The Malleable Middle Is Still Listening
PLUS: Placebo Mandates, Measles Slowing, Influenza and Whooping Cough
I’m David Higgins, a pediatrician and public health/preventive medicine physician who researches vaccine delivery and communication. This newsletter shares clear science, smart policy, and meaningful conversations—because the health of our communities depends on all three. If you haven’t already, hit the button below to avoid missing a weekly update.
What You Need to Know This Week
It’s been a few weeks since I shared vaccine and public health policy updates. Before diving into new data from a KFF poll on vaccine safety and trust, here are several headlines and why they matter:
The New Placebo Mandate for Vaccines: Unethical, Unscientific, and Impossible
Last week, an HHS statement that all “new” vaccines must undergo placebo-controlled trials set off alarm bells among scientists and public health experts. But why? Isn’t that the gold standard for research?
In my latest post with
, we break down what placebo-controlled trials actually are, why they’re sometimes unethical or impossible to conduct, and how the phrase “placebo-controlled” has been misused to undermine trust in vaccines.Some readers asked whether this was just a misunderstanding by federal health officials unfamiliar with vaccine trial design. But context matters: this is not a new idea, and the anti-vaccine movement has intentionally weaponized it for decades.
The Washington Post reports that RFK Jr., now Secretary of Health and Human Services, has publicly called for placebo-controlled trials of all vaccines in at least 34 appearances since 2020, during a time when he was earning more than $500,000 per year from a group that claims to protect children’s health by eliminating “environmental exposures” (read: vaccines).
Ask yourself: Is this truly just a misunderstanding of clinical trial design, ethics, and feasibility?
Are Measles Cases Slowing Down?
Just under 1,000 cases of measles have been confirmed in the U.S. this year, inching closer to a post-elimination record high of 1,200 in 2019. The good news: at least one major outbreak, which began in West Texas, appears to be slowing. For more on this encouraging development, check out this post from
and for a breakdown.I also joined NPR affiliate KUNC here in Colorado to discuss measles prevention, vaccine confidence, and how trusted messengers can protect community health. You can listen to that conversation here:
The Worst Pediatric Flu Season Since the H1N1 Pandemic
Last week, the CDC reported 216 pediatric flu deaths so far this season. This is the highest number since the 2009–2010 H1N1 pandemic. And that’s almost certainly an undercount. The final number will rise once all data are in.
This was a devastating flu season. And while multiple factors played a role, the most important—and most addressable—is declining childhood flu vaccination. Rates have dropped from 62% in 2019–2020 to just 49% this season. That’s deeply concerning.
This drop is likely driven by shifting attitudes post-COVID and growing barriers to accessing convenient flu vaccination. While flu vaccines don’t always prevent illness, they are highly effective at preventing hospitalization and death, especially in children.
We must double down on efforts to improve pediatric influenza vaccination. But that is getting harder as funding for immunization programs, research, and outreach is slashed and as confusion grows within our federal vaccine guidance and regulatory systems.
Whoop Whoop: Pertussis Is Hitting Hard
While all eyes are on measles, cases of whooping cough (pertussis) are surging. I’ve cared for two unvaccinated patients with pertussis in the past few months alone.
In 2024, there were over 35,000 cases of whooping cough, the most in over a decade. This comes amid dropping pertussis vaccination rates. Pertussis is serious. I’ll never forget the sound of an infant I cared for gasping for air between body-wracking coughs. That beautiful baby died of pertussis. It didn’t have to happen.
As I told Bloomberg recently: when diseases like measles and pertussis make a comeback, they’re not isolated events, they’re canaries in the coal mine. If we don’t act now, more vaccine-preventable diseases will return.
The Malleable Middle: What the Latest KFF Poll Reveals About Vaccine Trust and Misinformation
The latest KFF Tracking Poll on Health Information and Trust (released May 6, 2025) offers a snapshot of the current landscape of vaccine confidence in the U.S. The bottom line: Views are evolving, trust is shifting even faster, and most people remain in the malleable middle—understandably confused by conflicting messages, vulnerable to misinformation, but still open and listening.
Misinformation and the Malleable Middle
While trust in the safety of routine vaccines like MMR (83%) and flu (75%) remains strong, confidence in COVID-19 vaccines is notably lower, with only 56% of adults expressing at least some confidence in their safety. This divide is particularly pronounced along partisan lines: 87% of Democrats report confidence in COVID-19 vaccine safety, compared to just 30% of Republicans.
