Addressing vaccine hesitancy requires skill and patience – some days, the people who do it feel like they're drowning in a sea of lies.
Since her four-week-old son Riley died of whooping cough in 2015, and she began a new career in immunisation advocacy, Catherine Hughes has kept her finger on the pulse of what Australians are thinking and saying about vaccines.
She never used to hear much chatter in her circles about the debunked link between the measles, mumps and rubella vaccine and autism; for years, she says, the "sticky" myth seemed to just be simmering beneath the surface, it wasn't too big a problem.
In the past year or so, though, it has come spinning back into the spotlight — on social media, definitely, but also at pregnancy and babies expos around the country, where Hughes runs pop-up immunisation clinics and education sessions for parents-to-be.
"The most common thing we've encountered lately is what I'd call a vulnerability narrative," says Hughes, executive director of the Immunisation Foundation of Australia. "Parents will say to us, 'I don't believe the MMR vaccine causes autism, but could it trigger it in a child who is already predisposed?'"
Some expectant parents have also been querying the purpose of the recommended birth dose of the hepatitis B shot, which was recently scrapped from the US childhood vaccination schedule as part of Health Secretary Robert F Kennedy Jr's mission to overhaul vaccine policy.
Some of their questions are normal, reasonable, Hughes says — parents just want what's best for their kids. But in general, vaccine hesitancy is growing in ways she's never seen. And she's worried.
"There is a clear spillover effect happening where distrust or policy debates in the US are being mirrored here in Australia," Hughes says. "When high-profile global figures start questioning vaccine safety, that doubt travels, regardless of national borders. Unfortunately, it doesn't just stay confined to one vaccine either. It starts to erode the trust and acceptance we have worked so hard to build for our own childhood [immunisation] programs."
With immunisation coverage rates declining and outbreaks of infectious diseases like measles increasing, the consequences of vaccine hesitancy in Australia are becoming clearer. For years, Australia's pro-vaccination culture has been celebrated and admired, and our confidence in vaccines remains high compared to other countries.
But experts are warning of a triple threat to that hard-won success: COVID, vaccine policy decisions and discourse in the US, and a loss of trust in government since the pandemic hit.
Now, with health practitioners increasingly confronting patients who question the safety and efficacy of vaccines that have long been proven to work, efforts to curb hesitancy and improve uptake have taken on new urgency. It is delicate, time-consuming work that requires skill and patience — some days, the people who do it feel like they're drowning in a sea of lies and conspiracy theories.
Still, they persist: some because they understand the science and public health benefits of vaccination, others because they know the anguish of losing a loved one to vaccine-preventable disease.
For Catherine Hughes, one of the most effective strategies for addressing vaccine hesitancy involves a combination of science and storytelling. And hers is a particularly affecting story. After their baby died, Hughes and her husband launched the Light for Riley campaign, sharing confronting details of their son's last moments in the paediatric intensive care unit of a Perth hospital.
"I asked the doctor if there was any chance, even the slimmest of chances. He was very upset and told me that unfortunately there was no hope," Hughes wrote in a Facebook post at the time. "Pink foamy stuff had started to come up out of his lungs … I knew it wasn't good. Riley was placed in my arms, and I was shocked at how burning hot and swollen his tiny body was … The tubes were slowly and carefully removed, and we cuddled, cried, kissed him, and sang to him a lullaby as the life slowly drained out of him."
Their campaign pushed the government to include the pertussis vaccine in the National Immunisation Program's free pregnancy schedule — until then, it was only recommended for babies from six weeks. Still today, Hughes's story resonates with other parents who are either unsure about pregnancy vaccines or who hadn't realised how serious whooping cough can be.
"There's no doubt that when I share Riley's story with a parent at an expo it creates this sense of trust between us," says Hughes, who was appointed a Member of the Order of Australia in 2022. "They seem to be more likely to sit down and get vaccinated."
Then again, in 2024 Australia recorded its biggest-ever whooping cough outbreak, which spilled into 2025, coinciding with a drop in vaccination coverage. Measles, which is often referred to as the "canary in the coalmine" of infectious disease, is also climbing again, with 181 cases recorded last year, up from 25 in 2020.
Australia's childhood immunisation rates remain high by global standards but have been falling since COVID hit, a concerning trend given they had generally been increasing until 2020. The latest data from the Australian Immunisation Register shows less than 92 per cent of 12-month-old children are fully immunised, down about three percentage points since 2020, and less than 90 per cent of two-year-olds are fully vaccinated, down from 92 per cent — well short of the 95 per cent target for robust community protection, or herd immunity.
