine policies, there has been less attention paid to the harmful psychological impacts of misinformation and disinformation, the erosion of trust between medical providers and their patients and the discreditation of health care institutions, particularly in communities of color.
If left unaddressed, these wounds will impact an entire generation of South Side youth who are already disadvantaged on account of systemic racism and longstanding community disinvestment.
Health and Human Services Secretary Robert F. Kennedy, Jr. has contributed to vaccine hesitancy by playing on parental fears, affecting vulnerable communities with historical trauma related to vaccines. Sowing the seeds of skepticism by highlighting the number of vaccines required in early childhood, questioning the timing of vaccine delivery, focusing on causation between vaccination and autism that have been disproven and casting doubt on the knowledge of the medical community tap into the instinct that parents possess to keep their children safe. This approach encourages and reinforces vaccine hesitation.
National surveys reveal that parental confidence in federal public health agencies is fragile and hesitation creates openings for misinformation to thrive. What was once a routine part of pediatric health care, childhood immunizations, have now become a source of anxiety, contention or frustration for both caregivers and providers.
The effects of vaccine disinformation and hesitancy do not impact all communities equally. In well-resourced neighborhoods, families may feel more empowered to delay routine vaccinations, pursue alternative vaccination schedules and seek second opinions. Conversely, in communities with lower socioeconomic status and health literacy, many families have limited access to primary care, difficulties navigating transportation and health insurance, and fewer trusted health care providers that make recovery from a misstep more difficult. Vaccine-preventable infections can cause severe illness and may result in significant morbidity or mortality if there are delays or obstacles in accessing health care. The loss of trust in evidence-based medicine will undo much of the work health systems have done to rebuild trust among historically marginalized communities, increasing preexisting health care disparities.
How then do we respond as medical providers, as community members on the South Side, and as advocates for children’s health? Now is not the time to retreat but rather, the time to reengage. Health care professionals have a responsibility to address caregivers’ concerns directly and encourage families to share their opinions rather than assuming that silence equates to agreement or understanding.
Departments of Public Health and the health care community should expand current educational programming, activate and devise community health care worker initiatives to increase representation when sharing information about the impacts of vaccination, host local town halls and collaborate with schools. The behaviors children witness today from caregivers and medical providers will influence their future health care decisions and profoundly impact generational health.
Chicago’s challenge isn’t just decreasing vaccination rates but the deliberate undermining of trust in science, medicine and the health care system by our federal government. On our South Side, where access is already fragile, further erosion of trust in the medical establishment could be disastrous.
However, there is hope if clinicians, health systems and communities engage in honest dialogue and work together. The stakes are too high, and the cost too great to ignore. The future will judge us for this moment and calls on us to protect our city’s most vulnerable communities and rebuild trust that will extend for future generations.
Chuka Onuh is a second-year medical student at the University of Chicago Pritzker School of Medicine.
Dr. Julia Rosebush is an associate professor of pediatrics, section of infectious diseases at the University of Chicago Medicine Comer Children’s Hospital.