By Robert E. Geise, MD, FIDSA
President, Infectious Disease Society of Washington
Trustee, King County Medical Society
As I began my medical career in the mid-1990s, the world was As I began my medical career in the mid-1990s, the world was in the middle of an epidemic – the HIV epidemic. HIV caused 16% of deaths among adults ages 25–44 in the US in 1995 and was the number one cause of death in that age group. Between 1981 and 2000, there were 448,000 HIV related deaths. As a medical resident during the early and mid-90’s in Washington, DC, it was not unusual to admit 10–15 patients each call night with HIV related illnesses. As I finished my residency in 1998, those patients began to disappear from the hospital as the promises of effective antiretroviral therapy began to take hold.
During the last decade of my career as an infectious disease doctor, I faced another epidemic – COVID. Prior to the introduction of vaccines, COVID was the 3rd leading cause of death in the US, with over 1 million individuals dying in the US during 2020–21. With the development and implementation of vaccines and pharmacotherapies, we were able to decrease the impact of this disease through natural and vaccine-mediated herd immunity.
Medical science has always been about research, advancements, and the efforts of medical professionals (physicians, nurses, and other allied health professionals) to give patients the latest, most effective, and safest care. We discuss with each patient the risks versus the benefits of each medication, vaccination, and intervention we recommend.
In 2019, HIV was the primary cause for less than 0.2% of deaths in the US (still impacting disproportionately minority and economically disadvantaged groups) and was no longer one of the top causes of death in adults between the ages of 25–44. By late 2021, the COVID vaccine provided significant protection with a 95% decrease in hospital visits in those fully vaccinated, and those same individuals were 14 times less likely to die from COVID. Measles cases fell from one-half million annually in 1960, just prior to vaccine introduction, to 22,231 in 1968. With the introduction of a recommended 2nd dose in 1989, annual cases in the US fell to 86 by the year 2000. A study published in the MMWR in 2024 projected that between 1994 and 2023, over 32 million hospitalizations and 1.1 million deaths from vaccine-preventable illnesses were avoided.
But this is all data.
There are stories, too, such as my good friend Mikey’s. I met Mikey in the fall of my second year of residency, when he was brought in with severe abdominal pain, weight loss, metabolic acidosis, and general failure to thrive. Mikey had been HIV positive for many years and had gone through many medications. He had a prolonged hospitalization, and like many other young men his age, it appeared that he was facing the end of his life. I took care of Mikey for the better part of several months, including significant time in the hospital with many readmissions. At this point in his life, things were looking grim.
Thanks to the advances in HIV care, this was not the end. Mikey has recovered and continues to bring joy to the people in his life, including his wonderful husband, who has been with him for four decades. The world is a better place because of the advances we have made in medicine and because of having Mikey in it.
Yet despite our remarkable victories against HIV, COVID, and measles, medical science is under attack. Whereas six years ago, people were cheering nightly for those caring for the sickest in the COVID epidemic, now they question practices that have been standard for decades. Vaccine hesitancy and misinformation have been circulating for decades, and the policies and statements of the current administration, especially in the Department of Health and Human Services, are accelerating and exacerbating this distrust.
The latest of these are the attacks on the hepatitis B immunizations for infants and state support for HIV therapy.
The CDC’s Advisory Committee on Immunization Practices has, for decades, been a well-respected group of experts in the field that enjoys a high degree of public trust and professional respect. Unfortunately, in June of 2025, the 16 members were dismissed by HHS Secretary Robert F. Kennedy Jr. and replaced with less experienced individuals, some with views not supported by medical science.
One of their first changes was to remove the recommendations of a birth dose of the hepatitis B vaccine. For context, the hepatitis B vaccine has been one of the most successful public health interventions, providing 85–95% efficacy in preventing perinatal transmission when given at birth (along with hepatitis B immune globulin if the mother is known to be a hepatitis B carrier), and 98% protection if the full three-shot series is given. The rate of hepatitis B infections in children ages 1–9 decreased from 0.9 infections per 100,000 children in 1986 to less than 0.1 infections per 100,000 children. Children infected with hepatitis B before the age of 1 have a 90% risk of developing chronic hepatitis B, while those aged 1–5 have a 10–50% change. This can lead to lifelong risk of severe liver disease, including cirrhosis and liver cancer. In addition, decreasing the reservoir of chronic hepatitis B carriers can prevent further transmission. The hepatitis B vaccine is one of the safest vaccines available, with almost no side effects.
It is not only the ACIP that is reversing years of public health progress. As of March 1, 2026, the Florida Department of Health imposed an emergency rule that could prevent an estimated 16,000 residents from accessing HIV medications. At the same time, the state’s AIDS Drug Assistance Program (ADAP) changed formularies, no longer allowing access to some of the most used and effective antiviral therapies available. A preliminary analysis by the HIV Medical Association estimates these cuts could lead to over 4000 new HIV infections. These changes are not isolated to Florida – over 20 other states have made similar cuts.
The distrust in medical science is further demonstrated by a 2025 Kaiser Family Foundation poll. While 85% of Americans trust their primary care physician or their child’s pediatrician, only 65% trust doctors at the National Institutes of Health, 61% trust the CDC doctors, and only about half trust the FDA. Because of what parents are seeing on social media and governmental policy and statements, one in six are choosing to delay vaccines for their children. Although they trust their physicians, in most cases, they do not follow their pediatricians’ advice. Much of this distrust has been weaponized in our current social media and political environment.
As a result of parents choosing to delay or skip the MMR vaccine, the United States in 2025 had 2,281 confirmed measles cases, the highest since 1992, and the current outbreak in South Carolina at the end of February resulted in over 1000 cases. Despite this, vaccine laws and regulations continued to be undermined.
As providers, we need to be able to talk to our patients not only armed with facts and science but also with the skills to communicate them with compassion and understanding. Often, patients’ stories may be more powerful than studies, guidelines, and recommendations. As medical science continues to advance, we gain the ability to treat and prevent many dangerous and deadly illnesses. Society needs to take a step back, reconsider how we evaluate and trust medical science, and ensure we get our medical information from reliable, factual sources. It is vital that we turn the current tide of mistrust for the protection of ourselves, our children, and our society.