Childhood Vaccine Divide Risks Outbreaks as Virus Season Nears

An emerging patchwork of federal and state recommendations on childhood vaccines is likely to create gaps in immunizations that fuel an uptick in infectious diseases long considered preventable, local officials and public health researchers say.

Coalitions of Democratic-led states have released their own guidance and say they’re committed to conducting their own reviews of data and following the analysis of leading medical professional associations. State leaders say they’ve been left with no choice after US Health Secretary Robert F. Kennedy Jr. replaced all scientific experts on a key Centers for Disease Control and Prevention advisory committee with individuals who have questioned the safety of vaccines.

Meanwhile, Republican-led states want to give parents more flexibility in whether to vaccinate their children.

The diverging approaches are likely to produce a wide range of state laws on vaccines, which local officials and public health experts say will walk back decades of progress curbing the spread of measles, chickenpox, and other infectious diseases, particularly among children at heightened risk of severe infection.

“We’re going to see a health divide that’s growing between blue and red states, with blue states having better health outcomes, fewer deaths from infectious diseases, and red states having more,” said Lawrence Gostin, faculty director at Georgetown’s O’Neill Institute for National and Global Health Law.

States Weigh In

With respiratory virus season quickly approaching, states increasingly are falling into one of two categories: aligning themselves with medical professional groups and traditional scientific review processes or echoing the Trump administration’s scrutiny of vaccines and its push for parents to be the ultimate decision-makers on whether to vaccinate their children.

State leaders in the West Coast Health Alliance and the Northeast Public Health Collaborative say they are following the scientific review process that they argue the US Department of Health and Human Services has abandoned under Kennedy’s leadership.

“States are having to step forward and fill the void left by the total abdication of responsibility by the federal government,” Massachusetts Gov. Maura Healey (D) said in a Sept. 17 press conference.

Meanwhile, Florida Gov. Ron DeSantis’ (R) administration is taking steps to remove all vaccine mandates for children across the state. The move, if successful, would make Florida the first state to pull immunization requirements for schoolchildren and could encourage other Republican-led states to follow its lead.

This year, at least eight other states have made changes through executive order or legislation that could allow more students to claim a nonmedical exemption, such as religious or personal beliefs, when opting out of school vaccination mandates, according to KFF analysis.

ACIP’s Influence

The new members on the Advisory Committee on Immunization Practices voted last week to remove the federal recommendation that children under 4 receive Merck & Co.’s combination vaccine for measles and three other viruses.

The committee also broke from leading medical groups like the American Academy of Pediatrics and the American Academy of Family Physicians by ending the universal recommendation that all Americans get Covid-19 shots, requiring individuals to first confer with a medical professional before getting a vaccine.

States with vaccine policies still tied to ACIP recommendations will inevitably see shifts in access because of the committee’s changes, Gostin said.

“A lot of people in the country, and particularly poor and rural people, are going to lose access to affordable vaccines, full stop,” Gostin said in an interview.

America’s Health Insurance Plans said that its members will continue covering all currently recommended vaccines—including updated flu and Covid-19 shots—with no cost-sharing through the end of 2026.

But the vaccines most private health insurers and Medicaid programs must cover under the Affordable Care Act are tied to ACIP recommendations.

The advisory committee’s pediatric immunization schedules also determine which vaccines are included in the CDC’s Vaccines for Children Program for children ages 18 and younger who are Native American, Medicaid-eligible, underinsured, or uninsured. The more than 30-year-old program distributed more than 74 million pediatric vaccines in 2023 to participating health providers.

Phil Huang, director of Dallas County Health and Human Services, said in a Sept. 17 press briefing with other health leaders that the county faces an uphill battle carrying out immunization campaigns for Covid, measles, and other diseases due to federal policy changes.

“We’re very dependent on what will happen with ACIP and how those affect our VFC and adult safety-net vaccines,” Huang said.

‘Completely Chaotic’

Public health analysts say it’s all but certain that outbreaks of measles, chickenpox, and other vaccine-preventable diseases will be the new normal.

“We know that pathogens do not respect borders, so a patchwork of different recommendations will not be as effective as a unified approach,” said Charlotte Moser, co-director of the Vaccine Education Center at Children’s Hospital of Philadelphia and one of the 17 ACIP members Kennedy fired over the summer.

Outbreaks won’t just be isolated to areas of the country with more lax vaccine policies, said David Margolius, director of public health for the city of Cleveland.

“With what Florida is doing now, do we have to be thinking about all these vaccine preventable illnesses for our folks returning from Florida?” Margolius said in the press briefing with other health leaders.

Childrens’ young immune systems make them particularly susceptible to severe infection from diseases, along with seniors and immunosuppressed adults. The result of the mixed policies on vaccines, Gostin said, is “a lot of people are going to be hospitalized and die who wouldn’t otherwise have been.”

“It will be completely chaotic,” Gostin said.