In light of RFK Jr.’s anti‑flu vaccine campaign, how could emerging vaccine skepticism intersect with public‑health communication strategies to reshape influenza vaccination rates among high‑risk populations?
The convergence of high-profile vaccine skepticism with federal policy authority has created an unprecedented challenge for influenza vaccination among vulnerable populations. The 2024-25 flu season—marked by the highest hospitalization rates since 2010-11 and record pediatric mortality—provides a stark backdrop against which to examine how anti-vaccine messaging from HHS Secretary Robert F. Kennedy Jr. intersects with evolving public health communication strategiesUS data highlight severity of 2024-25 flu season - CIDRAPumn +1.
Influenza vaccination rates across high-risk populations have deteriorated significantly. Among adults aged 65 and older, coverage fell from 70.5% in 2019 to 67.1% in 2024, representing a statistically significant quadratic decline[PDF] Data Brief 547: Vaccinations Among Adults Age 65 and Older - CDCcdc . For the 2024-25 season specifically, flu vaccination coverage among adults 65+ decreased by 5.9 percentage points compared to the prior seasonFlu Vaccination Coverage, United States, 2024–25 Influenza Seasoncdc .
Children face an even more alarming trajectory. Pediatric flu vaccination rates have plummeted from approximately 64% five years ago to just 49% during the 2024-25 season, the lowest coverage in 15 seasonsHow the 2024–2025 Flu Season Impacted U.S. Childrenusppg +1. This decline carries severe consequences: 289 pediatric flu deaths occurred during the 2024-25 season, surpassing the previous record of 288 set during the 2009-10 H1N1 pandemic2024-2025 PEDIATRIC FLU DEATHS SURPASS PREVIOUS RECORD - Families Fighting Flufamiliesfightingflu . Among children with known vaccination status who died, 89% had not been fully vaccinatedCDC reports highlight 2024-25 flu season's deadly impact on US kids | CIDRAPumn .
Pregnant women also demonstrate concerning patterns. Flu vaccination coverage among this population was 47.4% for the 2023-24 season, 10.1 percentage points lower than the pre-pandemic coverage of 57.5% in 2019-20Flu, Tdap, and COVID-19 Vaccination Coverage Among Pregnant Women – United States, April 2024cdc .
Secretary Kennedy has deployed a multi-pronged strategy against influenza vaccination that extends well beyond rhetorical criticism to concrete policy action.
Kennedy repeatedly asserts that receiving the flu vaccine makes individuals "4.4 times more likely to get ill," citing Pentagon researchCrimes Against Humanity. “If you get the Flu Shot…you’re 4.4 times more likely to get ill…The Pentagon even published a paper stating this…” RFK Jr. https://t.co/Q7y86nRJYmx +1. He claims that the Cochrane Collaboration's meta-review found "no evidence that the flu vaccine prevents serious disease or that it prevents hospitalisations or death in children"RFK Jr. Misrepresents What the Science Says About Flu ...celinegounder . However, experts note this represents a misreading of what Cochrane studies can actually demonstrate—limitations in evidence quality are distinct from evidence of ineffectivenessRFK Jr. Misrepresents What the Science Says About Flu ...celinegounder .
Kennedy has personally linked his strained, raspy voice to the flu vaccine, though medical experts state there is no scientific evidence supporting this claimInside RFK Jr.'s long-running crusade against the flu vaccinewashingtonpost .
The skepticism has translated into consequential federal actions:
Removal of Universal Recommendations: The CDC removed universal recommendations for children to receive influenza vaccinations, shifting to a model where vaccines are recommended only for high-risk individuals or when parents and physicians deem them warrantedHas RFK Jr. kept the promises he made in order to get his job at HHS? : NPRnpr +1. Kennedy's own characterization: "Well, that may be, and maybe that's a better thing"RFK Jr. Says Fewer Flu Vaccines for Kids May Be a 'Better Thing' - MPRempr .