COVID and flu vaccination rates have also stuttered: just one in four Australians aged 65-74 received a COVID vaccine in the past 12 months and influenza vaccine uptake has declined in most age groups since 2020. Immunisation rates for recommended pregnancy shots like influenza, pertussis and RSV are "suboptimal", leaving parents-to-be and newborns at risk of severe illness or death.
It is probably not a coincidence, then, that vaccine hesitancy is climbing. The World Health Organization (WHO) in 2019 named vaccine hesitancy – a state of indecision and uncertainty about vaccination — as one of the top 10 threats to global health. The reasons why people choose not to vaccinate are complex, the WHO said, listing complacency, inconvenience in accessing vaccines, and a lack of confidence as key drivers.
In Australia, vaccine confidence has dropped considerably, according to the Vaccine Confidence Project: in 2023, 79 per cent of 45-54 year-olds agreed vaccines were safe, and 79 per cent agreed they were effective — down from 93 per cent and 94 per cent in 2015.
Now there are big red flags in a new study from the National Vaccination Insights Project, which surveyed 2,000 Australian parents about their attitudes towards childhood vaccines between September and October last year.
Compared to 2024, when the survey was first done, higher proportions of parents reported not believing vaccines are safe, and not trusting vaccine information from their child's doctor or nurse. Parents also reported hearing worrying messaging about vaccines in the media, with some highlighting anti-vaccine rhetoric in the US, including the discredited link between vaccines and autism.
"They are continually releasing new policies in the US that destabilise vaccine confidence globally … so in some respects, we haven't hit the bottom of what's coming," says Dr Jessica Kaufman, principal research fellow in the Vaccine Uptake Group at the Murdoch Children's Research Institute and the study's lead author. "My hope is that local Australian efforts [to tackle hesitancy] are significant enough that they at least counter some of that."
Still, Kaufman is particularly concerned about declining trust in doctors and nurses, "because that is also our best strategy to improve vaccine confidence". "Individual conversations with healthcare providers … are incredibly important in addressing hesitancy," she says. "And so … if trust in healthcare providers continues to erode, I'm worried about how difficult it will be to rebuild trust in vaccines and in the vaccine delivery system more broadly."
For Professor Julie Leask, a social scientist specialising in immunisation and public health at the University of Sydney, it's important to remember that vaccine hesitancy has always been a problem and always will be. There's also "nothing pathological" about being hesitant about vaccines, she says, and we should "listen carefully" to people who have concerns, especially if they've had negative experiences.
Because the complexity of hesitancy — and the urgency — is that if it is mismanaged, it can turn into refusal. "It's a really thin line, it can be really fluid," Leask says. "We used to say that if someone refuses vaccination, they tend to be pretty hardcore and fixed and you can't change them. But that's not true … it's a genuine continuum."
So what's going on? First, this isn't just a hesitancy problem, nor a COVID one. For many people, vaccine access issues — simply being able to find and pay for a doctor's appointment, for example — can be a major barrier, especially in recent years when the cost of living crisis is really biting in Australia. Still, some people came to see pandemic public health measures — vaccines, masks, lockdowns — as negative forces of control, while others resented limited COVID vaccine mandates and in some cases are now rejecting other vaccines, too.
Some people also suffered vaccine injuries or in extremely rare cases died after getting COVID vaccines — or heard unsettling stories about others who had, says Professor Katie Attwell, a political science and public policy scholar at the University of Western Australia. "Although those things were very rare, and probably to be expected when you're rolling out mass vaccination to a population in a global pandemic … some people felt they shouldn't have been required to have those vaccines. They've then lost faith in the process, or in the governments that ask or require vaccination of them or their children."
There were also crucial missteps in how politicians and public health officials represented COVID vaccines when they were being rolled out. Some messaging oversold the benefits: they are good at preventing severe disease and death, but they don't completely prevent infection, as some optimistically claimed.
And some politicians insisted Australians should accept the rare but serious risk of clotting from the AstraZeneca vaccine — which was eventually withdrawn — because it was comparable to the risk of clotting on the contraceptive pill.
"It's actually OK to talk with people about risk … we often underestimate their capacity to weigh risk with benefit," Leask says. "The problem is, if you don't talk about uncertainties with vaccination, about the limitations of vaccines … if you talk down safety issues, people who are particularly attendant to those will become more mistrustful."
