LAKEVILLE, Mass. — She didn’t have any trouble with her current pediatricians in Fall River. Really, she didn’t. She liked them. They were kind. They were great with her newborn daughter. They had helpful answers to most of her new-mom questions.
“My only issue was the vaccines. They push ’em,” she said, rocking her 6-week-old’s carrier. “They’re like, ‘Well, she needs them all by 2 or we can’t keep her as a patient. And I’m like, ‘OK, I understand that, but at the same time, like, why?’ And they’re like, ‘It’s our protocol.’”
That wasn’t a good enough answer for her, and that was why she was here at Middleboro Pediatrics at 4:45 p.m. on a hot summer Thursday, meeting a new doctor named Aaron Bornstein. In a sense, they were auditioning each other. She was testing his willingness to take her questions and concerns seriously, without judgment or sneering — to “work with her,” as this sort of flexibility is often called in this genre of conversation between someone who represents medical authority and someone else who’s wary of it. He, meanwhile, was probing just how wary of his medical advice she might be if her daughter became his patient.
“My argument is —” but then her baby began to fuss, cooing and kicking her chubby legs, and she reached out to comfort her. “My argument is, what happened to my body, my choice? Like, she still doesn’t know she’s outside of me, technically.”
She looked straight at Bornstein. He was leaning back in his armchair, wearing a blue button-down, beige slacks, a popsicle-pattern tie and butterfly-pattern socks — professorial with a dash of Ms. Frizzle. It was an outfit selected for the strange pressures of his job, which could involve credibly breaking down statistics for a parent while also credibly weighing the pros and cons of zoo animals with a 5-year-old. The work had gotten a lot harder in the last few years. Conversations about vaccine hesitancy that might have happened once a month were now happening two or three times a week. Rhetoric that had lurked in conspiracy-minded corners of the internet was now coming from the federal government itself.
In January, the Trump administration had bypassed normal procedures and slashed the number of recommended childhood vaccines, a change that public health experts saw as a dangerous deviation from evidence-based practice. A judge had struck down the new schedule, but last month, President Trump signed an executive order demanding that the measles, mumps, and rubella vaccine be broken up into three separate shots, and claimed in a speech, without evidence, that the combined shot “could be quite lethal.” Vaccine confidence is lowest in the MAGAverse — in a survey late last year, 80% of Democrats reported trusting immunizations writ large, while only 48% of Republicans did — but the trend is visible even in Massachusetts, among the bluest of the blue. Bornstein couldn’t help but notice “We The People” tattooed on this mom’s forearm.
This conversation was a compromise. Many independent pediatrics practices had dismissal policies like the one this mom had come up against in Fall River. The American Academy of Pediatrics had recognized it as an acceptable approach since 2016. But amid these federal changes, and the ensuing confusion among families, some doctors wondered about the best tack. Should they double down? Should they allow parents more wiggle room, given that the government was recommending one vaccine schedule and the AAP another?
Bornstein and his three partners wouldn’t tell parents to go elsewhere if they didn’t agree to vaccinate their kids. In fact, they welcomed those families. When a clinic 20 minutes away formalized a dismissal policy earlier this year, Middleboro got so many new patients they were meeting two or three of them every week. “We’re almost like a practice of last resort,” said Martin Gross, one of Bornstein’s partners.
They did have some stipulations, though. One of them was the conversation this mother was here to have: a meet-and-greet, so the pediatricians could understand the root of a parent’s concerns — but also just how far that fear had spread. “If I think your child’s got a bad infection, will you reject my recommendations for antibiotics? Are you going to reject my ability to do an adequate evaluation?” Bornstein said. “Because at some point I need a level of trust that you’re coming here because you want my guidance. If you’re going to reject all of that upfront because you don’t trust anything about my incentives or my experience or my expertise, then this is not a match.”
Misleading averages, alienated families
On the face of it, everything might not look so dire. The majority of parents report trusting childhood immunizations, and among kids in kindergarten, the most recent national coverage rate for the measles, mumps, rubella vaccine is 92%, a drop of only a few percentage points from the 95% around which it hovered from 2015 to 2020.