Termination of Promotional Campaigns: The CDC was ordered to shelve the "Wild to Mild" advertising campaign urging flu vaccination within Kennedy's first days as HHS SecretaryHow Robert F. Kennedy Jr. will undermine and ultimately destroy US vaccination programssciencebasedmedicine . The campaign's death coincided with the worst flu season in nearly 30 years, with influenza-like illness visits hitting 7.79%—the highest since at least 1997-98How Robert F. Kennedy Jr. will undermine and ultimately destroy US vaccination programssciencebasedmedicine .
Shift to "Informed Consent" Messaging: HHS has mandated that future vaccine advertisements focus on "informed consent," putting more emphasis on possible vaccine risksHow Robert F. Kennedy Jr. will undermine and ultimately destroy US vaccination programssciencebasedmedicine . This shift fundamentally alters the framing of CDC communications.
Thimerosal Removal Mandate: Kennedy's reconstituted ACIP endorsed flu vaccines only if free of thimerosal, a preservative the CDC continues to describe as "very safe"RFK Jr. vaccine panel makes controversial decision on flu shotyoutube +1.
Research demonstrates that political figures exert measurable influence on vaccination behavior among their supporters.
A randomized controlled trial among 387 non-vaccinated Trump voters found that exposure to Trump endorsing the COVID-19 vaccine made participants 85% more likely to express vaccination intention compared to a control group (RRR = 1.85, 95% CI 1.01-3.40, p = .048)Testing persuasive messaging to encourage COVID-19 risk reductionplos +4. Critically, an expert's factually accurate message showed no significant effect (RRR = 1.14, p = .68)Testing persuasive messaging to encourage COVID-19 risk reductionplos +4.
A large-scale YouTube advertising experiment deploying Trump's vaccine endorsement to millions of users increased vaccinations by an estimated 104,036 doses across 1,014 treated counties at a cost of approximately $1 per additional vaccineUsing Donald Trump’s COVID-19 Vaccine Endorsement to Give Public Health a Shot in the Arm: A Large-Scale Ad Experimentstanford .
Conversely, exposure to opposing-party endorsements produces backlash. Republicans who viewed Democratic vaccine endorsements reported they would be "significantly less likely to encourage others to vaccinate and had more negative attitudes toward the vaccine"Elite party cues increase vaccination intentions among Republicansmit . This suggests that Kennedy's sustained messaging against flu vaccines, reaching supporters who trust him, could produce measurable decreases in vaccination intention that expert counter-messaging may fail to overcome.
HHS's mandated shift toward "informed consent" messaging creates a complex dynamic. Research on message framing indicates that gain-framed messages (emphasizing benefits) are viewed more positively than loss-framed messages, with gain-framing reducing barrier perceptions regarding vaccinationThe Association between Message Framing and Intention to Vaccinate Predictive of Hepatitis A Vaccine Uptakemdpi . However, studies also show that providing clear information—including on risks—can support rather than undermine vaccination decisions among undecided individualsCommunicating risks and evidence in a public health emergencyyoutube .
A randomized controlled trial found that adding a descriptive risk label ("very low risk") next to numerical side-effect information increased COVID-19 vaccine willingness by 3.0 percentage points, while providing a mortality comparison to motor vehicles increased willingness by 2.4 percentage pointsEffects of side-effect risk framing strategies on COVID-19 vaccine intentions: a randomized controlled trial - PubMednih . Combined, these framing strategies increased vaccination intentions by 6.1 percentage pointsEffects of side-effect risk framing strategies on COVID-19 vaccine intentions: a randomized controlled trial - PubMednih . This suggests that transparent risk communication, properly framed, need not decrease uptake—but the framing matters enormously.
