Trusted messengers for vaccinations

Trusted messengers who share accurate vaccination information are a suggested strategy to increase confidence in vaccinations (Dada 2022, Martell 2025, Zhao 2025) and reduce vaccine hesitancy (Olson 2020, Crosby 2023, Shen 2022, Diaz 2021a). However, additional research is needed to confirm effects and whether connecting with trusted messengers may increase vaccination rates.

Available evidence suggests that trusted messenger programs may improve vaccine-related attitudes, reduce vaccine hesitancy (Martell 2025, Schoeppe 2017), and increase vaccination (Zhao 2025); multicomponent programs that use trusted messengers may increase vaccination among participants (Rodriguez 2023).

Increased vaccine confidence. A Washington state-based study suggests comprehensive programs that train parents as trusted messengers may improve vaccine-related attitudes, including increasing confidence in vaccinating their own children, reducing vaccine hesitancy, and increasing concerns about other parents not vaccinating their children (Schoeppe 2017). Parents in rural communities appear to be more likely to trust messengers that make individualized versus general recommendations and who are perceived as competent sources of pediatric health advice (Passmore 2025). Messages that address cultural concerns and include expert endorsement, along with information about vaccine safety and guidance on how to access vaccines, may increase confidence in human papillomavirus (HPV) vaccinations among parents who are Vietnamese American (Vu 2023). Efforts to increase the uptake of the COVID-19 vaccine within Indigenous communities suggest that trusted messengers can both encourage vaccination (Martell 2025) and increase the likelihood of vaccination among American Indians and Alaska Natives (AIANs) (Zhao 2025).

Best practices. Experts suggest leveraging existing community partnerships to train individuals as trusted messengers and collaborating to ensure the vaccination information shared with community members is socially, culturally, and linguistically appropriate (Jeffers 2025). To reduce parents’ vaccination hesitancy, experts recommend that trusted messengers partner with or come from community-based organizations, public health departments, primary care providers, schools, community pharmacies, social agencies such as mental health agencies and county health agencies, faith-based organizations, educational institutions such as historically black colleges and universities, and civic corporations such as sororities and fraternities (Crosby 2023). Partnerships in community settings such as pharmacies, primary care clinics, and public health departments, which are already trusted sources of health information may be particularly beneficial, as vaccinations can be given on site after vaccination information is shared (Crosby 2023).

Experts suggest that pharmacists may serve as trusted messengers to build patients’ trust in vaccines, the science behind them, and providers of vaccines, which may reduce vaccine hesitancy (Crosby 2023, Shen 2022, Martinez 2025). Pharmacists may partner with trusted religious leaders within their community, matching the religion of the messenger with that of the patient for greater trust (Meyer 2022). In addition to acting as trusted messengers, pharmacists are often able to administer vaccinations to adults, adolescents, and children, including influenza, COVID-19, and, in some places, HPV (Crosby 2023).

Experts recommend that trusted messengers should be trained in engagement strategies, how to offer support when navigating health challenges, and how to identify and combat misinformation (Badlis 2024). Vaccination information shared by trusted messengers should be plainly phrased and avoid medical jargon (Olson 2020), with the messages tailored to the both the audience and the vaccine, as some experts have discovered attitudes varied depending on the specific type of vaccination (Shen 2023). Experts recommend training specifically on COVID-19 and influenza to share accurate information, counteract misinformation, and increase confidence in the vaccines (Urban-Koch 2024). For example, a Michigan-based study suggests that trusted messengers sharing tailored influenza information that accounts for population-specific misconceptions and barriers may increase vaccination knowledge among Asian Americans (Wu 2022a). Experts recommend that trusted messengers consider the setting, timing, and impartiality of content when they share vaccination information with parents, taking parents’ perceptions of health care providers into account, since past negative relationships may have impacted vaccination decisions (Cochrane-Ames 2017).

