Vaccine Hesitancy Isn't Just About Misinformation

Medscape

08-05-2025

Measles has returned to the spotlight with the deaths of two unvaccinated children during an outbreak in Texas. As an emergency physician, I am concerned by the ever more polarized debate in which proponents and skeptics of vaccinations characterize the other with an increasing hostility. For this reason, I found the season finale of HBO's The Pitt refreshing in how it harnessed the power of narrative fiction to humanize both clinicians and families through its case of an unvaccinated teenager who falls severely ill with measles.
In the penultimate episode, we meet 13-year-old Flynn Edwards after he developed a perplexing rash and severe pneumonia, ultimately requiring intubation. We later discover he is unvaccinated and his mother believes immunizations are dangerous. Flynn is diagnosed with measles.
When Mrs Edwards arrives at the emergency department, she declines the spinal tap recommended by the medical team. Scrolling through her phone, she frantically cites far-fetched potential side effects from the internet — such as paralysis — to justify her previous refusal to vaccinate her son. Visibly frustrated, the attending emergency physician, Dr Robby, leaves the room. After some foul language, he vents: 'They want medical treatment, but they don't want medical advice!'
Despite his lapse in professionalism, we can relate to Dr Robby's exasperation as he struggles to keep Flynn alive from a disease that could have been so easily prevented. (Sadly, the US Centers for Disease Control and Prevention estimates one in five unvaccinated children with measles will require hospitalization, and one in 500 will die from the infection). But my favorite aspect of the episode is how we can simultaneously sympathize with and learn from the flawed reactions of both Dr Robby and Mrs Edwards.
Like Flynn, Mrs Edwards is a victim of contagion, but of a different kind: misinformation. She falls right into the trap of the internet's worst fearmongers when Dr Robby tries to reason with her. Neither of them can stand each other as they argue about what course of action is best. Some creative license is at play in how Dr Robby says the things many doctors might be thinking but know better than to verbalize. And for her part, Mrs Edwards fights back with her fair share of snide remarks.
Toward the end of the episode, Mrs Edwards' husband apologetically tells the staff, 'She really is a good mom.' I loved this line because I could believe it. Despite her behavior, Mrs Edwards does indeed seem like a devoted mother, which only amplifies the tragedy of her son's illness, because she invested so much time and energy doing her own research. By relying on false information, her intense efforts could backfire and cost Flynn his life.
Taking care of a child suffering from a preventable illness is heart-wrenching. When we ask ourselves why these things happen, sometimes, we might be tempted to lay blame. The Pitt deserves kudos for its nuanced and compassionate portrayal of so-called anti-vaxxer parents like Mrs Edwards and where we as clinicians often err in our communications, despite our best intentions. The dynamic between Mr and Mrs Edwards is insightful: Many families feel torn and struggle with decision paralysis as they try to navigate a sea of information, both accurate and inaccurate.
Most parents are good people trying to do the best for their kids. In what I have gleaned from conversations, many parents of unvaccinated children don't seem convinced that vaccinations are harmful. However, they also know their child's individual risk for contracting a disease like measles is small. When they weigh what they see as a small benefit against even the slightest potential risk for theoretical harm, some default to indecision, and therefore, inaction. For others, the thought they might choose to introduce something into their child's body that couldpotentially cause harm is too anxiety-provoking to bear. For them, their refusal to vaccinate may be as much a manifestation of anxiety as it is a product of misinformation.
Recent studies also affirm parental anxiety drives vaccine hesitancy. It seems we are missing opportunities to reach anxious parents by focusing on calling out factual inaccuracies while neglecting to address parents' unmet emotional needs. Facts are necessary and help people make informed decisions, but emotions can drive decisions, too. Dr Robby falls into this trap when he counters Mrs Edwards solely with facts while failing to build rapport and assuage her fears. In turn, she lashes out at him instead of reflecting on the logic of his explanation.
As medical professionals, we must find ways to address parental anxiety while conveying the facts. When it comes to things like shots and spinal taps, choosing inaction carries far greater risk to their children. Parents' anxieties are sometimes misplaced because their assessment of risk is miscalculated. Facts alone will not magically help anxious parents see the error in their logic; instead, we also need to help them work through their anxieties as they weigh contradicting information.
We may not be able to persuade the small minority of vaccine-resistant parents who have an unshakable belief that immunizations and spinal taps are dangerous. Furthermore, as the current outbreak highlights, some people resist vaccinations due to outright religious objection or a human tendency toward social conformity. These cases require different approaches, depending on the underlying factors. But we probably can persuade plenty of vaccine-hesitant people to accept immunization for themselves and their children.
The season finale concludes with Mrs Edwards and Dr Robby defiantly at odds. But I remain cautiously grounded in optimism. As exhausting and repetitive as it may feel, we have a duty to convey the consequences of these decisions to our patients and their families.
The parents of unvaccinated children want the best for their children, as do the rest of us. I can only hope that if we can find more compassionate ways to present the facts as we highlight the mismatch between parents' anxieties and their assessment of risk, we can come together and reach the best decisions for their kids. In the meantime, The Pitt is a timely reminder for our profession during the latest measles outbreak: We ought to refine our messaging to better address parents' anxieties and build trust as we work to dispel misinformation.