In strongly vaccine-hesitant populations, personal benefit information reduced hesitancy more effectively than collective benefit messaging (mean difference -1.49, p = 0.0015)Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): A single-blind, parallel-group, randomised controlled trialpublichealthscotland . Where perception of vaccine risk is most salient, decision-making becomes centered on personal rather than collective considerationsEffects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): A single-blind, parallel-group, randomised controlled trialpublichealthscotland .
The transition from universal recommendations to "shared clinical decision-making" (SCDM) introduces substantial implementation barriers:
Time Constraints: Over 90% of surveyed providers agree that SCDM requires more time than routine recommendations, yet this time is rarely available[PDF] Shared Clinical Decision Making for Vaccinescveep . A study of pneumococcal vaccine uptake following a 2019 SCDM recommendation found that coverage declined by up to 23% among eligible populations[PDF] Shared Clinical Decision Making for Vaccinescveep .
Loss of Presumptive Approach: Research shows that the "presumptive approach"—where providers announce that shots are due rather than opening negotiation—is the single strongest driver of vaccine acceptanceCIDRAP Op-Ed: Quiet dismantling: How ‘shared decision-making’ weakens vaccine policy and harms kids | CIDRAPumn . SCDM mandates open-ended conversations that signal ambivalenceCIDRAP Op-Ed: Quiet dismantling: How ‘shared decision-making’ weakens vaccine policy and harms kids | CIDRAPumn .
Access Disparities: More than 100 million Americans lack usual access to primary careCIDRAP Op-Ed: Quiet dismantling: How ‘shared decision-making’ weakens vaccine policy and harms kids | CIDRAPumn . For them, "discuss with your clinician" is not neutral guidance—it is a barrierCIDRAP Op-Ed: Quiet dismantling: How ‘shared decision-making’ weakens vaccine policy and harms kids | CIDRAPumn +1.
EHR Limitations: Only 38% of providers report their electronic health record systems display SCDM recommendations as "recommended," while 23% indicate their systems show no recommendation at all for SCDM vaccines[PDF] Shared Clinical Decision Making for Vaccinescveep .
Awareness Gaps: A survey of healthcare providers found that nearly half were unaware of SCDM recommendations for HPV vaccination, with time commitment cited as the most frequent implementation barrier by internists (39%)Healthcare professionals' awareness of and barriers to shared ...nih .
Public health experts have attempted "prebunking" strategies to inoculate populations against anticipated misinformation. Inoculation theory posits that exposure to weak arguments against held beliefs, paired with refutations, strengthens resistance to stronger subsequent attacksInoculation Theory | OER Commonsoercommons . Meta-analyses support this approach with small to moderate effect sizesInoculation Theory | OER Commonsoercommons .
The Vaccine Integrity Project, launched by former CDC Director Rochelle Walensky, has produced comprehensive reviews of vaccine safety and effectiveness in anticipation of ACIP meetings, aiming to "empower people with the proper information, complete information, and also the uncertainties of that information"Public health experts try to 'prebunk' misinformation about vaccines ...umn .
However, the effectiveness of prebunking against messaging from a federal health authority figure—rather than fringe sources—remains untested. The research showing that Trump voters responded more strongly to Trump's endorsement than to expert messaging suggests that prebunking may have limited effect when the misinformation source is a trusted political figureTesting persuasive messaging to encourage COVID-19 risk reductionplos +4.
Healthcare providers remain the most trusted source of vaccine information, with 83% of adults trusting their doctor or healthcare provider "a great deal" or "fair amount"KFF Tracking Poll on Health Information and Trust: Vaccine Safety and Trust | KFFkff . Trust in personal doctors is the strongest predictor of vaccine uptake (adjusted odds ratio = 1.53, p < 0.001)Trust in Information Sources and COVID‐19 Vaccine Uptake - PMCnih .
