Vaccination Slumps and Research Cuts Threaten Long-Term Public Health

As cases of vaccine-preventable diseases, notably measles and pertussis, continue to rise in the United States, several experts gave Medscape Medical News a big-picture perspective of long-term implications and challenges for clinicians.

What might the current low vaccination rates and lack of vaccination support from the current administration mean for short- and long-term public health? 

The increase in vaccine-preventable illnesses and deaths in the United States seen in recent years is only going to get worse, with long-term effects on public health, said Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, Philadelphia, in an interview.

The COVID-19 pandemic and its accompanying vaccine mandates harmed the public trust in health professionals, and those effects are still being seen, said Offit.

“Last year we had 12 deaths from whooping cough in the United States, so there was already evidence of erosion in vaccination rates,” he said. The installation of a Secretary of Health and Human Services who states publicly that vaccines kill people every year will make the problem worse, Offit added. An anti-vaccine infrastructure is now in place in the federal government, he said.

“I think we are on the edge of a precipice,” with regard to long-term public health impact of low vaccination rates and misinformation, Offit told Medscape Medical News.

“Low vaccination rates, paired with a lack of federal support for immunization efforts, create a dangerous public health environment,” said David M. Higgins, MD, a pediatrician and preventive medicine specialist at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, in an interview.

“In the short term, we’re already seeing a resurgence of measles and other vaccine-preventable diseases. In the long term, the erosion of our childhood immunization infrastructure and public trust in vaccines could reverse decades of progress in disease elimination,” said Higgins, whose e-newsletter, Community Immunity, includes insights and updates on news related to vaccines and public health.

“Low vaccination rates and a lack of visible support from public health leadership can undermine public trust in vaccines, leading to more frequent and severe outbreaks of vaccine preventable diseases,” said Jeff Goad, PharmD, MPH, president of the National Foundation for Infectious Diseases, in an interview.

“In the short term, communities may see spikes in vaccine-preventable illnesses, such as we are seeing with measles, increased hospitalizations, and strain on healthcare resources,” said Goad. “In the long term, persistent low vaccination uptake could allow previously controlled diseases to become endemic again and reverse decades of public health progress,” he said.

Are measles outbreaks and other surges in vaccine-preventable infectious diseases likely to continue and increase?

The impact of low measles vaccination is already apparent, said Higgins. “We’re in the middle of a global measles crisis, which will continue to result in outbreaks and cases here in the US,” he said. The global surge in measles is driven by a combination of pandemic-era disruptions to vaccination programs, especially in lower-income and conflict-affected regions, and increased vaccine hesitancy in wealthier countries such as the United States, Higgins said.

“When vaccination rates fall, it’s not a matter of if an outbreak will occur — it’s when,” Higgins emphasized. “Measles is only a plane flight away, and every imported measles case into the US enters a patchwork of communities where vaccination rates are falling, creating dry kindling ready to spark another measles outbreak,” he said.

Low vaccination rates could prompt short-term surges not only in influenza and COVID-19 but also in older, vaccine-preventable diseases such as pertussis and mumps, Goad said. “Gains in reducing cancer from diseases like HPV [human papillomavirus], which have seen 8src% lower higher-grade cervical precancers in women since the roll-out of the HPV vaccine, could be lost,” he added.

How might clinicians have to adapt their strategies and practices if vaccination rates continue to fall?

Overcoming vaccine hesitancy will be best handled by clinicians on an individual basis, said Offit. “Ask people what they are concerned about. It is perfectly reasonable for patients to ask questions about vaccines,” he said. Especially new parents, who are being asked to vaccine children for multiple diseases at the same time, using ingredients that many people don’t understand, he said.

Unfortunately, misinformation about vaccine safety and effectiveness is easily distributed and accessible, Offit said. The COVID pandemic contributed to a loss of faith in medical institutions, he added. “Science is on our side, and the vaccine misinformation currently endorsed by public officials is wrong,” Offit told Medscape Medical News. However, vaccine studies are being planned that may show bias toward misinformation and further impact public health long-term by continuing to scare parents, he said.

Clinicians should listen to patients with understanding, but make sure they understand the benefits and risks of all their options. “The choice not to get a vaccine is not a risk-free choice,” Offit said.

Rebuilding confidence in vaccines is now part of the job of infectious disease professionals, Higgins told Medscape Medical News. “Infectious disease professionals must invest even more in proactive communication and community engagement,” he said. “This means addressing vaccine confidence, misinformation, and structural barriers. Clinicians must be equipped not only to recommend vaccines but also to listen, respond to concerns, and collaborate with trusted messengers and community leaders,” said Higgins.

“Giving a strong recommendation remains critical and effective, but it should be paired with an openness to honest and empathetic dialogue when parents hesitate. Tailoring our language to align with what patients most value can make a real difference,” he added.

“Vaccination rates are still heavily dependent on a healthcare provider’s recommendation,” Goad told Medscape Medical News. “Now is the time to improve electronic health record algorithms that identify patients needing vaccination, make a point to talk to parents and patients about vaccination at every visit, and keep on alert for any outbreaks in your community,” he said. “If vaccine-hesitant patients and parents need more information beyond public health, consider other trusted sources, such as the National Foundation for Infectious Diseases or the American Academy of Pediatrics,” he said.

How will eliminating research on vaccine confidence affect vaccine development and public health?

Understanding the reasons behind vaccine hesitancy is important, Offit said. The mandates regarding the COVID-19 vaccines were seen by many as excessive government overreach, he said. “I’d say about a third of this country is pushing back against that,” he added.

Looking ahead, Offit said he predicts more outbreaks and also more parents getting waivers to avoid vaccinating their children for school, which means more school outbreaks. In addition, public response to the “medical freedom” movement may result in fewer adults getting vaccinated as well, which also increases infection risks for those in the community unable to get vaccinated, he said.

“Cutting research on vaccine confidence is like flying blind,” Higgins emphasized. “We can’t improve what we can’t measure or understand. This kind of research isn’t just about attitudes; it’s about improving the quality and effectiveness of vaccination services in the US,” he said.

Vaccine hesitancy is complex, dynamic, and deeply rooted in social and cultural contexts, Higgins noted. “Without research, we lose the ability to track changes in public sentiment, test effective communication strategies, and address misinformation with evidence,” he said.

“Worse still, cutting this research sends a chilling message that studying vaccine confidence is politically risky, and sets a dangerous precedent, weakening the very public health systems the US developed to keep our communities safe,” Higgins said.

“Vaccine confidence research helps us understand why people decline vaccines and what interventions work best to address their concerns,” Goad told Medscape Medical News. “Without this research, public health messaging may become less targeted and misinformation and disinformation may spread unchecked, filling the vacuum left by evidence-based communication,” he said.

In addition, cutting funding for the university science research programs puts the development of the vaccines themselves at risk, with further long-term impact on public health, Goad explained.

“Universities are often the engines that drive innovation in vaccine development,” Goad told Medscape Medical News. “Without appropriate funding, basic science discoveries that lead to novel vaccine platforms will be slowed,” he said. “Clinical trial infrastructure that enables rapid response to emerging pathogens will be limited, putting the public at risk from the next pandemic. Training the next generation of clinical scientists, virologists, and public health leaders through gradu