Whatever beliefs parents hold about health care, they ultimately have the best interest of their child at heart, Dr. Linda Glass of Pediatric Associates of Lewiston says.

So when it comes to their children’s safety, parents’ questions about vaccinations are fair game.

“The majority of what we normally hear is, No. 1, safety, because everybody loves their children and they want them to be safe,” she said. “That’s a paramount issue for parents.”

While questions are welcome, vaccine fear is unwarranted, health care providers say. Through the years, they say, vaccines have proven their effectiveness at bringing down preventable disease, with the benefits far outweighing any risks.

Since the COVID-19 pandemic, pediatricians have been fielding more questions about the safety and efficacy of childhood vaccines. And now the federal government has changed long-standing recommendations around childhood vaccines, with perhaps more on the way, further clouding the matter.

The uncertainty surrounding childhood vaccination schedules comes after decades of agreement between national medical organizations and the federal government.

The American Academy of Pediatrics, for example, recommends a schedule for children 6 and under and those 7-18, laying out the timing of more than a dozen vaccines, including those for flu; measles, mumps and rubella (MMR); COVID; hepatitis A and B; meningitis B; and HPV.

However, after a Sept. 18 meeting, the Advisory Committee on Immunization Practices, part of the federal Centers for Disease Control and Protection, recommended that the updated COVID-19 vaccine only be available without a prescription to people 65 and older or those 6 months and older with at least one underlying health problem. It recommended that all others should get a prescription from their doctor before getting the shot.

Gov. Janet Mills issued an order last month requiring Maine health care professionals who administer the vaccine to make it available to anyone 6 months or older regardless of prescriptions.

The Immunization Committee also recommended that the combined measles, mumps, rubella and varicella (MMR-V) vaccine not be issued to children under 4 years old — the vaccines are typically given at age 1 — and that the vaccines be separated, with measles, mumps and rubella in one shot and varicella in another shot. Roughly 85% of children in the U.S. already get those vaccines separately, according to a Sept. 19 National Public Radio report.

During that September meeting, there was a discussion around changing the recommended age of administration for the hepatitis B vaccine, which is recommended for newborns, but that discussion was tabled indefinitely.

The shift in federal recommendations comes as Health and Human Services Secretary Robert F. Kennedy Jr. has placed his appointees on the panel. Kennedy has a long history of making false claims about safety and efficacy of vaccines.

Glass said vaccines, such as the one for HPV, have been proven safe and effective.

The HPV virus can cause cervical cancer, along with other cancers. About 10% of women with an HPV infection on their cervix will develop long-lasting HPV infections, putting them at risk of cervical cancer, the CDC said.

Since the vaccine started to be administered roughly 20 years ago, Glass said, there has been a gradual decrease in the rate of cervical cancer from 11 cases per 100,000 in 1992 to seven in 2022, according to data from the National Cancer Institute.

The CDC estimates that of the 37,800 cancers nationally attributed to HPV from 2017-21, roughly 35,000 of them could have been prevented by the vaccine.

Because HPV is typically transmitted through sexual activity, some parents find it to be a difficult topic, she said.

Ultimately, Glass says, the benefits of the HPV vaccine far outweigh the risks. The panel has so far made no recommendations to change the schedule for HPV, which is usually administered in the pre-teen years around age 11 to 12.

The hepatitis B vaccine also has a proven record, Glass said. First recommended for babies in 1991, it has brought down the rate of newborn infections over the past three decades.

Reported cases of acute hepatitis B have decreased dramatically since 1991, going from more than 15,000 cases in 1991 to fewer than 5,000 cases in 2023, according to CDC data, bringing the U.S. within reach of eliminating the virus in recent years.

Giving newborns the hepatitis B vaccine at birth decreases the risk of mother-to-child transmission of the virus by 75%, the CDC says.

However, Glass said some parents in her practice are opting not to give their newborns the hepatitis B vaccine in the hospital, instead waiting until their child is home. More parents have started scrutinizing the vaccine, and some think their child does not need it that young.

“Many more conversations have arisen, because one of the first things every parent wants to know is, ‘Why is my child at risk for this when they’re born,’” she said, “And so, because they’re in that very, very new area (the hospital) with their child and not knowing a lot about their baby yet, they’re not sure they actually want anybody to do that and give a vaccination at that time.”

Steve Bien, a family physician in Farmington, has seen the same dynamic play out.

Like Glass, he has witnessed firsthand the success of vaccines.

Bien used to see kids with chicken pox fairly frequently earlier on in his 46-year career, but not anymore. Other preventable diseases, including meningitis, which can have very bad outcomes for kids, also used to show up but are now rare, thanks to vaccines.

“That was just bread and butter, you saw chicken pox all the time,” he said. “I can’t say the last time I saw chicken pox, so these things have just disappeared.”

Vaccines are a victim of their own success, Bien argued. Because there are not many cases of these preventable diseases anymore, people forget how horrible they can be.

The number of vaccines given to kids has also increased, he said. Children often cry or have other behaviors that are hard to manage when they are given vaccines, which can be hard for parents to manage.

“It can be as many as five (shots) at once, some of these vaccines have been combined, so it’s not quite that bad, but, you know, it’s certainly an ordeal for a child, and parents too,” he said.

Glass said that most parents who are questioning a vaccination’s safety are asking about the newer vaccines, such as those for the flu and COVID-19, which are regularly updated.

The conversations with parents hesitant about those shots usually last longer, she said.

The pandemic and the fast development of the COVID-19 vaccine have changed conversations around vaccines a lot, Bien said. He’s seen a growing mistrust of government contribute to vaccine hesitancy.

Some people, he said, see public health legislation as an overreaching attempt to control, rather than an effort to keep the public healthy.

“If they look at these efforts as an effort on the part of the government to strong-arm their choices rather than an effort on the part of the state government to safeguard public health, children’s health, then we’re really in trouble,” he said.

Physicians used to be the primary source of information for medical matters. But people are now seeking out independent sources of information online, leading them to ask more questions, he said.

Regardless, there is no doubt that immunizations have made a positive impact on public health, Bien said. Maine has a strong public health program, he said, and absent a major change to public health policy, the state will stay at the forefront of best immunization practices.

Glass says there is no harm in asking questions. But she does not want people to fear vaccines simply because questions are being asked.

She encourages people to communicate with their doctors for a better understanding of the risks and benefits of vaccines.

“You need to know both sides before you make decisions because you’re not going to have a perfect immunization, you’re not going to have a perfect medicine, it doesn’t happen,” she said. “So these conversations are fine, it’s just that I don’t want the whole country scared to death of immunizations just because people are talking and they are sort of questioned.

“Questioning doesn’t mean it’s wrong, questions are questions.”