Yet this trust exists in a deteriorating context. Trust in hospitals and physicians dropped from 71.5% in April 2020 to 40.1% in January 2024, and lower trust levels were strongly associated with reduced likelihood of receiving COVID-19 vaccinesTrust in Doctors PLUMMETS Post-COVID Good! A new paper in JAMA revealed that trust in hospitals and physicians dropped from “71.5% in April 2020 to 40.1% in January 2024.” The “shocking” finding was that “lower trust levels were strongly associated with a reduced likelihood of receiving COVID-19 vaccines and boosters.” For reference, Tony Fauci allegedly took six COVID shots and contracted COVID three times. If people took six shots for polio and got polio three times, they would be asking some serious questions.x . Only 35% of audiences surveyed by Dr. Peter McCullough now raise their hands when asked if they trust doctors and hospitalsCOVID Vaccine Fallout: Distrust in the Medical Community What happens when trust in medicine collapses? Dr. Peter McCullough told Flashpoint that when he asked audiences how many still trust doctors and hospitals, only 35% raised their hands — revealing the deep loss of confidence since the COVID-19 vaccine rollout. 👉 Learn more and support the fight for transparency at https://t.co/P3XXjxC4jH Credit: @RealAmVoice — Flashpoint with @GeneBailey, @HankKunneman, @LarryHuch, @Mercola #MedicalFreedomx .
For providers, the challenge is acute: they must navigate patient conversations in an environment where federal policy signals ambivalence, misinformation enjoys political legitimacy, and time constraints prevent thorough counseling. A practice facilitation trial providing support for physician outreach to unvaccinated patients found no significant effect on vaccination rates—only 29% of physicians accepted assistance, and mean vaccination doses showed no difference between intervention and control armsPractice Facilitation to Support Primary Care Physicians With COVID-19 Vaccine Uptake: A Randomized Clinical Trial - PubMednih .
The intersection of emerging skepticism with existing health disparities compounds vaccination challenges. Black adults were 80% more likely to be hospitalized with flu from 2009 to 2022, American Indian/Alaska Native adults 30% more likely, and Hispanic adults 20% more likely during the 2021-22 seasonCDC report finds racial disparities in flu hospitalizations and vaccine uptakeyoutube . Yet vaccination coverage during that season was 54% among White adults compared to 42% among Black, 38% among Hispanic, and 41% among Native adultsCDC report finds racial disparities in flu hospitalizations and vaccine uptakeyoutube .
For the 2024-25 season, flu vaccination coverage among Black adults declined by 4.1 percentage points and among Hispanic adults by 2.6 percentage pointsFlu Vaccination Coverage, United States, 2024–25 Influenza Seasoncdc . Among children, Hispanic and Black children both experienced 4.8-6.7 percentage point declinesFlu Vaccination Coverage, United States, 2024–25 Influenza Seasoncdc .
Research indicates that among frequent social media users, those with lower educational attainment were significantly less likely to receive COVID-19 vaccination, suggesting social media serves as a conduit for vaccine hesitancy among vulnerable populationsDigital Divide or Educational Divide? The Impact of Social Media on ...nih . Older adults, with comparatively lower digital literacy, successfully judged only 41.38% of health articles for credibility, and 62.5% of articles they shared contained falsehoodsJournal of Medical Internet Research - Prevalence of Health Misinformation on Social Media—Challenges and Mitigation Before, During, and Beyond the COVID-19 Pandemic: Scoping Literature Reviewjmir .
Trusted community messengers represent a potential counterweight to politicized skepticism. Community health workers in Houston facilitated 1,081 vaccinations through organizing community events and implementing individual education between May 2021 and June 2022Community Health Workers and COVID-19 Vaccine Trustesmed . A community-based health intervention in Singapore doubled influenza vaccination rates among elderly participants (from 30.1% to 60.7%)Influenza Vaccine Uptake in the Elderly: Biopsychosocial Vulnerabilities and Effectiveness of a Community-Health Worker Administered Preventive Program.nih .