Linda Menton has no doubt people have lost trust in vaccines. As far as hesitancy goes, she hears it all. Parents who want to delay their infant's MMR vaccine. Teenagers who won't take the HPV vaccine, despite it being a key reason Australia is on track to completely eliminate cervical cancer. Parents who are worried about the meningococcal B vaccine (no, it's not a new shot, she tells them, it's just new to the schedule in Queensland, where it is free for kids and teens because the B strain is emerging as the most common cause of illness and death from invasive meningococcal disease).
"It's hard because nowadays lots of people haven't seen any of these diseases," says Menton, a community immunisation nurse at Gold Coast Health. In that way, she says, vaccines are a victim of their own success. "I talk to them about when I was a student nurse, and I was … on night duty having to care for a little child who had meningitis, and I would be fingers and toes crossed all night long that the child would still be alive the next morning."
Menton is nervous about creeping vaccine hesitancy in her area, where rates of fully immunised one-year-olds (86.57 per cent) and two-year-olds (85.2 per cent) are among the lowest in the country. While she's hopeful some of the "vaccine fatigue" from the pandemic is easing, she still spends a lot of her time consulting with hesitant patients. She never judges or argues with them, she says — that usually only makes them dig in harder.
"It's about empowering them to make the decision for themselves," Menton says in her thick Irish accent. "I think if someone's hesitant, the big thing for me is always to ask why, and to listen carefully."
Then, she'll ask their permission to tell them about the disease, and the importance of protecting their family's health. And she is always up-front about possible vaccine side effects. The meningococcal B shot, for instance, often causes fever for children under two, which is why prophylactic doses of paracetamol are recommended. Other shots can cause irritability, and swelling at the injection site.
"There's no point hiding any of that information," Menton says. "It's very important parents have it all so they can make informed decisions", and so if any very rare but serious issues do emerge — allergic reactions, febrile seizures — they know what to do.
Melbourne GP Dr Preeya Alexander has also seen an increase in vaccine hesitancy over the past couple of years. At her Richmond clinic Alexander sees lots of patients who are hesitant about the influenza vaccine — particularly over 65s and younger adults who think flu is no big deal. She's seeing more patients who want to spread out their child's first vaccines or take measles out of the MMR shot — some because they're worried about "overloading" their baby's immune system.
"There's a lot of data that shows it's safe — I'm constantly telling parents your child is … exposed to more [antigens] in their day-to-day life than what is in a vaccine," says Alexander, who co-hosts the Health Report on ABC Radio National. "There's also a bit more concern about the MMR vaccine in particular … people say to me, 'But isn't it just a virus the immune system can deal with? Is it even that harmful … doesn't it potentially cause autism?'"
It's a good thing patients are coming to her with these questions, Alexander says — it shows they're comfortable with her. But while she has made a deliberate effort to upskill herself in how to address vaccine hesitancy – which resources to lean on, how to have nuanced, difficult conversations — other doctors won't have the time or the training.
Often these chats take 45 minutes and some patients need multiple appointments, Alexander says, but GPs are financially incentivised to prioritise 15-minute consults over longer ones. Given the majority of vaccinations in Australia are administered in general practice settings, it feels like a missed opportunity.
Alexander is also concerned about the corrosive influence of misinformation, which was already flourishing online before the pandemic but is now proliferating faster than interventions designed to tackle it. In Australia, many parents are more worried about vaccine misinformation than they used to be: a 2024 study by Jessica Kaufman and her colleagues found that, compared to pre-pandemic years, more parents believed that children receive too many vaccines, that vaccines cause autism, and that vaccine ingredients cause harm.
Alexander regularly spends hours tracking down the source of vaccine rumours so she can get ahead of the questions patients inevitably come to her with — the rollout of the maternal RSV vaccine last year is an exasperating example of what she's up against.
A popular pregnancy podcast at the time discussed two different RSV vaccines: a GSK product whose clinical trial was discontinued after it showed an increased risk of preterm birth, and a Pfizer product which was found to be safe and effective. The Pfizer vaccine, Abrysvo, was (and still is) recommended for pregnant women from 28 weeks' gestation. But the podcast host implied the shots had the same issues, Alexander says, giving the impression an unsafe vaccine was being used. No wonder women were worried.
"I do think there could be far more support for clinicians and immunisers on the ground [that helps them keep across] what patients might be hearing," Alexander says — perhaps the Department of Health or the RACGP could issue regular briefings: "This is where it's come from, this is why it's not true, here's the actual evidence and here are some resources."
Because some days, she says, it all just feels too much for one doctor. "It does feel like an overwhelming tide at times, with people with huge platforms who spread completely unfounded misinformation."
