Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee donations. Sometimes it feels like science communicators are screaming into the void, and paid subscribers help keep me going. If my writing has informed, entertained, or saved you from a questionable Google rabbit hole, a subscription is a great way to say, “Hey, keep doing this.” Plus, you get the satisfaction of knowing you’re supporting independent work instead of, you know, another giant media conglomerate. You can always find sources and citations at the end!

Subscribe now

Buy Me a Coffee

Thank you for taking the time to read my newsletter! I appreciate you being here.

“Stop fear-mongering.”

My SciComm friends and I hear this on a near-daily basis as we combat vaccine misinformation.

Sometimes, that criticism is justified if it’s coming from someone who isn’t qualified or correct when discussing risks.

Please note that fear can be manipulated. Images can be chosen specifically to provoke panic. Rare complications can be presented as though they are inevitable. Anecdotes can be used to make an unlikely event feel statistically common, and people can be pressured into making medical decisions without being given the information they need to understand the actual risks and benefits.

None of that is good public health communication, but I also don’t see many genuine public health and science communicators using these methodologies.

That is because simply presenting the risks of serious, vaccine-preventable diseases should be enough alone to encourage people to make educated decisions. This is not the same as fear-mongering. However, knowing and understanding the real risks of said vaccine-preventable diseases may be enough to elicit a healthy fear of contracting them. Once again, this is not the same as fear-mongering.

Sometimes, calling something “fear-mongering” is simply a way of dismissing the uncomfortable fact that most vaccine-preventable diseases are genuinely dangerous.

We Have Somehow Confused “Fear” with “False Information”

Fear is an emotion and isn't inherently misinformation.

If I tell you that measles can cause pneumonia, encephalitis, hospitalization, permanent disability, and death, I am not necessarily trying to scare you.

I am, unfortunately, describing the disease.

The CDC estimates that about 1 in 5 unvaccinated people in the United States who contract measles are hospitalized. About 1 in 20 children with measles develop pneumonia, and approximately 1 in 1,000 develop encephalitis. Measles-related encephalitis can result in seizures, deafness, or intellectual disability, and approximately 1–3 children per 1,000 who become infected die from respiratory or neurologic complications.

Those aren't scare tactics, but they are real risks. When the risks are as real as they are with a disease as serious as measles, we should be able to say:

“This disease can be dangerous.”

without having to immediately follow it with:

“But don't worry!”

Sometimes the appropriate response to a dangerous disease is, in fact, to be concerned about it.

A Healthy Fear is Different from Panic

There is a big difference between simply suggesting to you that you should be terrified because your child could die any moment and telling you:

“This is a serious disease, and vaccination substantially reduces the risk of your child experiencing its complications.”

The primary difference is that the first is fear-based persuasion, and the second is risk communication.

The first attempts to create an emotional reaction that may not correspond to the actual probability of harm, while the other gives you information that allows you to understand why prevention matters.

Healthy fear doesn't mean living in terror of infectious disease, especially when we know what can help: vaccination.

A healthy fear means having an appropriately calibrated understanding of risk.

We already do this in other areas of life. We teach children that cars are dangerous. We use car seats. We wear seat belts. We teach kids not to play in traffic.

We do NOT tell them:

“Don't be afraid of cars. Most car rides are fine!”

because that would leave out really important information. The consequences could be dire, right?

We also don't tell them:

“Cars are terrifying death machines, and you could die every time you get in one!”

Because that would exaggerate the risk. Instead, we teach them how to understand and manage the risk. Vaccines really aren’t any different.

“But these diseases are rare now.”

Yes, and that's actually the point.

Many vaccine-preventable diseases became rare because generations of people were vaccinated. The absence of disease can create a strange psychological problem: we begin to forget why prevention was necessary in the first place.

When someone has never seen a child hospitalized with measles, never cared for an infant struggling to breathe from pertussis, and never witnessed congenital rubella syndrome, it can become difficult to understand why these diseases deserve our attention.