Research on trusted messengers found that community-based organizations can serve effectively as vaccine messengers for high-risk populations, particularly those well-established in their communities (averaging 53 years of presence) and serving predominantly Black and Latinx populationsTrusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizationsnih . One intervention utilizing a communication model emphasizing reframing conversations increased HPV vaccination acceptance intention: for every one-unit increase in self-confidence scores, the odds of vaccination acceptance increased by 19%Assessing the Efficacy of the 3R (Reframe, Reprioritize, and Reform) Communication Model to Increase HPV Vaccinations Acceptance in Ghana: Community-Based Interventionmdpi-res .
However, these grassroots strategies face systematic resource constraints as federal promotional activities are curtailed.
The stakes of declining vaccination are quantifiable. The 2024-25 season produced preliminary estimates of at least 43 million flu illnesses, 560,000 hospitalizations, and 38,000 deaths—the first high-severity season since 2017-18Influenza-Associated Pediatric Deaths — United States, 2024–25 Influenza Seasoncdc . The cumulative hospitalization rate of 128.3 per 100,000 was the highest since 2010-11Influenza Activity in the United States during the 2024–25 Season ...cdc .
Among hospitalized patients, 89.1% had one or more underlying medical conditions, 16.8% were admitted to ICU, 6.1% required mechanical ventilation, and 3.0% died in hospitalUS data highlight severity of 2024-25 flu season - CIDRAPumn . Only 32.4% of hospitalized patients had received a flu vaccineUS data highlight severity of 2024-25 flu season - CIDRAPumn .
CDC estimates that 2024-25 influenza vaccination prevented 9.4 million to 16 million symptomatic illnesses, 4.4 million to 7.1 million medical visits, 170,000 to 360,000 hospitalizations, and 12,000 to 39,000 deathsInfluenza Activity in the United States during the 2024–25 Season ...cdc . Interim vaccine effectiveness against hospitalization ranged from 41% to 55% among adults and 63% to 78% among childrenInterim Estimates of 2024–2025 Seasonal Influenza Vaccine ... - CDCcdc .
The emerging environment suggests several dynamics that will shape influenza vaccination among high-risk populations:
Political Cue Dominance: The evidence that political endorsements outperform expert messaging among aligned partisans implies that RFK Jr.'s sustained skepticism messaging will likely produce measurable declines in vaccination intention among his supporters that fact-based counter-messaging alone may fail to reverseTesting persuasive messaging to encourage COVID-19 risk reductionplos +4.
Structural Barrier Multiplication: The shift to SCDM erases standing orders, complicates EHR systems, and creates logistical bottlenecks that disproportionately affect populations without regular primary care accessCIDRAP Op-Ed: Quiet dismantling: How ‘shared decision-making’ weakens vaccine policy and harms kids | CIDRAPumn .
Provider Burden Transfer: Physicians must now conduct individualized risk-benefit conversations that federal guidance previously streamlined, within appointment constraints that average 12-15 minutes and patient panels already generating documentation spillover HHS’s Stance on Vaccine Shared Decision-Making Risks Patient Health and Overloads Clinicians | Milbank Memorial Fundmilbank .
Community Messenger Potential: Trusted community-based organizations and healthcare workers demonstrate capacity to reach hesitant populations, but these strategies require resources that federal policy is withdrawing from vaccine promotionCommunity Health Workers and COVID-19 Vaccine Trustesmed +1.
Disparity Amplification: Already-disadvantaged populations with lower baseline vaccination rates face compounded risk as both policy signals and misinformation targeting interact with limited healthcare accessFlu Vaccination Coverage, United States, 2024–25 Influenza Seasoncdc +1.
The intersection of emerging vaccine skepticism from federal health leadership with public health communication strategies represents a systematic restructuring of the vaccination environment. High-risk populations—elderly adults, children, pregnant women, immunocompromised individuals, and racial/ethnic minorities with historical access disparities—face the consequences of messaging that signals ambivalence from the institutions historically responsible for vaccine promotion, at a moment when disease burden has reached multi-decade highs.