What Pediatricians Predict If Vaccination Rates Continue To Fall

As President Donald Trump and Health Secretary Robert F. Kennedy Jr. make sweeping changes to the childhood vaccine schedule and repeatedly link vaccines to autism (a debunked claim), it’s no surprise that childhood vaccination rates are declining throughout the United States.

According to Centers for Disease Control and Prevention data, vaccination rates in kindergartners are at a new low: 92.4% of kids are vaccinated against measles and 92% are vaccinated against diphtheria, tetanus and pertussis (DTaP). This is compared to 95% in 2019-20, said Dr. Alok Patel, a pediatric hospitalist at Stanford Children’s Health in California.

“Somebody who is glancing at that number might say, ‘OK, cool, it’s still above 90%.’ But for us, there’s two major red flags,” Patel said.

“The first one is that with measles, when we fall below 95% in a community, we fall below the herd immunity protective level,” Patel said. This is when measles cases start to pop up in people who are unvaccinated, under-vaccinated or those who don’t mount an immune response to the vaccine. Measles cases are now at a 35-year high in the U.S.

Additionally, the 92.4% number is an average — some communities have higher vaccination rates while others have lower. “That number, especially in certain counties, can drop as low as the mid-70s. And so this is a … prime setup for kids to get measles,” Patel said.

More and more parents are seeking non-medical exemptions to excuse their babies and kids from routine childhood vaccination against diseases such as measles, hepatitis B, polio and more. Experts say this is due to a lot of factors, including a distrust in public health, namely after the COVID-19 pandemic, but is only made worse by a federal government that spreads vaccine misinformation by falsely calling certain shots “lethal” or exaggerating the number of shots kids need.

The decrease in vaccination rates will not only have immediate health impacts for kids, their families and their communities, but will have long-term impacts, too.

Here’s what doctors want you to know:

“Measles is almost a smoke detector of a potential fire of a rise in preventable illnesses,” Patel said.

Measles is the most contagious illness, so when vaccination rates fall, the increase in measles happens first.

“But we are seeing a rise in cases of tetanus, pertussis, and unfortunately, if this trend continues, this paves the way for a return of other diseases as well, such as mumps, rubella, Haemophilus influenzae type b — and one that I sincerely fear a return of is hepatitis B,” Patel said.

According to Patel, “Kids who get hepatitis B in infancy are at a greatly increased risk of having chronic liver disease and potentially liver cancer. And kids can get hepatitis B from a microscopic amount of blood.”

As with measles vaccination rates, rates of hepatitis B vaccination are also declining, along with vaccination rates for tetanus, pertussis, polio and diphtheria.

“And this isn’t necessarily a vaccine, but we’re also seeing a rise in parents refusing the vitamin K shot at birth. … It’s a vitamin that has greatly reduced the risk of spontaneous bleeding in newborns, which can be deadly, which can cause lifelong neurodevelopmental issues,” Patel said.

The parents who are opting out of vaccination are not “bad parents,” stressed Patel. “These are not parents who are intentionally wanting to harm their kids. Their parents have gotten some really untrustworthy, terrible information.”

“I think that one of the important messages is that vaccination rates can fall very quickly, but they can take quite a long time to recover,” said Dr. Melissa Stockwell, the division chief of child and adolescent health and a professor of pediatrics and population and family health at Columbia University in New York.

“It’s not an immediate switch, and that’s really in part because of what may be causing vaccination rates to drop,” she added.

First, it takes time to actually vaccinate everyone who is unvaccinated or under-vaccinated, Stockwell said. “There’s this big public health response to get everybody caught up,” she noted.

“But part of what’s happening now is a bit of a loss of trust potentially in [the] healthcare system or in public health, and trust has to be rebuilt, and that takes a very long time,” Stockwell added. “Coming back from low rates can take time, and we’ve seen this in other countries where there are these cycles of recovery of rates and relapse.”

For example, in the United Kingdom, there have been instances when vaccination rates drop, then there are measles outbreaks, and then a public health response when vaccination rates increase and measles rates slow down — and then the whole cycle happens again.

“It becomes this cycle of recovery and relapse, and it takes time to come out of each cycle, but also there’s a risk that you never end up back at that high persistent rate again,” Stockwell explained.