Saying that you haven’t seen any of these events yourself is not at all the same thing as (1) them not actually happening or (2) them not being as serious as they are.

The success of vaccination can make the diseases it prevents seem less serious. That's one of the several paradoxes of public health.

When prevention works, people can forget what is being prevented.

Pertussis is Another Good Example

Whooping cough can sound almost quaint when we call it “whooping cough.”

It sounds like just another unpleasant childhood illness, but pertussis can cause apnea, pneumonia, seizures, encephalopathy, pneumothorax, and death. Infants are particularly vulnerable, which is why Tdap is recommended to pregnant folks around 27-ish weeks.

The CDC reports that approximately one-third of infants under 12 months who develop pertussis require hospitalization, with the greatest hospitalization burden among infants younger than 6 months.

The youngest babies are precisely the people who haven't had the opportunity to complete their own primary vaccination series. Again, that is why maternal Tdap vaccination matters.

Vaccination during pregnancy provides antibodies to the baby before birth and has been shown to prevent more than 75% of pertussis cases in babies younger than two months, while protecting about 90% of babies from serious infections requiring hospitalization.

Telling an expectant parent that pertussis can be deadly to a newborn isn't fear-mongering. In this case, it is explaining why we like to vaccinate for it during pregnancy.

Vaccines Aren’t Risk-Free

This is where honest vaccine communication becomes especially important. Vaccines, like every medication and medical intervention, can have side effects.

Most vaccine side effects are mild and temporary, such as soreness, fatigue, or a low-grade fever. Some vaccines have uncommon or rare serious adverse events. The CDC explicitly acknowledges that vaccines can cause adverse reactions and recommends communicating both their benefits and risks.

Pretending otherwise doesn't build trust. If someone asks you whether a vaccine can cause a serious reaction, the answer should not be “absolutely not.” There must be nuance.

A complete response would look something like:

“Serious reactions can happen, but they are rare. Here's what we know about them, here's what we know about the benefits, and here's how those risks compare with the risks of the disease.”

This is true informed consent, and importantly, acknowledging vaccine risks does not require minimizing disease risks. We can hold both truths simultaneously. We should be able to do that.

Risk Is Not a Binary

One of the biggest problems in vaccine conversations is that people often frame the choice as vaccination being an unnecessary risk, but that NOT vaccinating doesn’t carry risk.

That is not accurate and certainly not how medicine works. Every single decision carries some risk. That’s the nature of it. Vaccination involves the risk of adverse reactions, while not vaccinating involves the risk of becoming susceptible to the disease.

Then, the disease itself carries risks of complications, hospitalization, disability, and death. Then, there can be risks to other people when contagious diseases spread through communities.

I think for many well-meaning people, the question comes down to which option carries the greater overall risk for this person, given what we know about the vaccine and the disease.

Really, this is a much more useful question.

“Fear Mongering” Can Sometimes Become a Way to Minimize Disease

We should be very careful about this. When someone you see online or hear in person says something along the lines of “don’t scare people with measles,”

They should mean that we don’t want to exaggerate measles, but if what they really mean is:

Don't tell people that measles can cause pneumonia, brain inflammation, disability, or death because that might make vaccination look more important... then we've crossed into something else entirely.

We cannot have an honest conversation about vaccination while pretending that vaccine-preventable diseases are harmless. The goal shouldn't be to make people afraid of vaccines.

The goal should be to make people appropriately informed about both sides of the decision.

We Need Better Risk Communication!

Good vaccine communication should be able to hold room for all of these things at once:

• Vaccines aren't perfect.

• Vaccines can cause side effects.

• Rare serious adverse events exist.

• Some people have legitimate medical reasons not to receive particular vaccines.

• Vaccines don't provide 100% protection against every infection.

• Breakthrough infections can happen.

• The diseases vaccines prevent can be serious, sometimes devastating, and occasionally fatal.

None of these statements are contradictory, and they serve as the foundation of informed decision-making.

