Vermont rejected federal vaccine rollbacks, but doctors are still seeing their impact

Dr. Tracy Tyson, a pediatrician in St. Albans, Vt., has seen the prevalence of vaccine skepticism rise and fall in waves: first with the advent of social media in the early 2010s and then during the COVID-19 pandemic. The third wave came as soon as Robert F. Kennedy Jr. took the helm of the U.S. Department of Health and Human Services, she said.

Since his confirmation in 2025, Kennedy has directed changes to the vaccine panel that advises the federal Centers for Disease Control and Prevention on immunization. Since then, the CDC has scaled back the number of recommended childhood vaccines and loosened recommendations for COVID shots.

“More now than ever before in my career, (parents) want to make up their own schedule,” Tyson said. “They want to do things differently if they do them at all. They want to decide when the vaccines are due, or, sadly, they just completely refuse vaccinations and don’t ask you questions.”

In the face of these federal changes, Vermont has doubled down on its commitment to the vaccination schedule in place before Kennedy took over, one still recommended by the American Academy of Pediatrics and other physician groups. In March, Gov. Phil Scott signed legislation that insulates the state against further federal changes to vaccine policy. The law allows the state to purchase vaccines from sources other than the CDC — previously the only source — and mandates that insurers will cover the cost of vaccines.

Still, pediatricians are seeing the impacts of federal changes manifest in the clinic.

Merideth Plumpton, who runs the immunization program for the Vermont Department of Health, said primary care clinics across the state are reporting more parents are hesitant to vaccinate their kids. And, Plumpton added, the nature of the conversations has shifted drastically from community well-being to individual autonomy.

It will take time to see if, and how this change in attitude shakes out in actual vaccine uptake, Plumpton said, since the full breadth of the pediatric schedule is administered over years.

The rate of Hepatitis B immunizations administered at birth has dropped slightly in Vermont. In December, the CDC formally stopped recommending the birth dose. From 2021 to 2024, around 86% of Vermont infants received the vaccine within the first three days of life; in 2025, that rate dropped to 80%.

Vermont’s vaccination rate against other illnesses remains high and in line with previous national trends: In December 2025, 90% of the state’s 2-year-olds received their vaccines for polio and measles, mumps and rubella. National data are less up-to-date, but CDC data from 2018 showed that 92.5% of 2-year-olds had received their polio vaccine, while 90.8% had received their MMR immunization.

“I don’t think that we are significantly different than the rest of the country,” Tyson, the pediatrician, said. “I think that (vaccine hesitancy in Vermont) is more widespread than people realize, and I think it hit us harder than I even expected.”

When Tyson encounters a family hesitant about vaccinating their child or confused about what is still recommended and available, she holds a vaccine counseling session, often mid-visit.

She said she talks to patients as if they are her own family members: She tells them how she approaches vaccine science and that she immunizes her kids on the pre-RFK Jr. schedule. In those conversations, she often directs them to the Children’s Hospital of Philadelphia website, which she says has clear, digestible information on vaccine science. Out of the 70,000 vaccinations she’s given over the 20 years in her career, she said she’s never seen any adverse outcomes.

“I’ve never held a family’s hand while they got through a vaccine injury, but I’ve held their hand when (their child) died from vaccine-preventable illnesses,” she said.

The counseling sessions are exhaustive, sometimes emotional conversations in an already packed day, slotted alongside discussions of nutrition, sleep, family issues, screenings for depression and anxiety and medical exams, in a 20-minute visit.

“I’m always running behind, running into my lunch break,” Tyson said.

She said she used to do this vaccine counseling once a month but now has these conversations at least once a day. “There are days when it feels like half my time is discussing vaccine hesitancy,” she said.

Up until 2026, she did not have to bill insurers for these conversations. Instead, insurers’ payments were pooled into fixed monthly sums, as part of an experimental primary care payment reform in Vermont that sunset at the end of 2025. Now, Tyson is back to billing for each individual service she provides — or doing it uncompensated.

But as Vermont’s clinics transition back to a fee-for-service model, the process of incorporating billing for these sessions has been slow and confusing. The American Medical Association recognizes the vaccine counseling sessions as distinct, billable services. Both BlueCross BlueShield of Vermont and Medicaid said they reimburse for these vaccine counseling appointments where an immunization is not administered.

But, unaware of the patient’s cost share and concerned about saddling them with extra costs, Tyson said her office only bills them when the conversation runs especially long. When she has listed vaccine counseling on a bill of services, families have become frustrated to see it there, she said.

Footing the bill for her time in these shorter conversations hasn’t begun to affect the practice financially yet, but it could eventually, Tyson said.

Dr. Ashley Miller runs her own pediatric practice in Royalton. She agreed with Tyson that working in a fee-for-service model once again makes it much harder to afford difficult conversations, such as those surrounding vaccines.

Miller sees half as many patients as she did when working at a larger hospital. She spends 30 minutes, rather than 15 on each visit. It’s a pay cut, but one she says is worth it to spend more time connecting with patients.

Still, discussions of vaccination safety and hesitancy take some of the joy out of practicing, she said.

What’s worse is when there’s no discussion at all.

“The hardest thing for me is when families come in and they just say, ‘No, we’re not going to do that,’” Miller said. Over the last two years, she’s seen more of this “full-stop” approach.

Dr. Joe Nasca, a longtime pediatrician in Georgia, Vt., seeks out longer, individualized conversations with his patients. It’s scary, he knows, to be a first-time parent, presented with the enormous responsibility of keeping a baby alive, all while being besieged by an onslaught of often-conflicting information about how to do so.

He estimates about 75%-80% of his patients in Franklin County come in and say, “You know, Doc, whatever you think is best, that’s what I’m going to do.” But the number of families worried about vaccination has increased since the pandemic.

He gives them guidance using a metaphor of bronze, silver and gold levels of immunity. The CDC’s current, slimmed-down vaccine schedule is bronze; adding a few more vaccines back into that schedule would be silver; and getting everything — a pre-Kennedy schedule — that’s golden.

Nasca acknowledged that some of his patients are demographically and geographically at lower risk for diseases that some regular-schedule vaccines prevent, such as Hepatitis B at birth or rotavirus.

But that level of tailoring is extremely difficult for one doctor juggling thousands of patients.

Nasca now works with other doctors in Georgia Pediatrics, but earlier in his career, he was a one-man show. In those days, he had to refuse to treat patients who were unvaccinated.

He had 2,000 patients in his roster, used paper documentation and took calls from parents at any hour of the day. It was too stressful, he said, to field calls at home in the middle of the night and to need to weigh whether a fever in an unvaccinated child could mean a cold or life-threatening meningitis. He remembered his early days in medicine doing spinal taps on feverish children to test for meningitis.

It was too much for one person to balance. He had to stop seeing about 20 patients who were not vaccinated at that time.

Nasca doesn’t think parents refuse vaccination for any reason other than love for their child, but it’s a decision he finds hard to square. Recently, he asked a parent he knew well, “Why is it that you don’t want to immunize your child?”

“She said it’s not a rational decision. She said it’s an emotional decision,” Nasca said, “I think that’s probably the root of it. It becomes an emotional decision for a lot of people.”

This story was republished with permission from VtDigger, which offers its reporting at no cost to local news organizations through its Community News Sharing Project. To learn more, visit vtdigger.org/community-news-sharing-project.