“When we discuss lower vaccination rates, it’s really important to remember that children, when they get an illness, and if they get hospitalized and they get complications from that hospitalization, those complications are going to live with that child for the rest of their lives,” said Dr. Anita Patel, a pediatric critical care doctor in Washington, D.C.

Even if doctors are able to treat a vaccine-preventable illness in an unvaccinated child, “what the public doesn’t see, but what we see as pediatricians, are those children who are now struggling with post-traumatic stress from an ICU hospitalization or literal chronic lung disease after having a prolonged intubation,” Anita Patel said, before adding that these kids also have muscle loss and may even have blood clots after hospitalization.

“The complications from critical illness are very real,” Anita Patel said.

Making the decision not to vaccinate a baby or child may feel like a decision for now, but it’s also a decision for their future health.

“What’s really difficult for some people to understand is the concept of prevention for the future,” said Alok Patel. “Parents are scared about today. They’re scared about tomorrow, and they aren’t necessarily paying as much attention to prevention 10, 20, 30 years from now, or what it means to protect a community.”

“If parents don’t get their kids the hepatitis B vaccine, or if we continue to see declining rates in kindergarten vaccines, this may create a setup for a disaster in the year 2030 or in five to 10 years from now, and that’s something that we really need to convey to people,” Alok Patel said.

Vaccinating babies and kids is about lifelong protection, not just protection in this moment, he said.

“Children and teens who don’t get vaccinated early in life are still at risk later on in life for these preventable illnesses, and they’re still at risk for getting liver cancer from hepatitis B, cervical cancer from HPV,” said Alok Patel.

Cervical cancer rates have dropped in many countries because of the HPV vaccine, he added. “I think that there’s these long-term consequences that parents, the public, really need to understand.”

“I worry about the rapid spread of acute and chronic illness, especially among vulnerable communities, if healthcare continues to be politicized and we are no longer working together to give people equitable, evidence-based information and things they can do to empower themselves and their family,” Alok Patel said.

Stockwell echoed these social concerns. “As vaccination rates drop … there is questions of equity, and who then may be disproportionately affected by those diseases,” Stockwell said.

Some people have decreased access to care, so if they were to get a vaccine-preventable disease, it could be harder for them to get the support they need to recover, Stockwell added.

“They potentially could be at more risk for more severe consequences if they have other social drivers of health that are affecting their health at the same time,” Stockwell explained.

Moreover, immunocompromised people, young children and people with certain health conditions are at higher risk of infection and complications, which makes a drop in vaccination rates particularly dangerous for these groups.

Most doctors and nurses in the U.S. aren’t used to treating vaccine-preventable illnesses because these sicknesses simply haven’t been in the country for decades and decades, according to Anita Patel.

And this is important. “Suddenly, you’re going to put an entire group of doctors who have never seen certain medical diseases that are potentially lethal, trying to have a high index of suspicion to even diagnose the issue. Let alone treat it in the right ways,” Anita Patel said.

“Your doctors, your nurses, your healthcare workers can only be as experienced as what they are experienced with taking care of,” Anita Patel added.

For example, if a doctor has not seen Haemophilus influenzae type b because it doesn’t exist in their community, they won’t know how to treat it.

Alok Patel added, “If we had two children come to the emergency department, let’s say both kids are 2-years-old, and they both have fevers and are pretty sick, and one kid is fully vaccinated versus another who’s unvaccinated, we have to worry about a much larger list of diseases in an unvaccinated child.”

“That means potentially more tests, potentially imaging such as a chest X-ray. That might even mean a lumbar puncture or a spinal tap because we don’t know exactly what they have,” Alok Patel said.

“These are children’s lives that we are essentially playing Russian roulette with at this point, and we are sending them into situations and hospitals where you might have care teams that actually don’t know how to treat the condition because they’ve never had to treat it before,” Anita Patel said.

The real-life consequences of vaccine hesitancy and anti-vaccine sentiments are evident as more measles cases occur and rates of other illnesses increase as well.

“If we continue to see medicine and science be politicized, and people following partisan values rather than evidence-based recommendations and public health guidance, we’re going to continue, unfortunately, to see more illness, more chronic illness and more people not trust medical care,” Alok Patel said.

“If we continue to see things politicized, all it does is it confuses parents,” Alok Patel added. “At the end of the day, aside from the downstream public health issues, I worry that more parents are going to be confused. More parents are going to wonder where do we need to turn to get good information when all they want to do is do the best for their kids.”