In fact, refusing to discuss the severity of vaccine-preventable diseases because we're afraid of being accused of “fear mongering” can become its own form of misinformation.

We shouldn’t be afraid of leaving out this information when there are well-intentioned people making these decisions for themselves and their children. This can materially change their understanding of risks.

What Does Healthy Fear Look Like?

Healthy fear can sound like any one of these thoughts:

“I don't want my child to get measles because measles can cause serious complications, so I'm going to learn about the MMR vaccine.”

or

“Pertussis can be especially dangerous for young infants, so I want to understand why Tdap is recommended during pregnancy.”

or

“I'm concerned about vaccine side effects, so I'm going to ask my healthcare provider what is common, what is rare, and what warning signs I should know about.”

Healthy fear should lead us to questions, prevention, and preparation. Fear mongering leads to panic.

Once again, these are not the same thing.

As Communicators, We Don’t Need to Choose Between Reassurance and Honesty.

Perhaps the biggest mistake we can make is believing that public health communication has to make people feel comfortable. As we know, sometimes the truth is uncomfortable.

A serious disease should make us take it seriously, and a rare vaccine complication should make us take informed consent seriously.

I think uncertainty should make us ask better questions rather than inventing some form of certainty where none truly exists.

We should not frighten people into vaccinating, but we also shouldn't reassure people out of taking vaccine-preventable diseases seriously.

There is a middle ground in honest risk communication.

Please reply directly to this post or leave a comment below. I read every single one, and your insights are invaluable.

Subscribe now

Leave a comment

Share

Yours,

Caroline Waltzman, MHA, CLSSGB

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee donations. Sometimes it feels like science communicators are screaming into the void, and paid subscribers help keep me going. If my writing has informed, entertained, or saved you from a questionable Google rabbit hole, a subscription is a great way to say, “Hey, keep doing this.” Plus, you get the satisfaction of knowing you’re supporting independent work instead of, you know, another giant media conglomerate. You can always find sources and citations at the end!

Subscribe now

Buy Me a Coffee

Thank you for taking the time to read my newsletter! I appreciate you being here.

While [some] legitimate conversations are happening in American healthcare about hospice, I’ve also recently heard quite a dangerous one.

The “dangerous” conversation here is what happens when legitimate problems surrounding weak oversight and patient needs get reinterpreted into the much broader idea that “hospice is too expensive” for insurers and the government.

We cannot act like hospice is an elective luxury that people access because they simply want another layer of healthcare. Hospice is a specialized form of care for people with terminal illnesses and for the families who are living through the process of dying.

Right now, the federal government is taking significant action against the hospice industry.

In May 2026, the Centers for Medicare & Medicaid Services (CMS) implemented a six-month nationwide moratorium on new Medicare enrollment for hospices and home health agencies. CMS described the policy as a data-driven response to fraud, waste, and abuse in these high-risk provider categories.

There are also legitimate examples of hospice fraud.

In April 2026, the Department of Health and Human Services Office of Inspector General announced arrests in a case involving more than $50 million in alleged healthcare fraud, including sham hospice facilities that allegedly enrolled people who were not terminally ill and billed Medicare for their care. Those cases deserve both investigation and prosecution.

However, we need to be very careful about allowing fraud committed by some few fake hospice providers to become an argument against hospice care itself.

These dollars could and should have been spent on the hospice patients and families who need them. Hospice can be very expensive for these families. So when we talk about the cost of hospice at the federal level, what is this “cost,” and compared with what?

What is Hospice?

Hospice is end-of-life care for people with illnesses that cannot be cured.

Under Medicare, a patient generally qualifies when their hospice physician (and their regular physician, when applicable) certifies that they are terminally ill with a life expectancy of six months or less if the illness follows its normal course. The patient must elect hospice (if able) and choose comfort-focused care rather than Medicare-covered treatment intended to cure the terminal illness and related conditions.

This six-month criterion is frequently misunderstood, as it is not a six-month expiration date.

