When I interviewed Anita Emly in 2021 for my book The Wellness Trap, I knew I wanted to keep talking to her. She had a fascinating history, as a mom who formerly refused vaccines and later became a vocal advocate for vaccination, and she was compassionate, nuanced, and generous in recounting her story. She helped me understand the confluence of factors that can make bright, thoughtful people vulnerable to anti-vaccine misinformation, and the many slow and subtle shifts it takes to begin to trust science-based medicine again.
Now, as anti-vaccine rhetoric increasingly makes its way into mainstream public-health institutions, her perspective is more needed than ever. Today I’m thrilled to welcome her as a guest author, in a piece adapted and expanded from something she shared in a private support group for former anti-vax and vaccine-hesitant parents. Here’s Anita:
When people find out I used to refuse vaccines, the question I hear most is: “What made you change your mind?”
Sometimes that’s a frustrating question. Change was a long process. Years later, I’m still having realizations about it. For instance, vaccines were not on my mind during my dad’s cancer battle, yet his experience with immunotherapy prepared me for changing my mind on vaccines (though I didn’t realize that at the time).
Today, I want to share one pivotal point in that process.
A big part of my vaccine fear sprang from people urging me to “read the inserts.”
This advice came with an ominous undertone: Inside these folded pieces of paper tucked into vaccine packaging, hidden away where most won't know to look, you’ll find The Truth They Don’t Want You To Know.
Vaccine package inserts are technical and unwieldy. I made an earnest attempt at reading them. The list of ingredients was off-putting. The “side effects,” even more so. When I saw Sudden Infant Death Syndrome (SIDS) mentioned in an insert, my heart clenched in terror. How could the doctors not warn me?
Someone showed me the insert for a Tdap (tetanus, diphtheria, and pertussis) vaccine, highlighting the part that said it hadn’t been studied in pregnancy. This led me to refuse Tdap during my first pregnancy, in spite of my doctor's recommendation.
From there, I easily accepted claims about vaccines not being well studied. If doctors recommended the Tdap vaccine without research, what else were they overlooking?
During my second pregnancy, my midwife offered me the Tdap vaccine. I knew that she understood my desire for a low-intervention pregnancy and birth. She had thus far supported my “crunchy” approach. So I was surprised when she gently pushed back on my “no.”
My midwife explained that Tdap vaccination in pregnancy would help protect my newborn while he was too young for his own vaccines (and, I realized, also too young for the natural remedies I had come to trust). She then asked me: please look into it more before our next appointment.
Because I’d felt respected and supported by this midwife, I felt compelled to respect her in return and take her request seriously. In my effort to look into it more, I stumbled upon a Facebook group that called itself an “evidence-based” forum for both pro-and-anti-vaxxers to discuss vaccines.
I joined the group and asked about Tdap in pregnancy. I wasn’t expecting much. The benefits, I assumed, were theoretical. I was so confused when the links came pouring in. Study after study after study,1 showing that the Tdap vaccine in pregnancy didn’t increase the risk of miscarriage or other bad outcomes, and did protect newborns from whooping cough death and complications.
I couldn't understand how those studies existed when the inserts said they didn't!
That's when I learned that inserts mostly cover studies done by manufacturers. They often leave out independent studies or real-world data.
The key to understanding a vaccine insert is not only knowing what they are, but also knowing what they are not.
Inserts are not intended to represent the entire body of research around a vaccine. They don’t show what recommendations have been made by the CDC’s Advisory Council of Immunization Practices (ACIP). They don’t explain what professional organizations like the American College of Obstetricians and Gynecologists (ACOG) have to say, and the research they use to back it up.
Inserts are regulatory documents from the FDA. The FDA has very specific regulations around how the inserts are formatted, what information is included, and the language that is used. That format and language are incredibly easy for a layperson to misinterpret, but there’s nothing in an insert that justifies refusing vaccines!
A common example of misinterpretation is the Adverse Reactions section. It’s so easy to mistake it for a list of “side effects.” It is not. Instead, it outlines negative medical events that happened to anyone in the clinical trials, regardless of what caused them. It includes the bad things that happened to people in the placebo group, who never got a vaccine at all. It includes things like death by gunshot wound (which happened to 1 person in the Gardasil vaccine group and 3 people in the placebo group, according to page 7 of the Gardasil package insert). It can also include experiences that people report after vaccination, again, regardless of causation.