For Julie Leask, the idea that misinformation — this nebulous "thing out there" — fuels vaccine hesitancy is a fallacy. For one thing, she says, it assumes people passively accept every myth or misleading social media post they encounter, that they can't critically analyse vaccine messaging and make decisions for themselves. It also ignores their genuine concerns about vaccines or healthcare. Plus, she adds, we tend to talk about information and misinformation as if they're binary, but they're not: sometimes "the most effective misinformation" is partly made up of facts, kernels of truth.
Take, for instance, the US CDC's recent decision to overhaul the childhood vaccine schedule, with the agency no longer recommending routine vaccination against six diseases — including meningococcal and influenza — that can be very serious or even deadly.
Public health experts have expressed outrage about the change, warning it lacks supporting evidence and customary input from experts and will endanger children's lives. Still, the analysis used to explain the decision is peppered with references to peer-reviewed studies and motherhood statements about "gold-standard scientific research" and restoring trust in public health.
"What they're doing is careful," Leask says. "They're not saying, 'Don't have the vaccines'. They're carefully undermining confidence in some vaccines, and they're also giving weaker recommendations, which will complicate and confuse how vaccines are talked about in primary care and delivered, and reduce coverage. Is that misinformation? No, it's not that simple."
All this is a problem for the US, which is on the brink of losing its measles elimination status after an explosion of cases in 2025. It's also a problem for Australia.
"The US is in an unusual situation where you have this despotic, populist president who has installed an anti-vaccination proponent [in RFK Jr] to lead health, essentially putting Dracula in the blood bank," Leask says. "I would wager that it will contribute to a slight decline in our vaccination rates because of increased hesitancy. The magnitude of that is another question. It could be very slight, it could be more substantial."
RFK Jr is not the only authority causing concern. Dr Kirk Milhoan, the chair of the Advisory Committee on Immunisation Practices (ACIP), last month suggested vaccines against measles and polio — and maybe all diseases — should be optional, and offered only via consultation with a doctor. In a wide-ranging interview with the podcast Why Should I Trust You? Milhoan also cast doubt on the rigour of the national safety monitoring system, saying he was "pulling back the curtain" on the risks of vaccines. The goal of ACIP, he said, is to protect individual autonomy over public health.
What Leask finds most troubling is the unleashing of anti-vaccination rhetoric at scale, "in a seemingly really compelling way, by sanctimoniously dressing up statements with 'We want to build trust' and 'We want people to make informed decisions' and 'We want gold-standard science'." There's nothing new about anti-vaxxers adopting the language of science, she says, "but there's an added layer of sophistication that comes from the incredible funding and oxygenation" of anti-vax activism these last few years.
Perhaps one of the biggest risks of the US's climate of vaccine scepticism is not just that it could shake Australians' confidence in vaccines, but that it might do so for local medics.
"Once you impact the confidence of health professionals, even if it's just a little bit, parents pick up on those cues," Leask says. "That GP who's already a little bit flu vaccine hesitant? It might reignite their hesitancy and see them giving slightly weaker recommendations for the vaccine than they might otherwise give."
If screaming "believe the science!" at vaccine sceptics worked, we wouldn't be grappling with a hesitancy problem. The only strategy Dr Rachel Heap has seen work is what she calls "a thousand cups of tea" — having a series of one-on-one conversations, listening closely to why people are wary of vaccines, and unpicking the beliefs that have led them there.
At least that is the approach Heap and her comrades embraced under the banner of the Northern Rivers Vaccination Supporters (NRVS), an advocacy group formed in 2013 to tackle misinformation and lift their region's dismally low immunisation rates.
"There is a cultural narrative here that mainstream medicine is bad, going the natural way is good," Heap says of her community, which spans the NSW towns of Byron Bay, Lismore and Mullumbimby, Australia's "anti-vax capital". In other words: it is better to catch an infection than be vaccinated against it.
That people are allowed to sell the message that many of the diseases we vaccinate against were never that bad in the first place is one lie, says Heap, who is speaking as a former member of the NRVS, not as an employee of NSW Health. "The second lie is that vaccines are more dangerous than the diseases."
Heap should know — an intensive care specialist at Lismore Base Hospital, she sees up close what it's like to lose someone to a vaccine-preventable disease. "These are the ghosts that sit on my shoulders," she says of the babies she's cared for who have died of whooping cough, the adults with COVID and flu who land in her ICU. "I sit with people in grief and that's hard. When I sit with people in grief who also have regret, it weighs heavier. And I think that's one of the messages that can cut through."
But there is a dark side to this work. It is frequently frustrating and can take a heavy personal toll; feeling as if the fight you're putting up isn't making a dent can be demoralising.
