A Balanced Approach to US Vaccine Policy: Building Trust and Community Engagement

In a recent JAMA Perspective, Dr. Lainie Friedman Ross from the University of Rochester Medical Center and Dr. Mark Navin from Oakland University propose a pragmatic middle-ground strategy for the United States' vaccine policy. They emphasize that the current system requires reassessment to address declining vaccination rates and rising vaccine-preventable diseases.

The authors highlight that recent federal and state actions, such as Florida's proposal to eliminate school vaccine mandates, have contributed to a decline in immunization coverage. Data shows that non-medical exemption rates have increased to 3.6% during 2024–25, with some states exceeding 5%. Consequently, outbreaks of diseases like measles have surged, resulting in thousands of cases and the first U.S. measles fatalities in a decade.

Ross and Navin argue that the political climate has exacerbated the crisis, but the medical community also bears responsibility. After the 2015 Disneyland measles outbreak, organizations like the American Academy of Pediatrics and the American Medical Association promoted removing non-medical exemptions, policies that have inadvertently fueled public backlash.

The authors clarify that vaccine mandates were never solely about coercion but served as a behavioral nudge—creating social norms that encouraged vaccination, especially among the ambivalent population. Removing these mandates risks signaling that vaccines are unsafe, despite strong evidence supporting their safety and efficacy.

To move forward, the authors advocate for a reset in vaccine policy centered on humility and collaboration. Recommended strategies include personalized education for willing but forgetful parents, communication training for healthcare providers, and partnerships with trusted community leaders and organizations. They stress that mandates should complement, not replace, effective communication and trust-building efforts.

This approach aims to rebuild public confidence, address vaccine hesitancy, and restore high immunization coverage, ultimately protecting community health against preventable disease outbreaks.