A person does not automatically lose hospice because they are still alive six months after enrollment. If they continue to meet the eligibility criteria, hospice can continue through additional benefit periods after recertification. Medicare provides two 90-day benefit periods followed by unlimited 60-day periods for people who remain eligible.

This is very important because prognostication is difficult. A physician can determine that a person is likely to have six months or less to live based on the trajectory of their disease. That does not mean anyone can predict the exact date of death. Further, hospice is not limited to one diagnosis.

People with advanced cancer receive hospice care, but so do people with advanced heart disease, neurologic conditions, dementia, respiratory disease, and other terminal illnesses.

The “hospice decision” is ultimately about the intersecting answers of prognosis, goals of care, and the needs of the patient.

Hospice is Medical Care

The word “hospice” can sometimes create the impression that a patient has simply stopped receiving healthcare. That is not what happens.

CMS describes hospice as a comprehensive, holistic program that provides care and support to terminally ill patients and their families.

Depending on a patient's care plan, hospice can include:

• Physician services

• Nursing care

• Medical equipment

• Medical supplies

• Medications for pain and symptom management

• Hospice aide and homemaker services

• Physical, occupational, and speech therapy

• Social work

• Dietary counseling

• Spiritual counseling

• Family counseling

• Grief and bereavement support

• Short-term inpatient care for pain and symptom management

• Short-term respite care for caregivers

This is not “doing nothing.” Hospice is simply a change in the goal of medical care. The healthcare team may shift their primary question from “What treatment can we use to cure this disease?” to:

• How do we control this person's pain?

• How do we manage their symptoms?

• How do we help them remain comfortable?

• How do we support the people caring for them?

• What matters most to this person during the limited time they have left?

As you can see, these are still healthcare-related questions.

What Exactly Does Medicare Pay For?

For people who qualify and receive hospice through a Medicare-approved provider, Medicare generally pays the full cost of covered hospice services. Patients may have a copayment of up to $5 for certain outpatient medications used for pain and symptom control and may pay 5% of the Medicare-approved amount for inpatient respite care.

Medicare can also continue to cover healthcare for medical problems that are unrelated to the terminal illness, subject to the normal Medicare rules for those services.

That is an important fact when someone describes hospice as an enormous out-of-pocket expense for the patient. For a Medicare beneficiary, the hospice benefit itself is generally very low-cost to the patient, but that does not mean dying is inexpensive.

This is where our healthcare financing conversation becomes much more complicated.

Insurance Covers Healthcare. It Does Not Cover Everything that Caregiving Costs.

Medicare does not generally pay for room and board simply because someone is receiving hospice care. If someone lives in a nursing home, assisted living facility, or other residential setting, hospice coverage does not automatically make the underlying room-and-board costs disappear.

Medicare also does not cover treatment intended to cure the terminal illness once hospice has been elected.

Emergency department visits, hospitalizations, and ambulance transportation related to the terminal illness generally need to be arranged through the hospice team to be covered under the hospice benefit. So there is a critical distinction here: the hospice benefit covers hospice care, but it does not mean that every expense created by a terminal illness is suddenly covered.

The Unpaid Healthcare Workforce Sitting in the Living Room

A hospice nurse might visit a patient, a social worker might help a family navigate the emotional and practical challenges of dying, a hospice aide might assist with personal care, and a physician might manage symptoms.

However, most hospice care happens where people live, so we must then consider that someone is (hopefully) still providing care between those visits. Often, it is a spouse, an adult child, a sibling, a parent, a friend, or a family member who never thought of themselves as a caregiver until suddenly they were one.

They may be the person administering medications, helping someone get to the bathroom, changing bedding, preparing food, repositioning a person who cannot move independently, monitoring symptoms, managing equipment, communicating with clinicians, and staying awake during the night. Sometimes ALL night.

Hospice can provide support for that caregiver, but hospice is not synonymous with 24-hour paid home caregiving. This is an enormous distinction.

