Pediatricians take lead on vaccine messaging as US flu season begins

As flu season begins in the US, following the deadliest flu outbreak in children outside of a pandemic since record-keeping began in 2004, pediatricians are taking the lead on vaccine messaging.

The US Centers for Disease Control and Prevention (CDC) does not plan to resume its “wild to mild” flu vaccination campaign, which was halted in the midst of the record-breaking flu season.

Even as places such as Australia and Japan report severe flu seasons, there has also been a drop in global virus samples shared with the US, which help scientists understand which viruses and variants are circulating and how they are mutating.

In the 2024-25 flu season, 280 children died from influenza – making it the second-deadliest pediatric flu season on record in the US, second only to the 2009-10 swine flu pandemic. The CDC classified it as a “high severity season”.

A total of 109 children were diagnosed with encephalopathy, or brain swelling, related to flu infection, with one-third of those patients suffering acute necrotizing encephalopathy. Three-quarters of the patients with brain swelling needed to be admitted to the intensive care unit, and one in five died from the condition.

Among the children who were eligible for the vaccine, 89% had not been fully vaccinated.

The CDC is launching a new national campaign to “raise awareness and empower Americans with the tools they need to stay healthy during the respiratory virus season”, said Emily Hilliard, press secretary for the US Department of Health and Human Services (HHS).

Hilliard did not mention the role of vaccines or respond to a request for more information about the campaign.

Pediatricians and other trusted figures are stepping into the communications gaps.

“We saw a really bad season last year, and I worry that this season could be even worse,” said Jonathan Miller, associate chief of primary care at Nemours Children’s Health and president of the Delaware chapter of the American Academy of Pediatrics (AAP).

Caitlin Rivers, director of the Center for Outbreak Response Innovation at the Johns Hopkins University, said: “Pediatricians, family doctors, pharmacies are all really important sources of information.”

Pediatricians are the most trusted source of information on vaccines, according to a recent survey by the nonpartisan group KFF. Some 85% of parents said they trust their pediatrician a “great deal” or “fair amount” when it comes to information on vaccines. Only a third of parents said the same of Robert F Kennedy Jr, the HHS secretary.

“I feel optimistic that parents will listen to pediatricians and to primary care providers when we encourage them to do this,” Miller said. He works with primary care providers at his facility to recommend the flu vaccine “at every opportunity”, when patients come in for routine visits, follow-ups, or even some sick visits, if they’re well enough.

Every child benefits from getting vaccinated, Miller said, adding: “If you are high-risk as a child for flu, you are more likely to have bad outcomes, but a lot of kids who are otherwise healthy also have bad outcomes.”

Nearly half (44%) of the children who died last winter had no underlying conditions and common conditions such as asthma are among the underlying conditions adding to risk, Rivers said.

“People don’t always perceive themselves or their kids as being at higher risk, but, in fact, they may be,” she said.

Although the flu vaccine doesn’t stop onward transmission entirely, it does lessen it. “It reduces the risk of you passing on the virus to other people,” Rivers said.

Last season, the hardest-hit group was infants under the age of six months, who cannot yet get the vaccine.

The CDC’s “wild to mild” campaign, which focused on how flu vaccines protect against severe illness and death, first began in 2023 and was “very, very well received” among the public, said Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases, at a recent press conference.

The health department suspended it soon after Trump took office.

At the CDC, “they’re not allowed to talk about that campaign, despite the fact that it had very clear messaging”, Daskalakis said.

“Even before the shutdown, there has been really a concerted effort to limit communication around vaccines, specifically influenza,” he said, noting that he expects “that we’re not going to see a brisk uptake of flu vaccine” since “there’s already a lot of confusion around vaccines because of what’s happened with RFK Jr”.

In the absence of clear guidance, health providers may hesitate to offer vaccines against respiratory illnesses such as flu, Covid, and RSV, Daskalakis said.

But medical groups, such as the AAP, are making vaccination recommendations, and the American Lung Association announced a new campaign in October to educate people on vaccines for the respiratory season.

Providers and health systems are also stepping up local vaccine messages, giving the shots greater prominence than in years past, Miller said. For families skeptical of the shot, providers can offer the nasal-spray vaccines, he said. They’re very safe and effective, and they can be given to children two years and older without medical contraindications.

“I think that’s helping some families feel more comfortable getting vaccinated than they otherwise would have been,” Miller said.

Making it easy to remember and schedule the shots also helps, Rivers said. “People respond really well to convenience and reminders.”

The CDC’s Center for Forecasting and Outbreak Analytics expects this year’s respiratory virus season to be similar to last year’s. Yet severe outbreaks in Australia and Japan, the latter of which has declared a flu epidemic, has experts concerned.

“It’s not a direct lesson for what we can expect, but it’s a clue,” Rivers said. “And that does give me pause that maybe we’ll be in for something a little bit bigger.”

Respiratory viruses are “unpredictable” and can mutate and change, Miller pointed out. The best way to stay protected is to get updated vaccines each year, he said. During the US government shutdown, the CDC did not publish data on national flu trends as it normally does.

“It’s very laborious and difficult, I think, for the average person to access high-quality data right now compared to when CDC is participating in reporting,” Rivers said.

While states report some of the data publicly, “it’s just data”, Rivers said. “If you’re not accustomed to looking at the data and understanding what it means, it might not give you enough information to really make choices.”

And the lack of guidance signals a worrying trend, Rivers said: “There are very severe possible consequences for allowing our public health system to degrade.”