Not too shabby for a nation where the sitting health secretary is famous for spreading vaccine misinformation, you might say. Then again, 95% is the level of vaccine uptake needed to prevent outbreaks, and more measles cases were recorded in the U.S. in 2025 and 2026 than in the previous 24 years combined, leading to the first measles deaths in nearly a decade. What can seem like a small dip in national numbers may obscure vital details. “The average is not really representative of the problem,” explained Rochelle Walensky, a Harvard infectious disease doctor and former director of the Centers of Disease Control and Prevention. “I always say: Your head is in the fridge, your feet are in the oven, and on average, you’re fine.”
Take the measles outbreak that engulfed Spartanburg, S.C., from October to June. The state’s MMR vaccination rate was 94%. The county’s was 89%. But at the school linked to the first cases, only 17% of students had proof of required immunizations.
Like politics, disease risk is local: a vast public health problem that often fell to each doctor as an individual, no matter if each appointment was only supposed to last 15 minutes. “The amount of time and effort involved in dealing with these families became untenable,” said Jesse Hackell, who practiced in a New York suburb for 41 years and has authored AAP reports on vaccine hesitancy.
That is one argument for dismissal policies. Another is the contagion risk posed by having an unvaccinated child in a waiting room alongside infants and kids with immunodeficiencies. Yet another is to convey that getting your child vaccinated is the cornerstone of modern medicine and the best advice a pediatrician can give. For a parent to refuse them outright may represent a fundamental, irreparable breakdown of the doctor-patient relationship.
“Over 20 years, we probably only dismissed a handful of families — less than a dozen — because when push comes to shove, drawing a line in the sand, while I can’t prove it to you with statistics, seems to indicate to most families how seriously we take this,” Hackell said. “The vast majority of people with whom we have these discussions are people who are hesitant, people who are confused, people who just need some time and some talking to bring them around.”
But that was a central argument against dismissal policies, too. “Families have been brave enough to come to health care, often feeling alienated from it, and then they get this coercive declaration, which then alienates them even more,” said Julie Leask, a social scientist and professor of public health at the University of Sydney Infectious Diseases Institute, in Australia.
Middleboro’s meet-and-greets were a middle ground. They could be inconvenient, uncompensated, after-hours conversations that could last much longer than appointments themselves. Practices could be penalized for taking in such patients, given that vaccination rates were one of the metrics on which insurers measured physicians’ success.
There were moments when one or two partners in the practice felt drawn toward a dismissal policy — moments of frustration, when they’d given hours of their time talking in circles with families who would not budge and sometimes responded with conspiracy theories and even insults. The possibility of parents threatening clinicians was very real. Technically, the threat of dismissal would be unenforceable: Massachusetts’ Medicaid agency makes clear to physicians that if they take tax dollars, they can’t fire patients who refuse vaccination.
But Middleboro’s reasoning was mostly philosophical. Kids don’t get to choose their families — and vaccine-hesitant parents are not a single, monolithic, immovable bloc. They’re people, full of fears and idiosyncrasies and inconsistencies, their reactions informed as much by their upbringing as by the shadow of annoyance that might’ve passed over a previous doctor’s face. Taking this unpaid time upfront, Bornstein hoped, might help shift the tenor of appointments later, and might even convince some to vaccinate once there was a sense of trust.
“We don’t kick people out. We work with people,” he told that mother, who asked not to be named in this article. “The one thing I will say is this. If we have a family who chooses not to vaccinate, there’s a form that we have you sign that just says we had that conversation about these vaccines, these were recommended. It helps protect us from liability.”
“Understandable. In case something did happen and she did get something that a vaccine could have —” she paused, searching for the right word. “… postponed, or, you know, helped her or … prevented.”
She wrinkled her nose and laughed, as if the idea were absurd. Bornstein didn’t correct her. “That’s exactly it,” he said, and went on: “So whooping cough and measles are both very contagious diseases —”
But she interrupted him: “Yeah, but it’s not just the measles vaccine, is it? It’s MMR.”
“It’s MMR,” he agreed. “But for those two in particular, if a child has not been immunized by a certain age, we don’t let you in the waiting room, we room you directly from the car.”