A 2026 systematic review of home-based palliative-care caregiving found that caregiver burden is influenced by psychological well-being, caregiving demands, restrictions on the caregiver's life, and logistical and financial factors. Another recent systematic review of family caregivers in hospice care identified increased financial burden and work disruption as recurring themes in caregivers' experiences.

In other words, even if the medical hospice benefit is largely covered (and it isn’t always), the family can still pay a tremendous price.

The Cost of Caregiving Does Not Appear on the Hospice Bill

A caregiver may reduce their work hours, take unpaid leave, use vacation or sick time, or stop working altogether. They may also spend money on transportation, food, household supplies, or additional caregiving. They may have to modify their home, spend hours on the phone coordinating care, and lose income while simultaneously watching their family's expenses increase.

The economic burden of family caregiving at the end of life has been documented in the palliative-care literature for years. A systematic review found that the financial burden of family caregiving can affect both the provision of care and the well-being of caregivers.

So when we consider whether hospice is “too expensive,” we should not only look at what Medicare pays a hospice agency. We should also look at how much unpaid labor families are providing to fill gaps and what this can look like for a hospice patient when their caregiver’s labor is no longer sustainable or available.

The Alternative to Hospice is Not “Nothing”

If someone loses access to hospice, they do not just stop being terminally ill or experiencing pain. They do not stop needing their medications. Their family does not suddenly become less exhausted from the hospice rigamarole, and their caregiver does not magically regain the ability to work full-time. Their need for medical equipment does not disappear, their emotional needs do not disappear, and their symptoms do not disappear.

The care has to happen somewhere else. It becomes displaced and winds up in other pockets of the U.S. health system that are already overly burdened — obviously, at no fault of hospice patients. Sometimes these cases show up in a primary-care office, and other times, it’s home health, a nursing facility, an emergency department, a hospitalization, and it can mean a family member providing even more unpaid care at home.

So, saying “hospice is expensive” is an incomplete policy argument. I dare say it’s not even relevant because, in the context this statement is currently being used, it’s ignorant. A “complete” and genuine pondering of hospice in this sense would include how end-of-life care fits within the entirety of the U.S. healthcare system and who bears those costs.

The Emotional Cost Doesn't Appear on the Itemized Bill Either

There is another part of hospice that is almost impossible to quantify. Hospice can mean that a family is confronting death while the person they love is still alive. How difficult.

This can create what researchers describe as pre-death grief, including anticipatory grief and grief related to the losses occurring during the illness itself. A systematic review found that anticipatory grief can involve worry and separation distress about a future without the person, while illness-related grief involves the losses that are happening in the present.

This can be incredibly complicated and manifest as a spouse grieving the loss of the future they imagined, an adult child grieving the gradual disappearance of the parent they knew, or a family simultaneously grateful for every additional day and absolutely devastated by what those days look like.

We can find ourselves feeling relief when a difficult symptom finally improves and then feel guilty for feeling relieved. We can also desperately want the person we love to stay alive while also recognizing that continued treatment may no longer be what that person wants or needs.

There is no neat emotional spreadsheet or decision tree for this.

The Patient is Grieving Too

It is easy to talk about hospice entirely from the perspective of the family, but many times, the person receiving hospice knows what is happening.

They may be afraid of dying, pain, losing independence, or becoming a burden. They may worry about their spouse's ability to cope and their children's future. They may also grieve the things they will never experience. They may be angry, or they may feel sadness, fear, guilt, uncertainty, or spiritual distress. While they’re experiencing these internal conflicts, they may also be trying to protect their family from those feelings at the same time their family is trying to protect them.

That is why hospice includes social workers, counselors, chaplains, and bereavement services alongside medical care. Hospice not only provides physical relief for the patient, but it also addresses the person who is dying… as a person.

Hospice’s Value Outweighs Recent Hospice Fraud Claims

I’m not here to write to you about ignoring hospice fraud because we shouldn’t. It would be a disservice to hospice families who need hospice coverage and services.

