In our previous episode, we wondered if the anti-vaccine propaganda from the present federal (and some state) administrations has had any effect on missed or canceled well visits. Conclusion? Not that we can see in terms of misses or cancellations. That's good.
But what about vaccine refusals? Are patients refusing vaccines at a higher rate?
The answer: Yes, it looks like they are. With some caveats, of course, but the conclusion seems unavoidable. Let's take a look.
First, where does the data come from? We examined the vaccines our clients ordered, dating back to 2019 (a little over 3 million, so it's a decent sample size), and identified when they were marked as Refused by the families. My first draft image of the change in refusal rates over time was too messy, so I asked an AI friend to simplify what we're looking at. If we group the "most essential childhood vaccines" together, here's what it looks like:
What's an "essential vaccine?" They all are, if you ask me, but I removed Flu, COVID, and RSV for reasons you will understand in a moment.
You can clearly see when COVID hit in 2020, when almost no one who visited a practice refused a key vaccine. You can see it quickly bounce back to a "typical" level of refusal around 2% until...mid-2023. When it starts to climb, and climb quickly. As of this month, in 2026, the vaccine refusal rate is well over 5%, more than 2.5 times what it was two years ago.
This is a big deal.
There are some elements of the data we need to consider.
Many PCC clients, perhaps most, have vaccine requirement policies (to protect other families, among other things). A family who refused the MMR vaccine at their 1-year visit may no longer belong to the practice...which means that they won't continue to refuse vaccines. The implication is that the actual rate of refusal is much higher.
What does the data look like if we distinguish each of the individual vaccine families? Check it out:
To reiterate, this is the same data as the first graph with the individual families grouped. The HPV obviously stands out with a baseline of ~20% refusal that has climbed to ~28% or so. I didn't realize that MenB had such a generally higher rate as a pre-COVID baseline (5%, now nearing 10%). And HepB, with the ironic yellow line, seems to be taking off. Sigh.
Want to see what happens when you add COVID, RSV, and Flu? It's fascinating.
Here's what's going on with that volatility...take the orange line for RSV, the one that appears in 2023. It swings wildly - why? Because it's a very seasonal vaccine, and you can see that the refusal rates peak in the April-Aug time of year. That's also when there are very few RSV vaccines offered/given. But during RSV season, the vaccine is very popular.
The flu rates - the yellow line - are interesting because many of the years show a funny double-bump (2019, 2020, 2021, 2022, and 2025). I want to look into it.
Zoom into that COVID-19 line, the volatile dark blue. Tell me my eyes aren't playing tricks: it looks like this fall had the lowest seasonal COVID-19 refusal rate since 2020?
Tell me what you think - what are you seeing in your offices? Have you counted?