It's a major reason why Heap shut down the NRVS in 2022. Suffering from burnout, it had all become too much — working in an ICU during the worst years of the pandemic, losing her uncle to COVID, the unrelenting barrage of misinformation and unhinged conspiracy theories. Then Lismore was hit by devastating floods. Heap's home was damaged, some of her friends and neighbours lost everything.
Her drives home from work — past anti-vax protesters and conspiracists howling that the virus was a hoax — started to feel like running the gauntlet. How could she possibly counter that?
"There was open and active denial of the fact that this was actually happening — [that COVID] wasn't really a bad disease," Heap says. "It's like, well, I'm currently looking after somebody on a ventilator who would disagree with you." She felt sad, angry and empty, she says, "and to even try was beyond the time and resources and energy that I had at that time."
Four years on Heap still feels "pretty hopeless, helpless" about the growing challenge of vaccine hesitancy. "I've got such existential dread about it, and it's not just Australia, it's the world. It's in the same category as 'God, I can't believe we're still arguing about climate change'. Like seriously, the planet's on fire," she says. "It's coming from algorithms and tech bros and the most powerful men in the world. So I'm not terribly optimistic for humans at the moment."
She's also worried that people have forgotten that vaccines don't just protect individuals — they keep communities safe, too. Have we stopped caring so much about each other?
"I do have a concern that the social contract of vaccines — that collective social responsibility — has taken a big hit with a combination of the pandemic, algorithms, social media, retiring behind a screen rather than face-to-face interaction," Heap says. "The art of conversation is half about listening … and I think the problem with interacting via computers is that you're nearly always on transmit. You're not necessarily listening."
Things might yet get worse before they get better, but that doesn't mean vaccine hesitancy can't be addressed, and Australia's immunisation rates recovered. Katie Attwell points to the strong relationship between trust in government and trust in vaccines (or, as the authors of one study last year put it, "governments should treat distrust as a public health risk").
Recent research shows Australians' satisfaction with democracy has declined over the past two decades. Our trust and confidence in government has also dropped, particularly since the pandemic.
But Attwell warns against victim blaming. "I don't like the idea that we need to work on trust as though it's something that sits in the public, as though it's their fault," she says. "Because when people don't trust government, it's quite often because government has not behaved in a trustworthy way."
For instance, if people perceive that governments aren't responding well to pressing problems — climate change, say, or the cost-of-living and housing crises — resentment can build and trust can be eroded. If you're feeling resentful or angry at the government, Attwell says, you may be less likely to get the vaccines they want you to get. "So I think we need to flip the lens there and say, 'What are governments doing to inspire people to trust not just in vaccination, but in the other things that help them feel like they are living a valuable and meaningful life?'"
Building trust — a defence against misinformation — is a priority of the National Immunisation Strategy, published last May. But the strategy risks paying lip service to the urgent issues it highlights if it is not fully implemented.
"The National Strategy is very comprehensive and will contribute to trust-building if the government can make it all happen," Leask says. "But the budget is modest when you consider its ambition, and the implementation plan extends to this year only." Trust can only be increased with "two-way communication embedded nationally", she adds, yet the plan merely hints that collaborative implementation forums "may" be convened.
Leask also believes Australia should establish a vaccine injury compensation scheme. Global studies show that fair and accessible claims schemes are fundamental to maintaining trust and confidence in vaccination — it is a key reason the COVID-19 Response Inquiry recommended the COVID scheme be reviewed. The National Immunisation Strategy also flags "exploring the feasibility of a no-fault vaccine compensation scheme" that covers all vaccines in the national program.
"I really believe that people have a right to compensation when they do their bit for society and have a vaccine, but are one of the very, very few … who have a serious injury," Leask says. "Having such a scheme is just right. We don't have to justify it through saying it will improve trust and confidence. We justify it through saying it is a fundamental part of a fair and robust vaccination program."
When people do their bit for society. Like Rachel Heap, Attwell suspects Australia is suffering from "some social fracture" that needs to be recognised and repaired: "People just being really rude and inconsiderate in public places, a kind of unkindness and carelessness that I think has gotten worse and is perhaps attributable to the pandemic. It would be nice if we could have some public conversations about that, and some healing."
The political class are probably very keen to move on, to put COVID behind them, Attwell adds — dredging it up again is probably not going to win them much political capital. "But I think the population is traumatised and altered by it. Maybe not in hugely significant ways, maybe it is variable. But unless and until we work out how to grow past or contend with it, these problems are not going to go away."
Credits
Writer: Hayley Gleeson
Editor: Catherine Taylor
Illustrations: Lindsay Dunbar