CMS has designated hospice as a high-risk area for Medicare fraud and implemented a nationwide six-month enrollment moratorium for new hospices and certain ownership changes in May 2026. Federal prosecutors have also brought cases involving alleged sham hospice operations.

In one case announced in April, federal authorities alleged that defendants operated sham hospice facilities and used identities of people who were not terminally ill as hospice beneficiaries to generate fraudulent Medicare payments.

More recently, reporting from California has documented the devastating consequences of fraudulent hospice enrollment, including patients being placed into hospice without appropriate authorization and subsequently having difficulty accessing other medical treatment.

These are great reasons to protect the integrity of hospice. Fraudulent hospice organizations hurt patients and legitimate hospice providers, and they can interfere with the care people actually need.

My concern is that the appropriate response to fraud is to identify the fraudulent providers, stop fraudulent billing, prosecute people who commit fraud, and strengthen the systems that allowed it to happen. It is not to pretend to the public or suggest that the underlying, overwhelming need for hospice care simply does not exist.

So, Expensive Compared With What?

When uninformed (like now), healthcare policy can fall into the trap of treating one program's spending as though it exists in isolation. News flash: it doesn't. If we reduce spending on hospice, that doesn't mean that we’ve suddenly reduced the amount Americans spend caring for dying people.

The spending just shifts to hospitals, nursing facilities, other healthcare providers, families, caregivers who leave the workforce out of desperation, patients who experience more burdensome care, and sometimes to the emergency department when symptoms that could have been managed through hospice become a crisis.

We Should Want Better Hospice, Not Less Hospice

There is a version of this conversation that I think just about everyone should be able to agree on. We should make sure that people who are actually dying can access the care they need without our healthcare system buckling and families struggling financially. The answer to hospice fraud should be better hospice oversight.

The answer to inappropriate enrollment should be better enforcement. The answer to excessive spending should be better payment policy and utilization management.

None of those answers require us to decide that dying people are too expensive to care for.

So, when RFK Jr. stands up and says “hospice is too expensive,” my first question for him is:

What does it cost us when we don't provide it?

And truthfully, I don’t think he knows (or cares).

Sources and Citations

• Medicare Hospice Care: eligibility, benefit periods, covered services, cost-sharing and exclusions.

• CMS Hospice: hospice payment structure, covered services and hospice as comprehensive support for patients and families.

• CMS Hospice/Home Health Enrollment Moratorium: May 2026 nationwide six-month moratorium and rationale.

• HHS Office of Inspector General Hospice Fraud Enforcement: April 2026 federal hospice-fraud case involving alleged sham hospice facilities.

• Associated Press California hospice fraud: reporting on fraudulent enrollment and consequences for patients.

• Koh et al., Palliative Medicine (2026): systematic review of factors associated with caregiver burden in home-based palliative care.

• Meta-synthesis of family caregivers in hospice care (2026): financial burden, work disruption and emotional experiences of hospice caregivers.

• Williams & McCorkle, Palliative & Supportive Care: review documenting increasing caregiver anxiety, depression and psychological distress as patients approach death.

• Pre-death grief systematic review: distinction between anticipatory grief and illness-related grief before death.

• Gardiner et al., systematic review: financial costs and implications of family caregiving at the end of life.

Please reply directly to this post or leave a comment below. I read every single one, and your insights are invaluable.

Subscribe now

Leave a comment

Share

Yours,

Caroline Waltzman, MHA, CLSSGB

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee donations. Sometimes it feels like science communicators are screaming into the void, and paid subscribers help keep me going. If my writing has informed, entertained, or saved you from a questionable Google rabbit hole, a subscription is a great way to say, “Hey, keep doing this.” Plus, you get the satisfaction of knowing you’re supporting independent work instead of, you know, another giant media conglomerate.

Subscribe now

Buy Me a Coffee

Thank you for taking the time to read my newsletter! I appreciate you being here.

