Vaccines, Trust, and the Unvaccinated Child with Dr. Paul Offit

What does declining confidence in childhood vaccines mean for the child with fever in the pediatric ED?

Dr. Bob Belfer speaks with pediatric infectious disease physician and vaccine expert Dr. Paul Offit about vaccine hesitancy in 2026. Using the framework of confidence, complacency, and convenience, they explore how the COVID era changed public trust and why the consequences of vaccine decisions can fade from memory when vaccines succeed.

They revisit Andrew Wakefield’s retracted MMR paper and discuss a recent study of more than 2.5 million U.S. children that found no association between MMR vaccination and autism. Dr. Offit explains the purpose of the National Vaccine Injury Compensation Program, why a report to VAERS does not establish causation, and how the Vaccine Safety Datalink can investigate a potential safety signal. The conversation also covers COVID-19 and influenza vaccination, measles outbreaks, the hepatitis B birth dose, and changes in how vaccine recommendations are presented.

Finally, they turn to the pediatric ED: how should an unimmunized toddler with fever and no clear source change a clinician’s concern for invasive bacterial infection?

Studies and resources discussed

World Health Organization Strategic Advisory Group of Experts on Immunization. Report of the SAGE Working Group on Vaccine Hesitancy. 2014.

Burstain TL, Jacques D, Burstain JM. Association between first MMR vaccination before age 2 years and childhood autism in a U.S. EHR cohort of 2.5 million children. Pediatr Infect Dis J. Published online July 28, 2026. doi:10.1097/INF.0000000000005349.

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351(9103):637-641. Retracted in 2010.

Offit PA. Flawed research and its enduring repercussions. Science. 2020;370(6512):43. A review of Brian Deer’s The Doctor Who Fooled the World.

Centers for Disease Control and Prevention. About VAERS and About the Vaccine Safety Datalink.

Health Resources and Services Administration. About the National Vaccine Injury Compensation Program.

About the guest

Dr. Paul Offit is Director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. He is a professor of pediatrics and the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania. He co-invented the rotavirus vaccine RotaTeq.

About the podcast

The PEM Podcast features thoughtful conversations, practical teaching, and the people and ideas shaping pediatric emergency medicine. It is hosted by Dr. Bob Belfer and is part of HipPEMcrates, an independent pediatric emergency medicine education platform.

Visit HipPEMcrates.com for pediatric emergency medicine articles, literature reviews, clinical pearls, and educational resources.