Dr. Barbara Nightingale, Allegheny County Health Department deputy director for clinical services, sits for a portrait in her office, Thursday, Oct. 23, 2025, in Downtown. As herd immunity for common viral infections declines the county this year launched a campaign to combat vaccine hesitancy. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
The Trump administration seeks to upend vaccination practices. Allegheny County’s top immunization official and a key advocacy group counter with science. At stake: the herd immunity that protects everyone.
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As the Trump administration makes big changes to established vaccine policies, local public health officials and health care providers have become the last line of defense against federal actions they say are sowing confusion and throwing up barriers to access.
Earlier this month, the Centers for Disease Control and Prevention accepted controversial new guidelines for updated COVID-19 vaccines. They call for patients to talk to a doctor, pharmacist or other provider about risks and benefits before getting vaccinated. The move was widely condemned by experts, who said providers have been educating patients all along and that the new messaging would cause chaos as we enter the fall and winter respiratory virus season, and create further distrust around routine immunization schedules.
The recommendations — which can affect access and insurance coverage — were made by the CDC’s Advisory Committee on Immunization Practices (ACIP). Its members were picked by Health and Human Services Secretary Robert F. Kennedy, Jr., a vaccine skeptic with no medical background. The CDC also formalized the panel’s vote for separate vaccines to replace the combined measles, mumps, rubella and varicella (MMRV) shot for children under 4 because of a small risk of febrile seizures in that group. The American Academy of Pediatrics said the combined vaccine should remain an option for this age group.
With childhood immunization rates eroding in Allegheny County, officials are:
- Using billboards, advertisements and social media outreach to combat misinformation
- Sharing a toolkit with community partners
- Coordinating awareness efforts with pro-vaccination advocates including the Allegheny County Immunization Coalition (ACIC).
Pittsburgh’s Public Source separately interviewed experts to get a sense of how the county and ACIC are navigating this new landscape for federal vaccine policy: Barbara Nightingale, a psychiatrist and family medicine physician and the Health Department’s deputy director of clinical services, and William Coppula, a semi-retired North Hills pediatrician and ACIC member who’s practiced in the region since 1983.
Nightingale and Coppula’s answers to our questions were edited for length and clarity. Context provided by Public Source is in italics.
Q: How would you describe current levels of herd immunity for common infectious diseases in the county?
Barbara Nightingale: One of the best sources of data we have is from school immunizations. And we’ve seen a very slow, but very consistent, decrease across the board on required vaccinations for schools. That actually goes back more than a decade. (The percentage of county K-12 students who received all immunizations required for school entry was 93.6% during the 2024-2025 school year, according to a Health Department report. Information about infectious diseases — including surveillance and dashboards — can be found on the department’s website.)
Bill Coppula: We still have pretty good levels, but it doesn’t take much for those to drop. Pennsylvania is a state that allows individual exemptions for whatever reason — including medical, religious or philosophical — from getting a vaccine in public school or any school. And I always say every vaccine has a different story. So if you take flu or COVID-19 or chickenpox or measles — they all differ around what it means to be fully immunized because of how contagious they are or how easily they spread in public places. But we’re still talking above 90% or above 85% [depending on the disease] to get good, decent herd immunity. And the higher, the better to protect the people who just can’t get [vaccines] for medical reasons.
Q: What’s behind that decrease in herd immunity?
BN: We surveyed county residents to get a sense of what some of the barriers were. And we also talked to school nurses, while collecting the data from the schools, to get a sense of what they’re experiencing with parents and reasons why the vaccination rates are dropping. Some of it is growing rates of vaccine hesitancy. And some of it relates to kids moving between different schools and missing vaccine records — the rates are lower just because we don’t have them documented. Hearing from the residents themselves, we learned they know that they’re exposed to misinformation. … I think, here in Allegheny County, we’re experiencing what’s happening across the U.S. and really across the entire globe.
Q: What are some of those common concerns about vaccinations?
BN: We hear that people are concerned about a link with autism. There have been many studies that show vaccines are not linked to autism. So that’s one. Another one we hear about is concerns that [COVID-19] vaccines may be linked to infertility. Again, that has not been shown to be true. And this is maybe not something that we commonly think about, but people are looking at vaccines in an isolated way, versus thinking about the disease that they are preventing. Not being vaccinated puts you at higher risk for something that could be prevented. Those consequences include serious illness, death, hospitalizations, emergency room visits, those types of things.
BC: Nothing is without risk in the world, right? But compared to getting in your car and driving down the street, there’s not much risk to these vaccines. Rather, there’s a lot of benefit from them, including keeping disease rates down, or keeping you from dying or developing disabilities from vaccine-preventable illnesses.
Most vaccines now are preservative-free because they’re individual doses. So getting that information out there can help a lot, because a lot of people worry about these additives. (In June, the CDC’s advisory committee voted to ban the preservative thimerosal from all vaccines because of its mercury content. Research shows thimerosal is safe in vaccines and doesn’t cause autism or neurological problems, according to the American Academy of Pediatrics, which said “banning vaccine ingredients without solid scientific reasons sets a dangerous precedent and ultimately makes children less safe.”)
And there’s people right now saying, “Don’t give the hepatitis B vaccine to children at birth.” (President Donald Trump took that position last month.)
Here’s why it’s given at birth: If a mother has hepatitis B and a baby doesn’t get the vaccine, that baby will get hepatitis B from the mother [or pregnant person during childbirth] almost for sure. It’s not 100%, but it’s really close to it. But if the baby gets the vaccine, that lowers the risk. Now I know that doesn’t carry a lot of weight for a lot of people. They might argue, “Well, babies don’t get exposed to hepatitis B because they don’t have sex and they don’t use IV drugs,” and that’s true. But the other fact that isn’t well understood is if you don’t give the hepatitis B vaccine to infants, you may then decide to give it to 12- to 16-year-olds who might become sexually active or use drugs. The rate of uptake while trying to get the vaccine to that group is super low, so you’re just going to miss a lot of them.