Have you heard this question? For many, this common anti-vaccine argument can sound, at first, like a reasonable question:

“If your kids are vaccinated, why do you care if mine are? Doesn’t that mean your vaccines don’t work?”

These are questions worth answering because they give us a chance to talk about the importance of vaccination rates and vaccination through the lens of collective care. The premise of these questions rests on a misunderstanding of what vaccines are designed to do.

Vaccines are not intended to create an impenetrable bubble around every vaccinated individual. They are, however, designed to reduce the risk of infection, severe illness, complications, and transmission. When enough people are protected, higher vaccination rates make it much harder for diseases to spread through a community.

Vaccines Are Not Meant to Be Stand-Alone Forcefields

One of the easiest ways to understand this is to think about seat belts. A seat belt dramatically reduces your risk of serious injury or death in a crash. You don’t hear us asking:

“If seat belts work, why do we care whether the person in the car next to us wears one?”

Here, it can be a little more obvious how individual protection and community risk are two different things. You wear your seat belt to reduce your own risk. However, we also have traffic laws because other people’s behavior can affect your safety.

Vaccination works similarly! Being vaccinated can substantially reduce your risk, but it does not mean you have absolutely zero risk. Further, your risk isn’t necessarily the only risk that matters.

Not Everyone Can Simply “Get Vaccinated”

I think this is one of the biggest pieces missing from this argument. When we talk about vaccination, we’re not talking about a population in which every person has an identical ability to receive every vaccine.

We have to consider that there are babies who are too young for certain vaccines, there are folks undergoing cancer treatment, there are people with certain medical conditions or contraindications, there are people who don’t develop the same level of immune protection after vaccination, and there are people who are vaccinated but can still become infected.

That last point is particularly important in this specific conversation. A vaccine can be highly effective without being perfect. Medicine is full of interventions like this!

We don’t expect blood pressure medication to eliminate every single heart attack. We don’t expect a helmet to perfectly prevent every traumatic brain injury. We don’t expect sunscreen to make skin cancer impossible, and we don’t expect vaccines to make infection mathematically impossible.

Risk reduction is not the same thing as risk elimination.

So Why Does Your Vaccination Status Affect Me?

When it comes down to it, infectious diseases don’t respect the boundaries between households. Children go to school (even if you homeschool, they still exist within your communities), children play sports, they go to birthday parties, they visit grandparents, they go to the library, they might ride a bus, they sit amongst one another at lunch, and they interact with teachers, coaches, healthcare workers, siblings, and strangers.

We, as people, move through our communities, meaning disease transmission does as well. When vaccination rates are high, there are fewer opportunities for an infectious disease to find susceptible people and continue spreading. When vaccination rates fall, those opportunities increase, and eventually, diseases that had become relatively uncommon can begin finding their way back into communities (see any recent major health news headline).

That’s one reason outbreaks can happen even when many people in a community are vaccinated.

Then We Hear: “But if my child is vaccinated, shouldn’t they be protected?”

Often, yes, at least to a significant degree. That’s the point of vaccination. However, “protected” doesn’t mean “invulnerable.”

Please consider measles. The measles vaccine is extraordinarily effective, but not 100% effective. A small percentage of vaccinated people may still become infected if exposed. That means a vaccinated child can have a substantially lower risk than an unvaccinated child while still not having zero risk.

Then, population-level vaccination enters center stage. If almost everyone around that child is protected, there are fewer opportunities for the virus to spread. If vaccination rates decline, there are more susceptible people and more opportunities for an infection to move from person to person.

Individual protection and community protection reinforce each other!

This is “Herd Immunity”

You’ve probably heard the term herd immunity. It can sound a little “out there,” but the basic concept isn’t particularly complicated.

Imagine an infectious disease spreading through a community. If almost everyone it encounters is immune, the chain of transmission keeps breaking.

So, Person A infects no one… or Person A infects Person B, but Person B is protected.

