Recent changes in pediatric vaccination schedules from the U.S. Department of Health and Human Services have coincided with measurable declines in routine childhood immunization coverage across the U.S. (1) These changes reflect a shift toward vaccination frameworks modeled in part on Denmark’s health care system, which differs substantially from the U.S. in access, care and overall coordination. Denmark’s population is highly homogenous, and health care is universal. This is a stark contrast to the U.S., a country with a largely diverse and uninsured population. (2)
In an already fragmented U.S. health care landscape, where outcomes vary person to person, prevention is increasingly moving away from population-based strategies towards individual risk assessment and decision-making. Combined with shifting federal and state guidance and the growing visibility of vaccine-skeptical rhetoric via social media, families are left uncertain about vaccine safety, necessity and timing.
This uncertainty has tangible consequences in pediatric populations for conditions such as hepatitis A and B, respiratory syncytial virus, influenza, rotavirus and meningococcal disease. Childhood vaccinations against all of these are now recommended only for high-risk populations in the HHS vaccine schedule. (3)
Implications, access barriers and consequences
Declining vaccination coverage has national implications, but its effects are unevenly distributed across communities. Geographic location, health care access and socioeconomic factors strongly influence whether children receive routine immunizations on schedule. Rural areas, under-resourced communities and regions with limited pediatric care infrastructure face barriers, including fewer providers, transportation challenges and inconsistent insurance coverage. (4)
These access barriers, paired with misinformation, may result in further delays for previously routine vaccines. These gaps increase infectious disease susceptibility within already vulnerable populations and create conditions for outbreaks of diseases once considered well-controlled in the U.S., particularly among infants and immunocompromised individuals who rely on community immunity for protection.
For infectious diseases physicians, the consequences are increasingly visible in both clinical and public health settings. Lower pediatric vaccination rates translate into a higher likelihood of encountering vaccine-preventable infections, larger and more resource-intensive outbreaks, and increased demand for public health coordination. (5) Clinicians are tasked not only with diagnosing cases of vaccine-preventable disease but also with treating vaccine-preventable disease while navigating care in settings where trust in traditional medicine may be limited.
The unique role of ID physicians
Combating vaccine misinformation requires a multifaceted response in which ID physicians play a central role. At the clinical level, open discussion around vaccinations and disease risk can counter uncertainty before hesitancy becomes refusal. Beyond individual encounters, collaboration with public health partners, engagement in science-based public communication and advocacy for policies that improve access to routine immunization are essential. While misinformation spreads rapidly, coordinated and credible messaging from trusted health care professionals remains one of the strongest defenses against the resurgence of vaccine-preventable disease.
The relationship between declining vaccination coverage and rising infectious disease risk is not new. What is new is the speed at which misinformation spreads and its measurable impact on population immunity. As clinicians trained to diagnose and treat infectious conditions, ID physicians are uniquely positioned to recognize this moment for what it is: a preventable resurgence driven not by scientific uncertainty, but by failures in communication, access and trust.
References
- Centers for Disease Control and Prevention. (2025). Vaccination Coverage and Exemptions among
- Schmidt M, Schmidt SAJ, Adelborg K, et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol. 2019;11:563-591.
- U. S. Department of Health and Human Services. (2026). Decision memo: Adopting Revised Childhood and Adolescent Immunization Schedule.
- Lv X, Long A, Chen Y, et al. Socioeconomic Disparities in Childhood Vaccination Coverage in the United States: Evidence from a Post-COVID-19 Birth Cohort. 2025;13(12):1256.
- Brumbaugh KQ, Gellert F, Mokdad AH. Understanding Vaccine Hesitancy: Insights and Improvement Strategies Drawn from a Multi-Study Vaccines. 2025;13(10):1003.
