Vaccine Hesitancy Is on the Rise. So Is Whooping Cough.

Over the past decade, the U.S. has seen a troubling resurgence of vaccine-preventable diseases, including measles, mumps, and most recently, pertussis (whooping cough).

Pertussis, which disproportionately affects infants and young children, was once on the brink of elimination thanks to the widespread use of diphtheria-tetanus-acellular pertussis (DTaP) vaccines, which protect against diphtheria, tetanus, and pertussis. However, recent spikes in whooping cough cases have reignited concerns among public health officials, and the root of the problem is more complex than mere anti-vaccine sentiments.

The Rise of Vaccine Hesitancy

Vaccine hesitancy is distinct from the broader anti-vaccine movement. Anti-vaxxers existed before the COVID-19 pandemic and will likely persist afterward, driven by deep-seated beliefs that often resist scientific evidence. However, the vaccine-hesitant population is a newer and growing group, born out of confusion, mixed messaging, and a general distrust in how public health institutions communicate. The COVID-19 pandemic, with its barrage of conflicting information, contributed significantly to this phenomenon.

While skepticism is natural and even encouraged in scientific inquiry, the public health community has largely failed to address that skepticism with empathy and clarity. Instead, those who are hesitant are left to navigate a complex landscape of misinformation without adequate guidance, leading many to delay or refuse essential vaccines like DTaP. In the case of pertussis, this hesitancy is having severe, real-world consequences. Babies, who are the most vulnerable to severe cases of whooping cough, are suffering as a direct result.

Why the DTaP Vaccine is Critical

The DTaP vaccine has been a cornerstone of childhood vaccination programs for decades, significantly reducing the incidence of diphtheria, tetanus, and pertussis. Pertussis, in particular, is a highly contagious bacterial infection that can cause severe, life-threatening complications in young children, especially infants who are too young to be fully vaccinated. Before widespread vaccination, whooping cough epidemics were a regular occurrence, with thousands of deaths reported each year.

Today, the vaccine is highly effective, with studies showing up to 90% effectiveness in preventing severe cases of pertussis in fully vaccinated children. The urgency to address vaccine hesitancy cannot be overstated. The U.S. is returning to pre-pandemic patterns, where more than 10,000 cases of whooping cough are typically reported annually.

Measures like masking and remote learning likely helped reduce pertussis transmission during the pandemic. However, in 2024, pertussis cases have surged, reflecting a shift back to normal trends. Preliminary CDC data as of mid-September 2024 show five times more cases than the same period in 2023, with numbers now surpassing pre-pandemic levels seen in 2019. This trend is particularly dangerous because pertussis can spread rapidly through communities, especially among those who are not fully vaccinated.

According to data from the CDC, national DTaP vaccination coverage for kindergartners has seen a steady decline in recent years. In the 2021–2022 school year, measles-mumps-rubella (MMR), DTaP, polio, and varicella vaccine coverage dropped to approximately 93% for each vaccine, down from 94% the previous year and 95% during the 2019–2020 school year (when kids were vaccinated before the COVID-19 pandemic). The decline in vaccination rates during the pandemic, due in part to reduced access to vaccines and growing vaccine hesitancy, translates to approximately 250,000 kindergarteners without full protection against vaccine-preventable diseases like pertussis.

The resurgence of this vaccine-preventable disease is a reminder that the work of public health is never done, and that communication is key to preventing such outbreaks.

A Communications Breakdown

The recent increase in whooping cough cases reflects a broader public health crisis: a communications failure that has left a large portion of the public confused and distrustful. Reports show that the percentage of children with vaccine exemptions (non-medical reasons) has also increased to 2.6% in 2022–2023, up from 2.2% the previous year. This rise in exemptions is likely linked to increased vaccine hesitancy, fueled by misinformation and growing distrust in vaccines.

Experts agree that public health messaging during the pandemic was flawed in many respects. Complex issues like vaccine efficacy, herd immunity, and virus transmission were oversimplified in some cases, while contradictions in guidance further eroded trust. What we’re seeing today, with the resurgence of preventable diseases like whooping cough, is the long-term impact of these communication errors.

Learning From the Past

The history of public health offers valuable lessons in how to address vaccine hesitancy. Consider the global fight against polio. In 2009, India faced considerable vaccine hesitancy, particularly in Muslim-majority regions, where rumors circulated that the polio vaccine was part of a plot to limit Muslim fertility. Public health officials in India were able to counter these claims, not by force, but through patience, dialogue, and respectful education. They presented the evidence carefully, acknowledging people’s concerns without dismissing them outright.

In the fight against whooping cough, similar strategies need to be employed. Public health leaders cannot simply dismiss hesitancy as ignorance or stubbornness. They must engage in a patient and evidence-based dialogue that respects the concerns of parents and caregivers while providing clear, accessible information on the safety and efficacy of vaccines like DTaP.

A Call for Rebuilding Trust in Public Health

In public health, balancing activism with diplomacy is critical to rebuilding trust, especially in the face of vaccine hesitancy. As global leaders convene at the United Nations General Assembly (UNGA) to address pressing issues such as antimicrobial resistance, pandemic preparedness, and universal health coverage, we must not overlook the resurgence of preventable diseases like pertussis. These global health challenges highlight the need for cohesive, trust-based public health efforts that extend to every community.

Vaccine hesitancy serves as a reminder that public health activism must be grounded in thoughtful engagement rather than coercion. Alienating the public or vilifying skepticism only deepens divides. To rebuild trust, public health officials must adopt a compassionate and evidence-based approach that respects the concerns of vaccine-hesitant individuals, much like the international community’s approach to broader global health challenges at the UNGA. Effective public health strategies must avoid meeting opposition with force and instead build bridges through transparent communication and trust. Only then can we hope to prevent future outbreaks and protect our most vulnerable populations — especially our children.

Shreenik Kundu, MBBS, MSc, is a PhD student at McGill University and a Jean-Martin Laberge Global Pediatric Surgery fellow with extensive clinical experience. He previously completed a fellowship at the Global Surgery Foundation in Geneva, Switzerland, and a 2-year research fellowship at the Harvard Program in Global Surgery and Social Change in Boston. Robert Glatter, MD, is assistant professor of emergency medicine at the Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, and Northwell Health in New York.

The authors declare no conflicts of interest or financial disclosures related to this article.

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