The outbreak struggles to sustain itself (this is a good thing). However, if the disease encounters more and more susceptible people, transmission becomes easier.

Person A infects Person B, who then infects Person C, who then infects Person D.

Suddenly we are no longer talking about isolated cases. We are now experiencing an outbreak.

The exact vaccination coverage needed to maintain community protection varies by disease because different diseases have different levels of contagiousness. There is no single magic percentage that applies to every vaccine or every disease because of this.

The underlying principle remains that the more easily a disease spreads, the more population immunity figures into the conversation.

Also, this isn’t just about “your kids” and “my kids.”

This is where I think the original question gets even more interesting. Your child isn’t just a child who exists in isolation. We exist and interact within ecosystems and environments. Even if they’re homeschooled, they’re part of a neighborhood, a healthcare system (hopefully), and a community.

These very communities contain people with different levels of vulnerability. Once again, we consider the infant who is not yet old enough for a particular vaccine, the child receiving chemotherapy, the pregnant person, the older adult, the person with an immune disorder, the healthcare worker exposed to infectious patients every day, and the person who was vaccinated but didn’t develop adequate immunity.

Public health is partly about building and maintaining systems that protect people from risks they cannot completely control themselves.

That’s why we care about things like clean drinking water, sanitation, food safety, seat belts, smoke-free indoor air, and infectious disease vaccination. Individual choices absolutely matter, but at the same time, we cannot ignore that individual choices exist within fluctuating environments and circumstances.

“But it’s my child’s body.”

Yes. Parents have an enormous responsibility for making healthcare decisions for their children, and we all want exactly what is in the best interest of our children. Conversations about vaccination should absolutely allow room for questions, informed consent, medical contraindications, and conversations with qualified healthcare professionals. Your child’s doctors should invite questions because it means you care.

Please remember, though, that acknowledging individual autonomy doesn’t require pretending that individual decisions have no consequences for anyone else.

We already understand this principle in countless areas of public health. See below:

Smoking is an individual behavior, but secondhand smoke absolutely affects other people. Driving is an individual activity, but reckless driving can injure other people. Food preparation happens in private kitchens, but contaminated food can cause community outbreaks (as we’ve seen recently).

Infectious diseases are particularly obvious examples because transmission inherently involves other people.

The Goal Isn’t Exactly Perfection

I think this is an important distinction because public health communication sometimes gets reduced to absolutes. People aren’t perfect, and the U.S. healthcare system certainly isn’t perfect. No medical intervention eliminates all risk.

When we are assessing the need for vaccinations, we wonder whether the vaccination makes disease less likely and communities safer.

For vaccines suggested by the AAP and other evidence-based organizations, the answer is yes. That’s why the “If your vaccines work, why do you care?” argument doesn’t actually undermine vaccination. Frankly, it conveys a misunderstanding of what vaccination is supposed to accomplish.

We vaccinate our children to protect them. We vaccinate to reduce transmission. We vaccinate to reduce severe disease and complications, and we vaccinate because the health of a community isn’t simply the sum of isolated individual choices.

Sometimes protecting yourself also helps protect the person sitting next to you (collectively caring for one another). Sometimes the person sitting next to you is someone whose immune system, age, or medical circumstances mean they need that protection more than you realize. Vaccinating ourselves and our children protects all of us. That’s the point.

Please reply directly to this post or leave a comment below. I read every single one, and your insights are invaluable.

Leave a comment

Share

Subscribe now

Yours,

Caroline Waltzman, MHA, CLSSGB

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the K…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-F…

Read more

Subscribe now

When I was in graduate school, I was given the freedom to choose a health topic, explore it as a policy issue, and propose suggestions. I chose to address the frankly abys…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee …

Read more

Georgia Tech News Center ^

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio fo…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi …

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating throu…

Read more

Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid…

Read more

Subscribe now

There’s a palpable weight in the air these days. You feel it in the whispered exhaustion on social media, in the way mornings start with doom-scrolling and end with restless sleep, and even in how co…

Read more