On a September morning in Yeadon, Pennsylvania, dozens of families queued outside a local clinic. It was “exclusion day” — the deadline for students lacking required immunizations to be kept out of school.
But rather than send families home, school district officials worked with the county health department to vaccinate children at a nearby site, allowing them to return to class. Forty-two middle and high school students received protection against tetanus, pertussis, meningitis and other diseases that day.
“We’ve been doing this for a couple of years now, and it’s really effective,” said Lora Werner, director of the Delaware county health department.
The clinic was part of Delaware County’s broader back-to-school immunization campaign. Pennsylvania had recorded 693 measles cases by 14 September, with four residents dying from the disease so far this year. The effort includes a mobile vaccine clinic — a 33ft traveling RV that delivers shots at pop-up community events — along with school partnerships and publicly available vaccination data, all aimed at preventing immunization rates from falling.
The local initiative reflects a problem playing out nationwide. Robert F Kennedy Jr, the country’s top public health official, has repeatedly questioned vaccine effectiveness and challenged established vaccine science. That approach culminated in a recent Trump executive order seeking to separate the measles, mumps and rubella (MMR) vaccine and reduce the number of shots recommended for American children. Advocates say the administration’s claims about vaccine safety are not only false but are putting lives at risk.
As confidence in federal guidance has weakened, governors, state lawmakers, public health departments, medical advocacy organizations and frontline doctors have taken on a larger role in explaining vaccine safety. Across the US, they are mounting an urgent response to misinformation surrounding routine childhood immunizations.
“Our responsibility is to demonstrate what the science shows and put out a [vaccine] schedule that people can depend upon that is science-based and evidence-based,” said Andrew Racine, president of the American Academy of Pediatrics. “Measles is a canary in the coal mine and we have to now worry about other vaccine-preventable diseases, which is why the local effort at the state level is so critical.”
Executive order creates chaos
While children were receiving catch-up shots before the new school year, Trump signed an executive order promoting what he called “gold standard childhood vaccine recommendations”. The order proposes reducing the number of universally recommended childhood vaccines from 17 to 11 and dividing the MMR shot into three separate injections administered during additional medical visits. No new scientific evidence accompanied the directive.
Paul Offit, director of the Vaccine Education Center at Children’s hospital of Philadelphia, trains physicians to explain that the MMR vaccine has been used safely in the US for roughly six decades. Manufacturers have said they do not intend to create separate formulations because splitting the vaccine would provide no safety advantage, he said. Public health experts also warn that requiring more appointments could create additional chances for children to miss a dose.
For doctors and officials confronting vaccine misinformation, the executive order is the latest in a series of actions Kennedy has taken since his confirmation. Offit pointed to an appearance by Kennedy on Fox News last year, when he falsely said the measles vaccine causes blindness and death. “Could he be more dangerously irresponsible?” Offit said. “He should have been fired right there, but he wasn’t. And that’s when he knew: I can say whatever I want with impunity.”
Racine said the misinformation campaign has contributed to growing vaccine hesitancy. CDC data shows that the number of kindergarteners claiming exemptions for the 2025-26 school year reached a record, while kindergarten vaccination rates declined from the previous year. Hesitancy is particularly pronounced in some rural communities, he said, and states that once led the nation in vaccination coverage have seen rates drop after broadening exemption policies.
“This is the last thing parents wanted on their back-to-school list, to be confused about the childhood vaccine schedule or to be worried about their child coming home with measles,” said Shaughnessy Naughton, founder of the nonprofit advocacy group 3.14 Action. “It’s why so many doctors and health professionals are now stepping up and fighting back against these dangerous actors”
The pushback is state by state, doctor by doctor
With the federal government no longer serving as the country’s traditional science-based source of vaccine guidance, state lawmakers, health departments, local public health authorities and physicians are being asked to fill the gap.
After RFK Jr’s appointment as health secretary, legislators in several states reviewed vaccine laws and removed references to the CDC. In January, dozens of states said they would reject CDC guidance. Today, 30 states report using another source — including the American Academy of Pediatrics or the American Academy of Family Physicians — for childhood vaccine recommendations.
