Mass. doctors worry about vaccine hesitancy as skeptic RFK Jr. faces Senate

Massachusetts has some of the highest childhood vaccination rates in the country, but across the state doctors and public health experts said they’re concerned about growing vaccine skepticism and the potential for disease outbreaks.

With Robert F. Kennedy, Jr., an anti-vaccine activist and President Trump’s pick as the nation’s top public health official, facing Senate confirmation hearings this week, some physicians said they worry Kennedy may promote unfounded fears about vaccine safety. And they said eroding vaccination rates could fuel a resurgence of diseases once thought eradicated from the U.S.

“There’s vaccine skepticism across the political spectrum,” said Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital. “It’s something that I think is now at a higher rate than any time I can recall in my career.”

The diseases of biggest concern, experts said, are measles, polio and pertussis, or whooping cough. The vast majority of Massachusetts children receive vaccinations to protect them from these illnesses, which can cause lifelong health problems— even death. The shots are required to attend school, although families can request exemptions on religious and other grounds.

Statewide, some 94% of incoming kindergartners were vaccinated in the last school year, according to data from the state public health department.

But the rates vary significantly by community. Statewide, they’ve dipped below levels seen before the COVID-19 pandemic.

“It’s not a remote issue for us here, even here in Massachusetts, where there is a strong public health imperative and an educated population,” said Dr. Cassandra Pierre, an infectious disease physician and associate hospital epidemiologist at Boston Medical Center. “There are still communities where we have lower vaccination rates.”

If more people forego immunizations because of misinformation, doubts about vaccine safety, renewed debate about vaccines during the COVID-19 pandemic, or simply due to fatigue with the idea of getting shots, diseases like these could become a present-day reality, Pierre, Sax and other experts said.

‘The canary in the coal mine’

Measles is one of the diseases doctors and public health officials are closely monitoring. Measles was declared eliminated from the U.S. in 2000, meaning most new cases were contracted by people who traveled outside of the country.

A viral and sometimes deadly illness, measles has no known treatment. The virus spreads through the air when an infected person breathes, sneezes or coughs. Contagious particles can remain present for as long as two hours after an infected person has left a room.

Christina Hermos, a pediatric infectious disease specialist at the Children’s Medical Center at UMass Memorial Medical Center, said she hasn’t seen any cases in the state this year, but a measles outbreak here would signal that vaccination rates are low enough for the disease to spread.

“Measles is always like the canary in the coal mine,” Hermos said, “because measles is so incredibly contagious.”

Data from the federal Centers for Disease Control and Prevention show 2024 saw 16 measles outbreaks across the U.S., an increase from four the previous year. A measles case was confirmed in Massachusetts last year — the state’s first since 2020.

Pertussis rates ‘we haven’t seen in decades’

While measles remains rare, Hermos has seen cases of pertussis, or whooping cough, a highly contagious bacterial infection in the lungs characterized by a lingering, aggressive cough.

Children are typically immunized during infancy, and adults may get booster vaccines. Massachusetts reported 841 cases of whopping cough last year, according to the CDC. Nationwide, whooping cough spread to its highest level in a decade last year.

“What we’re seeing now is rates of pertussis that we haven’t seen in decades, and pertussis is a vaccine preventable disease,” Hermos said.

In recent months, Massachusetts public health officials urged residents to look out for the symptoms, including among adolescents, as they tracked higher rates of pertussis.

“We know [vaccination is] safe, we know it’s effective — and families, parents are continuing to get their children vaccinated.”

Dr. Robbie Goldstein

State Public Health Commissioner Dr. Robbie Goldstein emphasized that vaccines provide strong protection, and most children receive the full course of childhood vaccinations.

“ I think the data are really helpful to remind us all that people here in Massachusetts believe in vaccination,” Goldstein said. “We know it’s safe, we know it’s effective — and families, parents are continuing to get their children vaccinated.”

But Goldstein acknowledged vaccine skepticism is on the rise, and the national childhood vaccination rate has dipped.

He also said counties with lower vaccination rates, especially in the western part of the state, and Cape Cod and the Islands, could weaken herd immunity. State officials are planning a vaccine education program this spring to try to prevent disease outbreaks.

“ I think there’s a potential for additional myths and disinformation to spread over the coming years,” Goldstein said, “and that will make it easier and easier for an outbreak to happen here in Massachusetts and across the country.”

Could polio make a comeback?

One of the diseases that most worries Pierre, from Boston Medical Center, is polio. Also caused by a virus, polio was considered eradicated in the U.S. in 1979. It had become one of the most feared diseases in the country because it can cause paralysis of parts of the body, or death.

Before the vaccine was introduced in 1955, polio disabled more than 15,000 Americans. There is no known treatment. Over the past decade, there has been only one case in the U.S., reported in New York in 2022.

Pierre said she is concerned about a possible resurgence of polio — and not just among the unvaccinated, but among older adults, especially health care workers, who were vaccinated years ago. Over time, the shots’ protective effects may have waned.

Doctors said health care workers should be educated about the symptoms of diseases like polio, which they may not recognize. And they said if vaccination rates drop, some adults may need boosters.

“A lot of people in the United States that are in their 40s to their 90s are not very well protected anymore against polio because they have not had a booster since they were a kid,” said Dr. David Hamer, professor of global health and medicine at Boston University.

The best protection against outbreaks, Pierre said, is having as many people vaccinated as possible because even a modest decline in rates could cause an outbreak.

“I hate to say this, but it’s somewhat of an eventuality if we continue to see declines in our vaccination rates,” Pierre said. “Could we see large-scale outbreaks in Massachusetts? It doesn’t seem likely at this point, but it is important to know that herd immunity is a function of the community that you’re in.”

Kennedy, Jr. has publicly doubted the effectiveness of the polio vaccine. He has said he would not take away vaccines, but has questioned whether they are as effective and safe as the vast majority of health officials insists.

Like many other experts, Massachusetts health leaders stressed that Kennedy’s claims have been debunked, and primary care doctors should emphasize the importance of vaccines to every patient.

They added that many people don’t remember a time when diseases such as measles and polio were prevalent, so they don’t understand the dangers. They also said officials should be planning to improve surveillance and testing.

Boston University’s Dr. David Hamer, who also works with the Global Infectious Disease Surveillance Network, said officials should consider what to do if an outbreak occurs, and whether they have enough tests and vaccines to immunize children and adults who may need another dose to stay safe.

“Smaller outbreaks, we will have the resources,” Hamer said. “But if we were to have a statewide or national or regional outbreak, we might not be adequately prepared.”