A significant factor contributing to this disparity is the prevalence of misinformation, especially regarding mRNA vaccine technology. The poll found that nearly half of the public (45%) have heard the false claim that mRNA vaccines can alter a person’s DNA. However, while only 3% believe this claim is “definitely true,” a substantial portion remains uncertain, with 26% considering it “probably true” and 45% “probably false.”
This uncertainty is where misinformation thrives. It’s not the hardened cynics who will shape the future of vaccine confidence, it’s the malleable middle.
The Politics of Trust Are Shifting Fast
While overall trust in government health agencies like the CDC to provide vaccine information is relatively stable, what’s underneath that stability is anything but. Since 2023, trust has increased significantly for Republicans (+11%) and decreased sharply among Democrats (-18%). That’s a remarkable reversal and it speaks to how volatile trust in federal institutions has become, especially when vaccine policy is politicized. This isn’t new, but the speed of the shift is striking.
Confidence in Oversight Is Fading
A striking data point worth noting is that fewer than half of adults say they’re confident that government agencies ensure vaccines approved for use in the U.S. are safe and effective. Interestingly, this lack of confidence spans political lines.
Why? The poll offers one clue: most Democrats, Independents, and nearly half of Republicans say they don’t believe government health agencies are paying enough attention to science. But what counts as “science” today:
Are we talking about high-quality studies or cherry-picked preprints?
And how has the word “science” itself been co-opted into a belief system, rather than a rigorous process and method of discovery?
These aren’t just philosophical questions. They shape whether people see public health guidance as credible or ideological.
Healthcare Providers Still Lead on Trust
Here’s the good news: Healthcare providers remain the most trusted source of vaccine information, with 83% of adults saying they trust their doctors to give them reliable guidance. This presents an enormous opportunity for clinicians to lean into empathy, curiosity, and clarity in conversations about vaccines.
These moments—whether during a routine visit or a brief vaccine conversation—are where trust is either built or broken. Providers don’t have to be perfect. But they do need to be present, prepared, and willing to meet patients where they are.
One notable data point: Trust in the current Secretary of HHS for vaccine information ranks far below trust in other sources. (You may be able to guess why.)
The Malleable Middle Is Still Listening
Despite the noise of eye-catching headlines, social media hot takes, and extreme podcast chatter, the truth is: the malleable middle is still listening.
One of the things that keeps me grounded is seeing patients every week and talking with families from all walks of life. Rarely do I meet someone completely dug in on their views about vaccines. Most are understandably confused. They are trying to make sense of conflicting messages and genuinely looking for guidance. At the heart of it, they’re deeply concerned about their child’s health.
Just this week, I was talking with friends who are about to become new parents. They’ve read every book, asked every expert they can find, and they’re still terrified about making the right decisions about their child’s health. I get it. I’m a pediatrician and a parent, and I still feel that anxiety.
That’s the space pediatricians get to step into every day: a space of uncertainty, care, and hope. We have the privilege to listen, to show compassion, and to help families make informed decisions grounded in the best evidence available to raise healthy, thriving children.
In Summary
The latest KFF poll underscores both the fragility and possibility of vaccine confidence in America. Confidence in COVID-19 vaccines remains fractured. Trust in federal health agencies is slipping. Misinformation still clouds the conversation.
But healthcare providers remain a cornerstone of trust and that’s where real progress is still possible.
There remains an enormous malleable middle — people who are understandably uncertain. This moment calls for more than just correcting facts. It requires listening deeply, communicating with empathy, and rebuilding trust person by person, community by community.
The malleable middle is still open to hearing the truth we just have to keep showing up to tell it.
Thanks for being part of this community. Let’s keep pushing for truth, compassion, and science that saves lives—together.
-David
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Community Immunity is a newsletter dedicated to vaccines, policy, and public health, offering clear science and meaningful conversations for health professionals, science communicators, policymakers, and anyone who wants to stay informed. This newsletter is free for everyone, and I want it to be a conversation, not just a broadcast. I’d love to hear your feedback, questions, and topic suggestions—let me know what’s on your mind! And if you find this valuable, please help spread the word!