Keep in mind, too, what vaccines are, and what they are not.
Vaccines are protection against vaccine-preventable diseases.
Vaccines are not invulnerability or immortality shots. It’s no surprise that negative medical events happen to vaccinated people. It would be miraculous if they didn’t! So it isn’t enough to know that an adverse reaction happened. We need studies and analysis to illuminate whether there is genuine evidence of causation. For example, is this condition really happening more often in vaccinated populations?
When I saw SIDS mentioned in an insert, that’s because SIDS happened to some babies who’d gotten vaccines, just as SIDS happens to some babies who don’t get vaccines. When looking for any connection between vaccination and SIDS, a large body of research has found that vaccinated babies are actually 50 percent less likely to suffer from SIDS.
Knowing that I'd made decisions about my pregnancies based on a false belief, I started checking: were there other things I had misunderstood about vaccines?
There were. A lot of things, actually.
It turns out, I’d been “educated” about vaccines just enough to be afraid, but not enough to understand.
My anti-vax education pointed me to studies and resources that I was not equipped to interpret, and allowed me to misunderstand them in, frankly, predictable ways. The things I read omitted important context and made ominous insinuations. I was left to stew in unease and uncertainty. But I wasn’t left without hope: Visit the online store. (There is always a store.) You can buy a remedy, a supplement, a protocol—some product or practice that will supposedly help protect your health.
When I entered pro-vaccine spaces, the differences were stark. Science communicators often had to start with the basics to give me a foundation of understanding: explaining underlying scientific principles, defining terminology, illuminating clinical practice. And as much as anti-vaxxers scream “Follow the money,” no one on the pro-vax side was linking me to their store.
My misunderstanding about Tdap inserts happened several years ago now. The inserts were eventually updated to include pregnancy data2 to avoid misunderstandings and provide clarity to prescribers. Once the FDA officially approved the vaccines for use in pregnancy, those inserts were further updated. I still see some people claiming Tdap isn’t studied in pregnancy, but it seems less common now.
Seeing those pregnancy studies that weren’t supposed to exist was such a pivotal moment. It showed me I couldn't take for granted that the way I understood things was correct. That experience led me to really re-examine my beliefs about vaccines and see if they stood up to scrutiny.
Eventually, it became clear that they didn’t. And that started me on the path back to accepting vaccines. I got the recommended vaccines while pregnant, and my daughter got caught up right alongside her newborn brother’s routine vaccinations.
Anita was raised in New York City, a child of immigrant parents. She is active in her faith community and is currently a stay-at-home mom to three children. Becoming a mother led her down the path of vaccine hesitancy. Ultimately, she changed course and started vaccinating again. The loss of a family friend to vaccine-preventable disease motivated her to become an advocate. She writes and speaks about her experience in various outlets and assists in an online group that supports others leaving the anti-vax community.
CDC compilation of research:
Tdap in Pregnancy Research | Whooping Cough | CDC
Systematic Review of 21 studies looking at safety:
"Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups."
Specific examples of:
Efficacy in protecting baby
Tdap vaccine given during pregnancy reduces occurrence of infant pertussis | ScienceDaily
Safe for baby
Note: The two brands of Tdap (Boostrix and Adacel) were updated at different times.
For example, Boostrix seems to have first gotten approval to update with pregnancy data in 2019. You can find and download the April 25, 2019 Approval Letter under the “Supporting Documents” section, found here: BOOSTRIX | FDA
The use of Tdap in every pregnancy was recommended by the ACIP (The CDC’s Advisory Committe on Immunization Practices) back in 2012. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012 - PMC
This became clinical practice, backed by professional organizations like the American College of Obstetricians and Gynecologists (ACOG) but was not indicated on the inserts. Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination | ACOG
FDA approval happened in 2022. Once FDA approval was established, the inserts (regulated by the FDA) also would be updated to show that indication. FDA approves Tdap vaccine for use during pregnancy to prevent whooping cough