He glanced up at her. She might have balked, or accused him of treating unvaccinated people as second-class citizens. There was still time for that. But for now, all she said was, “OK.”
‘I want my child healthy’
Bornstein could still feel the mounting sense of horror, over 25 years later. He was a medical resident in Chicago, right around 2000, working in the emergency room, when an unvaccinated infant was added to his caseload. The trouble was a bacterial abscess on the child’s neck, swollen, red, warm to the touch, about the size of a ping-pong ball, large enough to force the head into a tilt. This wasn’t an illness that would have been prevented by a vaccine, but Bornstein could detect a through line of distrust. When he said he needed to admit the kid, put in an IV, do blood tests, and start antibiotics, the parents refused. For religious reasons, they said. Bornstein wasn’t sure what to do. Without treatment, the illness could be fatal. Treating against the parents’ wishes would entail calling state authorities and requesting an emergency removal. “That’s a mess,” he said.
That was the sort of scenario he hoped to avert with these meet-and-greets. In that particular case, the conflict was resolved without child protective services getting involved. “An older, sager ER physician asked, ‘Is this their first kid?’” Bornstein recalled. “I said, ‘Yeah.’ He said, ‘Have them call the grandparents’ — and the grandparents made the kid stay in the hospital.”
The worry he had about mistrust extending beyond vaccines wasn’t just theoretical. More and more now, parents were refusing the routine vitamin K shot given to newborns to help their blood clot, and doctors were starting to see babies hemorrhaging because of it. Some were balking at the erythromycin eyedrops that babies get so they don’t get conjunctivitis from bacteria in the birth canal.
“I got her vitamin K shot in the hospital because I’m not dumb. I want my child healthy,” the mother told Bornstein. “But I was like, can’t I just do the preservative-free one? And one of the nurses goes, that’s a thing?” To her, the fact that they made shots without preservatives seemed like proof that the normal shots had unnecessary ingredients. She worried about those chemicals. But she also worried about seeming stupid for worrying, or being judged a negligent parent. She’d hated how the nurses had made her feel bad for refusing the first dose of the hepatitis B vaccine right after her daughter’s birth: “They’re like, ‘If you don’t get the hep B shot, this can happen, that can happen, it can be severe, it can be fatal, blah blah blah blah.’”
She was 29, a truck driver living in a former shipping hub in southeastern Massachusetts. It was only 18 miles from Providence, and about 44 from Boston — Ivy League towns, with university hospitals — but it could feel farther. This was cranberry-bog country, Middleboro Pediatrics just a few doors down from the headquarters of Ocean Spray. “I was actually in school to be a doctor. I started college at 16,” she told Bornstein. “I took an anatomy class, a child psychology class, a bunch of that stuff.”
“You are someone who clearly pays attention to detail,” he said. “You’ll be the right person for our practice, I think.” He started gesticulating as he described the nuances of the vaccine schedule, how whooping cough was most dangerous under the age of 1, which meant it was important for that vaccine to be given in infancy.
“But at the same time, everyone’s body is different,” the mother said, rubbing her daughter’s back. “You could have a majority of people that react perfectly fine to it, but there’s still going to be people that probably don’t react fine to it. But what happens if they just didn’t test those people?”
Bornstein smiled. Now he was getting somewhere. He wanted parents to bring up their specific concerns, something he could ask about, engage with. If they wouldn’t tell him what they were worried about, there was little he could do. He explained that her question was one scientists had to address in designing vaccine trials: Did they have enough people enrolled to look for those rare side effects? Last year, for instance, there’d been a big study published out of Denmark based on data from 1.2 million people over 24 years; it showed that the conditions vaccine-skeptical groups often blamed on immunizations — autism, say — were no more common in the vaccinated group than in the unvaccinated.
The mom piped up. “I just feel it’s weird. Like my baby’s healthy. Why am I gonna then inject her with stuff? Why inject her with all these things now when her immune system is still building?”
“It’s a great question,” Bornstein said. “Our job for you is to help interpret risk and benefit, right? The number one thing that parents realize is you cannot eliminate all risk in life. They’re going to climb up to the part of the jungle gym you don’t feel comfortable with.”