Trusted messengers vary by community. Trusted messengers vary depending upon the composition of the community they serve; some communities may be more likely to trust medical professionals while others may be more likely to trust those they have more in common with culturally, socially, or spiritually (Olson 2020, Crosby 2023).

Research specific to parental vaccine hesitancy has shown that parents often consider health care providers as the most trusted messengers for vaccine information (Cochrane-Ames 2017, Olson 2020, Klein 2024), while noting that parents’ social networks of friends, family, and colleagues may impact a parent’s decision to vaccinate their child more than anything else, including their own vaccine perceptions (Olson 2020). In a Maryland-based study, parents and caregivers most trusted doctors, family members, and schools as messengers, though trust varied by gender, racial identity, political affiliation, health insurance status, and urbanicity; those with greater trust in their child’s doctor were more likely to vaccinate their child and themselves (Klein 2024).

Trusted messengers often vary by ethnic group as well. Research has shown that trusted messengers for Black communities often include health care providers, faith leaders, and social connections (Rabin 2025), and meet in safe spaces such as churches, barbershops, and salons (Nuss 2025). In Black communities in the rural south, religious leaders and interpersonal connections are often trusted messengers for COVID-19 vaccine decision making (Richman 2025, McCollum 2024). Trusted messengers for Indigenous communities include traditional healers, Elders, extended family members, Indigenous health care professionals, and local leaders (Martell 2025).

Parental trust may vary depending on demographics and circumstances (Martinez 2025). An El Paso, Texas-based study suggests that Hispanic parents are less likely to see religious leaders as trusted messengers for HPV vaccination information, relying instead on registered nurses (RNs), doctors, and pharmacists; parental surveys have shown an association between trust in RNs and acceptance of the HPV vaccine for their children (Martinez 2025). Parents of adolescents who are Vietnamese American view health care providers, cancer organizations, and government agencies as trusted messengers for HPV information (Vu 2023).

Trusted messenger programs for vaccinations have the potential to decrease disparities in vaccinations for groups that have been historically marginalized and disadvantaged, based on intervention design, if messengers share the language, culture, and understand the specific challenges faced by the communities they serve (Urban-Koch 2024). Experts suggest that increasing confidence and trust in vaccinations and the health care system more broadly may increase vaccination rates (Balasuriya 2021, Beste 2021). Additional research is needed to determine what efforts have the greatest impact on increasing vaccine equity in racial and ethnic communities (Ashenafi 2024). Segregation, systemic racism, and structural inequities within medicine, government, and communities must be confronted to increase trust in vaccines and health care more broadly (Dada 2022).

Misinformation remains a critical barrier to confidence in vaccines in many rural communities and communities of color (Richman 2025, Urban-Koch 2024). Efforts by trusted messengers in communities of color must address misinformation and distrust in the health care system more broadly, along with sharing accurate vaccination information (Urban-Koch 2024, Richman 2025). In addition to vaccination information, messages may feature collective appeals to protect the community at large, as well as themselves, and address mistrust and racism (Rabin 2025). In communities that are Black, clinicians such as pediatricians and school nurses (Fu 2019a) and non-medical community members such as faith-based leaders, beauticians, and barbers (Dada 2022) can all be trained as trusted messengers that contribute to vaccination campaigns aimed at Black parents, as well as community members that recovered from the disease in question (Fu 2019a).

Efforts to increase the uptake of the COVID-19 vaccine within Indigenous communities suggest that positive recommendations from trusted messengers who are also Indigenous increase the likelihood of vaccination among American Indians and Alaska Natives (AIANs) (Zhao 2025). For example, culturally competent trusted messengers that engage with Indigenous communities and encourage community members to share their experience of the COVID-19 vaccine may persuade other Indigenous community members to be vaccinated (Gardiner 2023). Multigenerational narratives of both deaths from vaccine preventable diseases such as smallpox and the success of vaccinations persist to the present (Zhao 2025). Traditional healers and knowledge holders, Elders, local leaders, and trusted community members such as health care professionals who are Indigenous are all potential trusted messengers for Indigenous communities (Zhao 2025, Martell 2025), and experts suggest that Indigenous women’s voices should be amplified based on community matriarchal structures (Martell 2025). Any outside messengers hoping to gain the trust of Indigenous communities must respect community sovereignty and perspectives when sharing vaccination information (Martell 2025), as well as tailoring messages to reflect the community’s history and values (Zhao 2025).