Fifteen states sued the Trump administration earlier this year over revisions to the childhood vaccine schedule and the dismantling of the CDC’s vaccine advisory panel. States have also created regional alliances. California, Oregon, Washington and Hawaii established the West Coast Health Alliance, while 15 states — among them Connecticut, Maine, New York and Massachusetts — formed the Northeast Public Health Collaborative. Both voluntary groups are intended to improve regional awareness and preparedness for infectious disease outbreaks.
Racine said public trust depends on clear, consistent communication as well as reliable access to vaccines. States are therefore reassuring medical providers that the standard schedule remains in place, requiring insurers to continue covering vaccines and producing public service announcements about the importance of measles immunization.
In Pennsylvania, the health department is using videos and infographics to show residents how easily measles spreads and explain the risks of going unvaccinated. A department spokesperson said the response has been overwhelmingly positive, with far more people choosing to vaccinate themselves and their families than opting not to. Healthcare providers administered more than 46,000 MMR doses across the state in August, up from about 31,000 during the same month last year.
Hawaii Governor Josh Green, a physician who helped create the West Coast Health Alliance, said he approaches vaccine communication “like a family physician”, giving the public detailed local data instead of focusing on mandates.
“I believe that people can and should make some decisions based on their belief system,” Green said. “Of course, however, they should also be given the best information possible.”
Green’s concern is rooted in his experience volunteering as a doctor during Samoa’s devastating 2019 measles outbreak. The epidemic killed 83 people, most of them young children, after a vaccine scare that was fueled in part by visits from anti-vaccine activists. Kennedy, who had become an anti-vaccine activist, visited Samoa in 2019 to examine the MMR vaccine just months before the outbreak.
“We would go into a village, and we’d find families huddled around a child who had just died,” Green recalled. “We would have a funeral service in the bedroom, and then we would have to walk outside and ask: ‘Does anyone want to be vaccinated?’”
Green traveled from village to village vaccinating family members. “We saw the same thing over and over again, people dying right in front of us,” he said. Samoa vaccinated nearly 37,000 people in two days, and the outbreak stopped within a week, Green said. He called the parallels to Kennedy’s current rhetoric “the same kind of stuff” he saw before that crisis. “It’s RFK’s playbook,” he said.
“He went into a vulnerable community of people that didn’t have a lot of education […] and he scared people, and they didn’t get vaccinated, and the country got crushed,” Green said. “Now they’re doing the same thing with other rural communities.”
Filling the information vacuum
Countering federal misinformation has also fallen disproportionately on doctors and nurses who never expected to be doing that kind of work, health officials said.
“Doctors are facing a lot – many of them have never seen measles cases before, and now they’re seeing it for the first time in their lives,” said Jeremy Funk, deputy director of the public health project at the non-profit Protect Our Care. He described an “enormous amount of burden” now being placed on pediatricians and state health officials to walk parents through basic vaccine safety information they never previously had to explain.
In Pennsylvania, that responsibility has landed heavily on county health departments – some of which face funding challenges or didn’t exist a few years ago. Delaware county was the largest county in the country without a health department until the pandemic, when the community built its own from scratch. “We wanted to make sure we were meeting people where they were,” said city council member Monica Taylor.
Today, that means school partnerships and a mobile health van bring shots directly to parking lots, parks and community events. “It’s really about being out in the community as much as possible and being accessible,” Taylor said.
Werner said Delaware county has not seen a surge in outright vaccine refusal, but has seen rising anxiety, including parents asking whether funding for free vaccine programs will survive, or parents confused by shifting federal signals.
“We saw more parents concerned that things might not be available,” Werner said, describing a summer awareness campaign the county launched, aimed particularly at reaching Spanish-speaking families. She credited the state health department with holding regular briefings for county officials and continuing to follow “the science”, even as federal recommendations shifted. Pennsylvania also began publishing school-level vaccination data for the first time this year, letting parents and administrators see exactly where local immunization rates stand and where support is needed.
“It’s a really hard place for public health right now with so much divisiveness being promoted,” said Werner. “As public health officials, we really want people, from those who are underinsured to those who are undocumented, to keep themselves safe and have good information to make decisions about it. We want to help people hear the information they need to hear.”