“Exactly.”
He was a father himself, he said. He wouldn’t recommend anything that he wouldn’t give his own kid. He wanted to talk through the risks and benefits of every vaccine with her — yes, the risks, because vaccines, like medications, could indeed have side effects, and she should know about them — while also weighing that against what might happen if her child caught a preventable disease that she hadn’t been vaccinated against. But the choice would always be hers.
“I don’t have the authority to do anything to your child, right? I have the authority to give you advice,” he said. “We encourage vaccines. But it’s equally important that you feel comfortable with why we’re doing it, and that the risks are low enough. Your question: Why would we give it to a healthy kid? You know, the silly analogy is, it doesn’t help putting the seat belt in after the car crash has happened.”
Statistical risks, anecdotal anxieties
What made the discussion delicate was that a parent might be both right and wrong at once. It was true: The vaccines she and Bornstein had each gotten as a kid weren’t all the same ones Bornstein would be recommending for her daughter. Certain immunizations did indeed come with certain risks. The example that always jumped to mind for Bornstein was an earlier version of the rotavirus vaccine, first recommended as a routine immunization in 1998, to prevent tens of thousands of infants needing to be hospitalized for severe, potentially life-threatening diarrhea annually. But doctors noticed an uptick in a condition called intussusception in which one bit of intestine slides inside another, like the segments of a pirate’s telescope. A study found the increase was associated with the vaccine, and it was taken off the market in 1999.
Newer rotavirus vaccines are now available. They’re associated with a slight increase in intussusception risk, but that risk is a sliver of what it had been for the earlier vaccine, and the benefit was thought to outweigh it: Per one study’s estimation based on Australian data, the vaccine might be linked to 14 cases of intussusception a year, but would prevent 6,500 gastroenteritis hospitalizations.
This mom was generally worried about undisclosed or undiscovered risks, but this episode hadn’t come to her attention. Her anxiety came from a more recent anecdote she’d heard.
Bornstein was explaining that the rotavirus vaccine was oral, that the disease had once been a leading cause of hospitalization in infants, that it caused severe vomiting and diarrhea and —
But then the mom interjected — and for a second they were both talking at once.
“I don’t like that it’s oral.”
“—dehydration.”
“She chokes on her damn formula, I don’t need her choking on a vaccine.”
“It’s like 1 milliliter. It’s tiny.”
“My friend’s son just had that and choked on it and went limp. The nurse grabbed him from her and had to sit there and smack his back like crazy and get him to kind of cough some of it up.”
“I would say that has not been our experience. Some of it —”
“That was in Maine, though.”
“Some of it is how you administer it. If you put a dropper in the back of the throat, it’s like putting a turkey baster in the back of your throat. If you squeeze it all, you’re going to gag. You have to tuck it in the cheek.”
She kept telling this story, unconvinced, even as he explained that this had more to do with how that nurse had given the vaccine rather than the formulation itself, that pediatricians used to see a ton of kids hospitalized with rotavirus but now it was much rarer because of these newer vaccines, that new, improved vaccines came onto the market just like new iPhones and electric cars.
Eventually, the discussion quieted down and moved on. She had a few insurance questions. Then it was time for her to go. She picked up the carrier, and headed out to the car, another tattoo visible on the back of her leg, as if in answer to the “We The People” on her arm. The ball was in her court now.
Not every patient who came for a meet-and-greet became a patient at Middleboro. Some said they didn’t want doctors who were going to talk so much about vaccines, and stormed out. Others simply never called to book a first appointment. Bornstein walked down the hall back toward his desk, past patients’ artwork: a painting of stick figures with what looked like flowers for hands, a Thanksgiving drawing expressing gratitude for the existence of chorizo. As he packed up for the day, he wasn’t sure whether this mother would enroll her daughter as a patient. But if he had to guess, he’d be seeing her again soon.
STAT’s coverage of trust in science and public health is supported by the Dana Foundation, Greenwall Foundation, John Templeton Foundation, and Boston Foundation. Our financial supporters are not involved in any decisions about our journalism.