Over the past several years, we’ve witnessed an alarming rise in vaccine hesitancy across the United States. From the reluctant parent to the social media-driven influencer, more and more Americans are questioning the safety and efficacy of childhood vaccines. As we approach the transition to a new administration — one that has promised to let vaccine critics like Robert F. Kennedy Jr. “go wild” — the situation is likely only to worsen.
While there’s much to celebrate about the current focus on improving overall health — particularly the incoming administration’s emphasis on the MAHA agenda, which promotes better food safety, nutrition, and physical activity — it’s crucial that we remember these must be priorities in addition to addressing vaccine-preventable diseases, not in place of them. As I’ve said before, you can’t die of early heart disease at 50 if you already died from polio at 5. The reality is that vaccine-preventable diseases are still a major threat, even in the 21st century, and we ignore that at our peril.
I hear from pediatricians and health officials across the country on a near-daily basis about their growing concerns over declining vaccination rates. Parents who would have once trusted their health care providers’ recommendations are now questioning vaccines that should be routine, like MMR (measles, mumps, and rubella). What’s even more troubling is that even the parents of long-term patients — children who have received all their vaccines in the past — are increasingly opting to delay or forgo these essential shots due to new doubts, often fueled by misinformation.
What’s worse is that the default response to health provider recommendations has shifted. For many parents, the idea of questioning, deferring, or outright rejecting vaccines has become the norm, rather the exception. This undermines the trust that has been built over generations between health care providers and families, and presents a serious challenge for those of us trying to protect the health of all Americans, especially our children.
The impact of this growing vaccine hesitancy will, of course, be felt most acutely by children whose parents are trying, in deeply misguided ways, to protect them. While we’re unlikely to see a dramatic rise in deaths from vaccine-preventable diseases in the U.S. in the near term, the personal costs are immense. A single case of measles can lead to weeks of missed school, sporting events, family gatherings, and other milestones. These are costs many Americans felt were unbearable and inexcusable during the Covid-19 pandemic, yet we’re now putting our children at risk of suffering the same disruptions — disruptions that are both preventable and unnecessary.
Beyond the immediate disruption to daily life, the effects of vaccine-preventable diseases can linger far longer. Just as we’re learning with long Covid, preventable acute infections can develop into chronic health problems. Measles, for example, can lead to permanent neurological damage, and studies have shown that mumps can increase the risk of infertility in adults. In addition, recent research has pointed to links between rubella and a higher risk of heart disease later in life. The personal cost is not just the missed birthday party or time off school — it’s a potential lifelong impact that could have been easily avoided.
The broader societal implications of declining vaccination rates are just as troubling. Vaccine-preventable diseases place an enormous strain on the health care system, leading to increased medical costs, hospitalizations, and lost productivity. In the face of an inevitably increasing number of outbreaks, attention will be diverted away from the critical initiatives in the MAHA agenda, not to mention the broader economic and national security goals that the incoming administration will be tasked with addressing.
The cost of this distraction isn’t just medical or financial — it extends to our national defense as well. During the early days of the Covid-19 pandemic, I attended an Indo-Pacific Chiefs of Defense Conference where our allies raised concerns about the spread of the virus in the U.S. and whether our troops could pose an infection risk to their nations. Similarly, if the U.S. military is plagued by outbreaks of diseases like measles or pertussis, it could jeopardize strategic military deployments and international collaborations. Imagine the impact on our national defense if we are denied access to vital military opportunities because vaccine-preventable diseases have made our soldiers too sick to serve or travel, or deemed too high risk to be allowed entry.
It’s critical to acknowledge that increasing hesitancy toward childhood vaccines is rooted in a deep mistrust of the broader public health and medical system. Many people view pandemic policies as heavy-handed or overly intrusive, and there is a growing reluctance to accept top-down directives. I’ve heard the concerns, and I understand the frustration. We must listen, not shame. Public health communication must evolve to respect personal autonomy while clearly explaining the safety, efficacy, and long-term personal and societal benefits of vaccines.
At the same time, we can’t ignore the bigger picture. The countries with the highest life expectancies all share one common factor: vaccination rates that meet or exceed those of the United States. Meanwhile, the countries with the lowest life expectancies often lag far behind in vaccination coverage. We simply can’t “Make America Healthy Again” by “Making America Unvaccinated Again.” If we truly want to secure a healthier future for our children and protect the gains we’ve made over the last century, we must redouble our efforts to ensure that vaccines remain a cornerstone of our national health strategy.
It is imperative that we address the growing challenge of vaccine hesitancy. While there is much we can — and should — do to improve nutrition, physical activity, and other aspects of the MAHA agenda, we must also remain vigilant in preventing the return of vaccine-preventable diseases. The costs, both personal and societal, are too great to ignore. I hope senators will remember and ask about these costs during upcoming confirmation hearings. Let’s not make the mistake of forgetting the lessons of history — vaccines are one of the most powerful tools we have to ensure a healthier, more secure future for all Americans.
Jerome Adams was the 20th U.S. surgeon general. He is a distinguished professor and the executive director of the Center for Health Enhancement and Learning at Purdue University.