The Roundup

Vaccine governance, school requirements, clinic dismissal policies, an ACIP prebunk, and the myth that pediatricians profit off vaccines

Hi community,

The twice-a-year ritual of changing our clocks stole an hour of sleep this week, but it’s still been a busy one. Instead of an essay, I am sharing five things I have been working on, most of which dropped this week: an update on The Next Era of Vaccine Governance series, articles on school vaccine requirements and clinic vaccine dismissal practices, a prebunk for the upcoming ACIP meeting, and a podcast I co-hosted on the myth that won’t die that pediatricians make big profits on vaccines.

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1. Engagement with “The Next Era of Vaccine Governance.”

The response to my post about The Next Era of Vaccine Governance was more than I expected. Many of you filled out the survey or reached out with comments and ideas.

Across those responses, a few themes stood out. Readers said the biggest unanswered questions about vaccine policy center on transparency, such as how decisions are made, who influences them, and how evidence is weighed. Many also emphasized the need for broader participation in policy conversations. And several noted that strengthening trust will require clearer communication about the data and processes that guide vaccine recommendations.

When I share this feedback with leaders, I often hear a similar response: “We are already doing these things!” That always makes me pause. If people don’t know these things are happening or aren’t hearing about it clearly, are they actually helping to build trust? As I said in the original essay, we can debate the accuracy of people’s perceptions endlessly, but legitimacy and trust do not depend only on technical correctness; they also depend on whether people can see, understand, and feel that institutions are responsive to their concerns.

One other thing that became clear to me is that this effort will require collaboration. Colleagues at The Evidence Collective will be helping to facilitate the interviews and conversations for this series. And I need you! Your responses and engagement are shaping what comes next, so thank you.

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2. School vaccination requirements: five questions with honest answers.

Katelyn Jetelina and I wrote a piece for her newsletter (Your Local Epidemiologist) this week, walking through five questions readers are asking about school vaccine requirements: Do they work? Should vaccinated parents worry? What’s happening in other countries? How should I talk to people who disagree?

The thing I found myself reflecting on most was this: requirements do more than help improve vaccination rates. School requirements are reminders and nudges that prompt families to seek preventive care, creating a moment of connection that might not otherwise occur. When families come in for school-required vaccines, they also receive screenings for chronic diseases, vision and hearing checks, and many other services that help keep them healthy.

It is an opportunity for clinicians to catch problems that might otherwise be missed. I have countless stories of this happening with my patients, where a school vaccine visit led to catching growth delay, prediabetes, or vision problems, all of which would not have been caught as quickly.

Here’s the other thing in the broader policy picture that is more complicated than either side tends to acknowledge. Most Americans still support school vaccination requirements, across partisan lines. In fact, several polls found that congressional candidates from any party who are critical of school vaccination requirements could lose significant support. Despite this, more than 200 vaccine-related bills have been introduced in state legislatures, and that gap between public opinion and legislative activity is worth watching closely.

Top 5 questions about school vaccination requirements

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3. Podcast: Do pediatricians get rich on vaccines? (hint: no)

This episode of the Unbiased Science podcast, which I co-hosted with Jess Steier, DrPH, features two incredible pediatricians: Dr. Sara Goza (nearly 40 years in practice in Fayetteville, Georgia) and Dr. Sian Jones-Jobst (20 years in Lincoln, Nebraska).

A claim has been circulating for years and was recently amplified at the highest levels of the federal government: that pediatricians make big profits from vaccinating children and that their recommendations are financially motivated. Unbiased Science spent six months investigating this: analyzing commercial reimbursement data across all 50 states, reviewing state Medicaid fee schedules, and interviewing pediatricians. What we found was that the opposite is true. Pharma does not pay pediatricians to vaccinate, pediatricians aren’t getting rich off vaccines, and many practices lose money on every dose administered.

But what struck me most about this conversation wasn’t the economics. It was that pediatricians like Dr. Goza — who did spinal taps in her office for years before vaccines became available — aren’t just being told their medicine is wrong, they’re being told their motivations are corrupt. That’s a fundamentally different and more damaging kind of attack.

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4. The Evidence Collective launches with a prebunk for the March ACIP meeting.

I’m a contributor to The Evidence Collective (TEC), a network of multidisciplinary scientists and clinicians who are also science communicators, collaborating to deliver clear, evidence-based information that breaks echo chambers with empathy and speed. One way we do this is through TEC briefs. These briefs translate complex public health developments into clear, practical insights, ready before you need them.

This week, TEC launched its Substack.

This has been in the works for a while, and I am excited to see it go live!

The launch piece is a prebunk for the upcoming ACIP meeting on March 18–19. If you’re not sure why this meeting matters or how to communicate about it effectively, this is a good place to start. It walks through the most likely COVID-specific claims that may surface, with the evidence you need to evaluate them clearly.

The March ACIP meeting is expected to focus on COVID vaccine safety and related topics. It’s also likely to include a discussion and potential vote on how the ACIP makes vaccine recommendations. That process question matters more than you may think. The ACIP uses specific frameworks to systematically and transparently review the certainty and strength of the evidence, then translate it into recommendations. Changing these may be more than a bureaucratic tweak; it could affect whether national vaccine recommendations remain grounded in rigorous evidence review and transparent decision-making.

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5. Should pediatric clinics dismiss families who don't vaccinate?

Finally, this piece, co-authored with Jess Steier, DrPH, and Elana Pearl BenJoseph, MD, MPH, dropped a few weeks ago and tackles a common question that doesn’t get enough honest dialogue: pediatric clinic vaccine dismissal policies.

This is a challenging topic, which I have come full circle on. I have practiced in clinics that dismissed families who refused vaccines, and in practices that chose not to. Over time, I have come to believe that preserving the relationship is usually the better path. Not dismissing families over vaccine decisions gives me the best opportunity to protect that child’s health over time. But I also understand why thoughtful colleagues, motivated by a duty to protect medically vulnerable patients, may reach different conclusions.

"Looking for a Pediatrician Who Doesn’t Push Vaccines”

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A final note: An opportunity to support Community Immunity

I have been thinking about this for a while, and wanted to share my thinking.

This newsletter has always been free, and it will stay free. Everything I write will remain available to all subscribers. But I’m adding a paid option for readers who want to support this work more directly.

Writing Community Immunity takes time and effort. I do this work on my own time. If this newsletter has been helpful to you, a paid subscription is a simple way to say thank you and support the work. And if the free version is what works for you, that’s genuinely enough. The community and conversation are what matter.

Thanks, as always, for being part of this community.

-David

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Community Immunity is written by Dr. David Higgins, MD, MPH, a practicing pediatrician and public health physician whose work focuses on vaccine delivery, health policy, and communication. This newsletter is where he writes about vaccines, public health, and community. When he’s not seeing patients or writing, he’s coaching youth soccer or exploring the outdoors with his family. Find him on LinkedIn, Instagram, Substack Notes, and Bluesky.

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