Q: Can you detail the Health Department’s campaign to combat vaccine hesitancy in the county?
BN: We want to make sure that we can have information available that is trusted and reliable. There are two main points at which we want to make sure that information is available: Through health care providers, because people are telling us they continue to trust their health care providers — doctors, nurses — as a source of information that’s accurate. And we also want to make sure the Health Department can connect with other organizations that people contact to make sure that they have access to reliable information. So we created a toolkit that we have shared with partners that contains accurate information that combats hesitancy, as opposed to social media, where we know that a lot of people are getting their health information. (The Health Department’s Vaccine Awareness Toolkit is available on its website in English and Spanish. During a county Board of Health meeting in July, the department’s director, Iulia Vann, said the campaign also includes advertising on billboards and in local media, and social media posts.)
Q: Are you seeing early signs that the campaign is having an impact?
BN: It’s very hard to measure because so many different organizations and individuals are also doing work. We hope that it’s working, but I don’t know that we have a way of measuring the direct impact of it.
Q: Experts say the CDC’s vaccine advisory panel isn’t making decisions based on scientific evidence, and that it’s created confusion and erected more barriers to vaccine access. How is the Health Department clearing up the confusion?
BN: The recommendations from ACIP [the CDC committee] differ from the recommendations from several reliable professional organizations like the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG). So one of the best ways that we have been able to get out the message is working closely with the state and following their guidance.
(Gov. Josh Shapiro signed an executive order earlier this month empowering state agencies with the authority to make decisions about vaccines. “I do not want you to be guided by someone like RFK, Jr., who I believe is wholly unqualified to give medical advice and who is restricting our freedoms here in Pennsylvania and across the country,” he told providers at Children’s Hospital of Philadelphia. The state Department of Health recommends that Pennsylvanians follow the most recent immunization guidance issued by AAFP, AAP and ACOG. )
BC: The Health Department is in a difficult position because their funding all comes either from the feds or the state. Our state’s pretty good, but they can’t give our counties money that they were expecting to get from the feds if they don’t get it. And now people are getting fired over not doing the things that coincide with the wishes of the current administration. I think people should be worried. And I do think there’s room to try to make it less onerous bureaucratically for local health departments to do their work amid all this chaos.
Q: How are the Health Department and ACIC joining forces on this issue?
BN: So we provide information they can use in their own campaigns. We also work with them to host different types of events, particularly geared toward vulnerable populations. People that may not have access to vaccines for different types of reasons, like if English is not their first language, or they have other barriers, like transportation, some of those things get in the way of someone just having readily accessible vaccines. So we work closely with different types of providers to host events throughout the county. We also provide vaccines for homebound individuals and coordinate with pharmacies … and we go into low-income senior high rises to provide vaccines during the respiratory virus season. We can’t do the work alone. It takes everybody working together.
Q: How is ACIC promoting vaccines in the county? And has the group’s strategy evolved with changes at the federal level that aren’t based on evidence and the spread of misinformation and disinformation?
BC: We try to reach larger numbers of people. But the ideal thing would be to try to identify areas of deserts of information, of access, and then try to do as much as we can to educate people in those places.
We had a table at the August Wilson Birthday Celebration Block Party in the Hill District and the grandparents were really upset because their grandkids weren’t getting vaccines. They got them for their kids, but their kids weren’t getting them for their kids. It’s just really interesting to talk to people and find out what’s going on in different parts of the county.
Q: What are some best practices that health care providers should adopt to address vaccine hesitancy among their patients?
BN: I think one of the most important things is empathy and recognizing that that parent or that individual wants the best thing for their health or their child’s health. And so the provider should really come at it from that perspective of, “We also want to help you and unite with you on that.” And just really going through and talking about what concerns patients have to make sure that they can address it with accurate information.
BC: In Western Pennsylvania, a lot of practices discharge patients who don’t get those routine school immunization vaccines. That’s one approach that has come up. And there’s been arguments within the American Academy of Pediatrics about the ethics of doing that. (In 2005, the group advised against discharging these patients. It changed that guidance in 2016, stating that “a pediatrician may consider dismissal of families who refuse vaccination as an acceptable option,” adding the decision shouldn’t be made without considering and respecting the family’s beliefs.)
“I was always of the philosophy that I never wanted to send a child away because their parents were making that kind of decision.”
Bill Coppula
I was always of the philosophy that I never wanted to send a child away because their parents were making that kind of decision. So I always fought to keep them in the practice and talk to their families and try to educate them. And we did, and it was somewhat successful. So we had a lot of people coming from other practices that didn’t have the option to see their own pediatrician anymore, because that provider made a decision not to see somebody who wasn’t getting certain vaccines by a certain date. It’s become a much more common practice in our region over the last 15 years. In rare cases, there were people I felt I had to discharge because they would either verbally attack or aggressively say things about me or my staff, that we’re trying to hurt children or something like that.
The Allegheny County Health Department’s Immunization Clinic is located at 425 First Avenue in downtown Pittsburgh. Walk-ins are accepted, but appointments are preferred. To make an appointment, call 412-578-8062 or sign up for MyChart to schedule one online.
Venuri Siriwardane is the health and mental health reporter at Pittsburgh’s Public Source. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
The Jewish Healthcare Foundation has contributed funding to Public Source’s health care reporting.
This story was fact-checked by Rich Lord.
This article first appeared on Pittsburgh’s Public Source and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.