Today, populations who are Black are 15% more vaccine hesitant and those who are LatinX are 4% more hesitant than the general population, which was reflected in COVID-19 vaccine uptake (Urban-Koch 2024). Concerns regarding vaccine safety, spreading of misinformation, and distrust in the overall health care system persist following the pandemic, driving further vaccine hesitancy and reducing vaccination rates (Ceccarelli 2024).

The invention of vaccines fundamentally changed humans’ relationship to disease and epidemic mortality. When first introduced, vaccines were widely greeted as saviors. Before the smallpox vaccine was created in the 1790s, 3 out of 10 people who contracted smallpox died, and survivors carried scars for the rest of their lives. Worldwide vaccine campaigns eradicated smallpox, with the last naturally occurring case in North America in 1952 and the world in 1979 (CDC-Smallpox). In the years directly prior to the release of the measles and polio vaccines, over half a million children contracted measles and over 16,000 cases and nearly 1,900 deaths from paralytic polio were reported every year (CDC MMWR-National Immunization Program 1999). Once vaccines became available, state governments passed vaccination mandates for children entering school as a way to prevent outbreaks (Orenstein 1999). The Vaccines for Children Program (VFC) was created in 1994 following the measles epidemic of 1989-1991 (roughly 55,000 cases and hundreds of deaths), which particularly impacted children who were uninsured or from families with low incomes (CDC-VCF 2025, CDC-VCF 30 years, CWF-Kolb 2025). The VFC ensures that all children can receive necessary vaccines from their regular health care provider, regardless of income, insurance status, or geographic location (CDC-VCF 2025, CDC-VCF 30 years, CWF-Kolb 2025); more than half of U.S. children qualify for coverage through the VFC (CWF-Kolb 2025).

However, some populations are less likely to be vaccinated. Children from families with low incomes are less likely to be vaccinated and are less likely to have received all of the necessary doses of recommended childhood vaccines (CWF-Kolb 2025). In 2019-2021, children who were Black or Hispanic were significantly less likely to have received the recommended vaccines by 35 months of age than children who were white, and children with no insurance or with public insurance such as the Children's Health Insurance Program (CHIP) or Medicaid were less likely to be vaccinated than those with private insurance (SHADAC-Hest 2024). In all of these cases, disparities vary widely by state (CWF-Kolb 2025, SHADAC-Hest 2024). As of 2023, vaccine coverage is lower among adults who are Black and Hispanic than those who are white, and lower among the uninsured than those with coverage (CDC-Hung 2026).

For populations of color, centuries of limited, poor, or damaging care, unethical medical experiments such as the Tuskegee Syphilis Study, and forced sterilization (primarily of women who were poor, Black, or Indigenous), have sowed widespread mistrust of health systems, medical research, and government-based health efforts (Ezell 2024, Tobin 2022, OBOS-History, Higgins 2014a).

Vaccine hesitancy increased after the 1998 publication in the Lancet of a now discredited and retracted study that used falsified, manipulated data and unethical, unnecessary invasive procedures on children to link the measles-mumps-rubella (MMR) vaccine to autism (IVS-Autism 2025). Media attention spread the claim widely, leading some parents to not vaccinate their children, and others to delay vaccination (Qian 2020, Eggertson 2010, Autism Speaks-Vaccines 2026). The false claim persists, despite the scientific consensus that there is no link between autism and vaccinations, preservatives in vaccines (thimerosal), the number of vaccines given at once, or the timing of vaccination (Johns Hopkins-Sharfstein 2025, IVS-Autism 2025, Taylor 2014, Autism Speaks-Vaccines 2026).

