Retired Director, Houston Travel Medicine Clinic, Houston, Texas
Disclosure: Bonnie Word, MD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Infectious Diseases Society of America Serve(d) as a speaker or a member of a speaker’s bureau for: Infectious Diseases Society of America Received income in an amount equal to or greater than $250 from: Infectious Diseases Society of America
| April 09, 2025
The United States immunization program stands as a notable public health accomplishment. As pediatricians, we have spearheaded efforts to educate parents and support vaccine recommendations, leading to significant reductions or eliminations of numerous infectious diseases in the United States. In January 2025, Texas reported a measles outbreak. We were unprepared for the report of an unvaccinated child's death, the first measles-related fatality since 2019. Many were alarmed by the response of Health and Human Services Head Robert F. Kennedy, Jr, who downplayed the severity of the situation by stating, "Outbreaks happen all the time... healthy children don’t die from measles," and suggested that diet and vitamins could prevent infectious diseases without urging vaccination.
Bonnie Word, MD
Tables 1 and 2 show the impact of administering immunizations. The US program has achieved a level of success such that many healthcare providers have never encountered patients with several of the listed diseases. The recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) are based on scientific evidence. A review of vaccine development and the rationale behind the CDC's involvement in the US immunization program follows.
Edward Jenner developed the smallpox vaccine in 1796, marking the start of the vaccine era. Between 1914 and 1955, seven vaccines were licensed in the US, including rabies, typhoid, pertussis, influenza, tetanus, diphtheria toxoids, and polio. After the severe polio epidemic in 1952, parents eagerly sought the inactivated polio vaccine approved in 1955. Congress passed the Polio Vaccine Assistance Act to fund CDC efforts to provide vaccines. In 1962, President Kennedy signed the Vaccination Assistance Act for mass immunization campaigns. The Federal Immunization Grant Program followed in 1963, funding states to purchase vaccines and support immunization programs authorized under section 317. At that time, only diphtheria-tetanus-polio and smallpox vaccines were available.
The CDC Advisory Committee on Immunization Practices (ACIP) was established in 1964. It is a federal advisory committee charged to review current licensed vaccines and all newly licensed vaccines, and to make recommendations for their use to the CDC director for the US civilian population.
Between 1963 and 1969, oral polio, rubella, and both live and inactivated measles vaccines were licensed. The inactivated measles formulation was withdrawn from the market in 1967. In 1964, a significant rubella epidemic occurred, resulting in 12.5 million infections, including 50,000 pregnant women. This outbreak led to the birth of 20,000 neonates with congenital rubella syndrome, along with an increase in fetal losses (11,250) and neonatal deaths (2100). Measles remained a concern, with 500,000 cases occurring annually. In 1966, the CDC launched its first measles eradication campaign; within 2 years, the incidence had dropped by 90%.
In the US, because of our immunization program, the last case of naturally acquired smallpox occurred in 1949, and in 1971, ACIP no longer recommended the routine administration of the smallpox vaccine. However, smallpox remained an issue globally, and proof of vaccine receipt was often required for international travel.
In 1966, the World Health Organization launched a global smallpox eradication program, with 44 countries participating. The global eradication of smallpox was officially declared in 1980, following the last reported case in Somalia in October 1977.
Vaccine development remained robust from 1977 to 2024. Over 20 new vaccines or new formulations of older ones were licensed, and ACIP recommendations for use were published in the Morbidity and Mortality WeeklyReport. Not all licensed vaccines are recommended for routine use; many are intended for international travel or specific populations, such as military personnel or laboratory staff.
In 1995, the first harmonized childhood immunization schedule was issued by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. This schedule is subsequently updated every January. As an intern in the early 1980s, I saw three vaccines on the schedule providing protection against seven diseases. Currently, there are 12 vaccines providing protection against 16 diseases on the routine childhood schedule, and four vaccines providing protection against six diseases on the routine adolescent schedule. Many, including myself, have observed the decline in cases of Haemophilus influenzae type b, invasive pneumococcal disease, rotavirus, and varicella since the vaccines were licensed.
However, the current measles outbreak is concerning. Historically, we have experienced small outbreaks, typically secondary to international travel in unvaccinated individuals. In 2024, the CDC reported a total of 285 cases of measles from 33 jurisdictions, 198 of which were associated with 16 outbreaks. As of March 24, 2025, 350 outbreak-related cases have been reported from Texas, New Mexico, and Oklahoma alone. There are additional unrelated measles cases from 10 other jurisdictions.
New leadership at the CDC, and Robert F. Kennedy, Jr.'s suggestion to review the link between vaccines and autism, may unnecessarily raise parents' concerns about vaccine safety. Extensive research has consistently demonstrated that vaccines are both safe and effective. The question he raises has been answered. Extensive scientific research has demonstrated that there is no correlation between vaccines and autism. Conducting this study again diverts resources from essential research, such as determining the causes of autism. It may also result in lower immunization rates, potentially leading to a resurgence of preventable diseases.
