Notes from the Field: Strengthening vaccine confidence through science, policy, and public engagement
According to the World Health Organization (WHO), it is estimated that globally, between 1974 and 2024, “vaccination averted 154 million deaths.” At present, vaccination rates in the U.S. are decreasing; this puts people’s health at risk. Drawing on experience in clinical care, national policy, and global health, Dr. Noele P. Nelson, Professor of Practice in Cornell University’s Department of Public & Ecosystem Health shares insights into why vaccines matter and how science communication plays a key role in strengthening vaccine confidence.
What are vaccines?
Vaccines help the body recognize and fight specific pathogens (disease-causing organisms), before a person becomes seriously ill. Vaccines help decrease infection or symptoms among people; this also helps reduce the spread of disease in communities.
What are vaccine-preventable diseases?
Vaccine-preventable diseases (VPDs) are diseases for which effective vaccines have been developed, licensed, and recommended. Some VPDs include measles, influenza (flu), and pertussis (whooping cough). Whether a disease is considered vaccine-preventable can vary depending on where vaccines are available and recommended. For example, hepatitis E may be considered vaccine preventable in countries where a vaccine is approved and available, but not in countries where it is not accessible or recommended.
What are some barriers to vaccine uptake?’
Barriers to vaccination range from personal to broader system-level challenges. People may not know a vaccine is recommended, may not receive a strong recommendation from a healthcare provider, or may face limited access to insurance coverage or uncertainty about where to get vaccinated. Misinformation and doubts about safety also influence vaccine decisions.
How is Dr. Nelson a part of the solution?
Dr. Nelson’s work spans clinical care, national policy, and global immunization guidance. As a pediatrician, she routinely administered and recommended vaccines to children and families. Later, when working with the Centers for Disease Control and Prevention (CDC), she helped lead the development of national vaccine recommendations that guide healthcare providers and strengthen protection against VPDs across the U.S.. Dr. Nelson also served as a workgroup lead for hepatitis vaccines on the CDC’s Advisory Committee on Immunization Practices (ACIP), contributed to additional ACIP workgroups, and participated in a working group of the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE).
At Cornell, Dr. Nelson collaborates with academic colleagues and advocacy partners to promote vaccination, particularly in light of the recent changes to immunization schedules in the U.S. Recently, she co-authored a study, provisionally accepted, highlighting the negative impacts that recent changes to the hepatitis B birth dose recommendations could have on hepatitis B morbidity, mortality, and healthcare associated costs in the U.S.. She also led a Perspective article, under review, on the continued need for routine childhood hepatitis A vaccination in the U.S.
Why this matters?
Addressing vaccine barriers requires tailored approaches. For hepatitis B in infants and children, Dr. Nelson and her colleagues emphasize the importance of vaccination at birth and completing the series during infancy to prevent chronic infection and severe disease later in life. Beyond simply stating that vaccines are safe and effective, their work focuses on helping people understand how vaccines work, why they are safe, and how safety monitoring systems function. Through media interviews and public engagement, they provide context that supports informed decision and builds trust.
Dr. Nelson notes that recent shifts in vaccine policy and recommendations have affected how people interpret vaccine guidance. Some vaccines that were previously routine have moved to shared clinical decision-making, which typically involves a discussion between the healthcare provider and the patient or parent/guardian about whether the patient should receive a vaccine based on their individual health circumstances. Traditionally, shared decision-making recommendations were reserved for vaccines with weak or uncertain evidence among specific populations. Recent shifts to this approach have occurred without corresponding changes in the evidence, leading to people hearing mixed messages from the media, government sources, and health professionals. Clear communication is important in helping people navigate these changes.
Dr. Nelson shares that vaccines are one of the most significant achievements in public health. Diseases such as polio, diphtheria, and rubella once caused thousands of cases annually but are now rare or absent in the U.S. because of sustained immunization efforts. This progress reflects decades of tremendous research, collaboration, and public health effort.
Dr. Nelson highlights the importance of recognizing the risks posed by diseases like measles when vaccination coverage declines. Greater awareness of how vaccine safety is evaluated and monitored, and the role of rigorous scientific evidence in shaping vaccine recommendations, is essential to maintain public trust.
Public engagement, clear communication, and evidence-based policy remain central to sustaining vaccine confidence. Improving public understanding of vaccines and strengthening health literacy will continue to be important. Supporting science-based public health policies and addressing the sources of vaccine concerns will also help counter misinformation and protect communities from diseases that were once controlled or eliminated.
Author: Apekshya Basnet
Source: https://blogs.cornell.edu/
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