Today, vaccination rates are falling, putting herd immunity at risk. In 2000, the Centers for Disease Control and Prevention (CDC) declared that endemic measles had been eliminated from the U.S. (NFID-Measles immunization). However, by 2008, measles cases had returned due to growing numbers of unvaccinated individuals (NFID-Measles immunization) and in the first half of 2025, the U.S. reported more measles cases than any year since 1992 (KFF-Williams 2025). Vaccination rates for children entering kindergarten peaked in the 2019-2020 school year and have been dropping since then. In the 2024-2025 school year, rates of MMR coverage at kindergarten entrance ranged from 78% in Idaho to 98% in Connecticut, though over half of states saw declines across all state-required vaccines (KFF-Williams 2025).

Views on vaccine requirements are becoming more partisan (KFF-Williams 2025). Misleading claims about vaccines by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and other political figures have added to parents’ confusion and uncertainty about vaccines (KFF-Washington 2025). As of 2025, 35% of parents (particularly those under age 35) feel that vaccine safety testing is insufficient and 26% believe that the CDC recommends too many childhood vaccinations; these parents are more likely to be Republicans or Independents than Democrats (KFF-Washington 2025). The federal government has revised the childhood vaccine schedule (reducing recommended vaccines from 17 to 10), weakened universal vaccine requirements, and eliminated or reduced funding for research into vaccines, vaccine promotion, and vaccine hesitancy (Motta 2026).

• Which organizations can you partner with in your community to find and train trusted messengers?
• What trusted spaces may serve as meeting places for events with trusted messengers? Can they also offer vaccines (e.g., pharmacies, community clinics, health departments)?
• How might communications strategies be tailored to reach groups within your community that may be vaccine hesitant? Who can you partner with in the community to customize messages that are culturally and linguistically appropriate?
• How can trusted messenger training be added to existing education for health care providers, pharmacists, and community health workers?

Many different kinds of nonprofit and government groups can train and provide support to trusted messengers. Voices for Vaccines, a nonprofit, family-led organization that builds networks, supports communities, and creates fact-based vaccination content for peer-to-peer conversations about vaccines and the diseases they prevent, also offers courses on becoming trusted messengers (Voices for Vaccines-Trusted messengers). The Minnesota Department of Health’s Cultural, Faith, and Disability Communities Branch manages the Vaccine Ambassador Program; vaccine ambassadors are trained as trusted messengers that share culturally tailored vaccine information with communities that were disproportionately affected by the effects of COVID-19 and broader health inequities (MDH-Trusted messengers). Bronx Health REACH, a program of the Institute for Family Health in Bronx, New York, provides science-based information about vaccinations through trusted sources in the Bronx community, with guidance from community members, faith-based leaders, teachers, salon and barbershop owners, and parents. Their new, culturally appropriate Doula Vaccine Education program provides doulas with technical support, training, and resources to teach pregnant and breastfeeding mothers about vaccines to protect themselves and their children (Institute for Family Health-Vaccines).

Materials that can be used by trusted messengers are available from a range of organizations. The Vaccine Resource Hub has evidence-based health messaging resources for communities, such as toolkits, videos, trainings, and digital media (Vaccine Resource Hub). Immunize Colorado, a statewide, independent nonprofit organization, has toolkits, factsheets, data dashboards, and social media content available in 13 languages (Immunize Colorado-Resources).

The American Academy of Pediatrics (AAP) features advice for pediatricians about how to talk to vaccine hesitant parents about vaccines, which includes building trust, discussing concerns and misconceptions, and promoting partnerships in care decision-making (AAP-Vaccine hesitant parents 2025); AAP also offers immunization discussion guides for pediatricians and primary care physicians to use according to age group (AAP-Immunization discussion guides 2025).

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