For the 2023-2024 school year, CDC reported US kindergarten immunization rates: DTaP (92.3%), HBV (93%), MMR (92.7%), polio (93%), and varicella (92.6%), all showing declines from 2022-2023. Vaccine exemptions increased to 3.3%, with nonmedical exemptions rising from 1.9% to 3.1%. As the primary care provider, you are a highly trusted information source. We must continue to safeguard our patients and educate their families to ensure they have the opportunity to lead a full and productive life. Our goal is to prevent additional measles cases and other vaccine-preventable diseases from resurfacing. Mr Kennedy has limited the vaccine information routinely available on the CDC website. Additional sources:
COMMENTARY
The US Immunization Program: Our Crucial Role in Preventing Avoidable Deaths
DISCLOSURES
| April 09, 2025The United States immunization program stands as a notable public health accomplishment. As pediatricians, we have spearheaded efforts to educate parents and support vaccine recommendations, leading to significant reductions or eliminations of numerous infectious diseases in the United States. In January 2025, Texas reported a measles outbreak. We were unprepared for the report of an unvaccinated child's death, the first measles-related fatality since 2019. Many were alarmed by the response of Health and Human Services Head Robert F. Kennedy, Jr, who downplayed the severity of the situation by stating, "Outbreaks happen all the time... healthy children don’t die from measles," and suggested that diet and vitamins could prevent infectious diseases without urging vaccination.
Tables 1 and 2 show the impact of administering immunizations. The US program has achieved a level of success such that many healthcare providers have never encountered patients with several of the listed diseases. The recommendations from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) are based on scientific evidence. A review of vaccine development and the rationale behind the CDC's involvement in the US immunization program follows.
Edward Jenner developed the smallpox vaccine in 1796, marking the start of the vaccine era. Between 1914 and 1955, seven vaccines were licensed in the US, including rabies, typhoid, pertussis, influenza, tetanus, diphtheria toxoids, and polio. After the severe polio epidemic in 1952, parents eagerly sought the inactivated polio vaccine approved in 1955. Congress passed the Polio Vaccine Assistance Act to fund CDC efforts to provide vaccines. In 1962, President Kennedy signed the Vaccination Assistance Act for mass immunization campaigns. The Federal Immunization Grant Program followed in 1963, funding states to purchase vaccines and support immunization programs authorized under section 317. At that time, only diphtheria-tetanus-polio and smallpox vaccines were available.
The CDC Advisory Committee on Immunization Practices (ACIP) was established in 1964. It is a federal advisory committee charged to review current licensed vaccines and all newly licensed vaccines, and to make recommendations for their use to the CDC director for the US civilian population.
Between 1963 and 1969, oral polio, rubella, and both live and inactivated measles vaccines were licensed. The inactivated measles formulation was withdrawn from the market in 1967. In 1964, a significant rubella epidemic occurred, resulting in 12.5 million infections, including 50,000 pregnant women. This outbreak led to the birth of 20,000 neonates with congenital rubella syndrome, along with an increase in fetal losses (11,250) and neonatal deaths (2100). Measles remained a concern, with 500,000 cases occurring annually. In 1966, the CDC launched its first measles eradication campaign; within 2 years, the incidence had dropped by 90%.
In the US, because of our immunization program, the last case of naturally acquired smallpox occurred in 1949, and in 1971, ACIP no longer recommended the routine administration of the smallpox vaccine. However, smallpox remained an issue globally, and proof of vaccine receipt was often required for international travel.
In 1966, the World Health Organization launched a global smallpox eradication program, with 44 countries participating. The global eradication of smallpox was officially declared in 1980, following the last reported case in Somalia in October 1977.
Vaccine development remained robust from 1977 to 2024. Over 20 new vaccines or new formulations of older ones were licensed, and ACIP recommendations for use were published in the Morbidity and Mortality Weekly Report. Not all licensed vaccines are recommended for routine use; many are intended for international travel or specific populations, such as military personnel or laboratory staff.
In 1995, the first harmonized childhood immunization schedule was issued by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. This schedule is subsequently updated every January. As an intern in the early 1980s, I saw three vaccines on the schedule providing protection against seven diseases. Currently, there are 12 vaccines providing protection against 16 diseases on the routine childhood schedule, and four vaccines providing protection against six diseases on the routine adolescent schedule. Many, including myself, have observed the decline in cases of Haemophilus influenzae type b, invasive pneumococcal disease, rotavirus, and varicella since the vaccines were licensed.
However, the current measles outbreak is concerning. Historically, we have experienced small outbreaks, typically secondary to international travel in unvaccinated individuals. In 2024, the CDC reported a total of 285 cases of measles from 33 jurisdictions, 198 of which were associated with 16 outbreaks. As of March 24, 2025, 350 outbreak-related cases have been reported from Texas, New Mexico, and Oklahoma alone. There are additional unrelated measles cases from 10 other jurisdictions.
New leadership at the CDC, and Robert F. Kennedy, Jr.'s suggestion to review the link between vaccines and autism, may unnecessarily raise parents' concerns about vaccine safety. Extensive research has consistently demonstrated that vaccines are both safe and effective. The question he raises has been answered. Extensive scientific research has demonstrated that there is no correlation between vaccines and autism. Conducting this study again diverts resources from essential research, such as determining the causes of autism. It may also result in lower immunization rates, potentially leading to a resurgence of preventable diseases.
For the 2023-2024 school year, CDC reported US kindergarten immunization rates: DTaP (92.3%), HBV (93%), MMR (92.7%), polio (93%), and varicella (92.6%), all showing declines from 2022-2023. Vaccine exemptions increased to 3.3%, with nonmedical exemptions rising from 1.9% to 3.1%. As the primary care provider, you are a highly trusted information source. We must continue to safeguard our patients and educate their families to ensure they have the opportunity to lead a full and productive life. Our goal is to prevent additional measles cases and other vaccine-preventable diseases from resurfacing. Mr Kennedy has limited the vaccine information routinely available on the CDC website. Additional sources:
CDC/ACIP: Vaccines and Immunizations
American Academy of Pediatrics
Immunize.org
National Foundation for Infectious Diseases
Parental information:
HealthyChildren.org
VaccineInformation.org
Children's Hospital of Philadelphia Vaccine Education Center
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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