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-Editorial
As the United States contends with rising outbreaks of vaccine-preventable diseases, public health experts are raising concerns about narrowing access to COVID-19 vaccines and the uncertain future of a key global HIV/AIDS initiative. These developments come at a time when trust in vaccines is faltering and long-standing public health successes are being put at risk.
Once considered largely under control in the U.S., diseases such as measles and whooping cough are resurging in several states. Health officials are attributing this trend to growing vaccine hesitancy and the disruption of vaccination programs both at home and abroad.
Dr. William Schaffner, Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, said that decades of vaccination campaigns had driven down diseases like polio, diphtheria, and neonatal tetanus. But their success, he noted, may have also bred complacency.
“When a disease is no longer feared or even remembered, the vaccine that prevents it loses value in the public’s eyes,” Schaffner said during a recent briefing. This perception, he warned, has led to declining vaccination rates and the reemergence of dangerous illnesses.
One particularly severe outbreak has occurred in a conservative Mennonite community in West Texas, where more than 1,000 cases of measles have been reported. Despite lacking religious opposition to vaccines, the community’s avoidance of modern medicine left it vulnerable. Several children have been hospitalized with complications, and three deaths have been reported.
The trend is not limited to isolated or rural populations. Schaffner pointed out that even middle-class, educated families are opting out of routine immunizations due to mistrust in public health institutions or a preference for “natural” lifestyles. These decisions, he said, are putting vulnerable populations at risk — particularly in the face of Medicaid and children’s health care cuts that could further reduce access to vaccinations.
“Vaccines are one of the greatest public health achievements of our time — but they only work if people get them,” Schaffner emphasized.
Compounding the challenge is a significant change in federal guidance on COVID-19 vaccinations. Dr. Peter Chin-Hong, a professor at the University of California, San Francisco, criticized the rollout of new protocols that drastically limit vaccine access for the upcoming fall season.
Under the new recommendations, COVID-19 vaccines will primarily be available to those 65 and older or younger individuals with qualifying comorbidities — though specific criteria have not yet been released. Chin-Hong expressed concern that this guidance excludes healthy pregnant people, young children, and frontline healthcare workers.
“These are groups at risk of serious illness or transmission,” Chin-Hong said. “By narrowing eligibility, we’re removing key layers of protection.”
The changes were announced not through official scientific channels, but via a short video on social media by political figures, including presidential candidate Robert F. Kennedy Jr. and physician Marty Makary. Chin-Hong criticized the approach as lacking transparency and undermining scientific communication.
“People are confused. Pharmacies and doctors don’t know what guidance to follow,” he said. “We’re seeing lower vaccine uptake as a result.”
Chin-Hong also pushed back on criticisms that repeated COVID-19 boosters are unnecessary. “Real-world data show immunity wanes, especially for older adults. Boosters save lives,” he said.
Meanwhile, the fate of the President’s Emergency Plan for AIDS Relief (PEPFAR) remains uncertain. The global health program, credited with saving over 25 million lives since 2003, is currently under strain due to a 90-day pause in foreign aid imposed by the current administration.
Dr. Jirair Ratevosian, Associate Research Scientist at Yale University and a former policy advisor, warned that the consequences of the pause are already unfolding across partner countries. Clinics are closing, treatment is being interrupted, and prevention programs are being scaled back.
“Treatment only works if it’s uninterrupted,” Ratevosian said. “When people stop therapy, viral loads rise, transmission increases, and lives are put at risk.”
His team estimates that the funding delay could result in up to 100,000 preventable deaths within a year. Further projections suggest that if the program ends, 11 million new HIV infections and 3 million additional deaths could occur by 2030.
PEPFAR’s congressional authorization expired in March, leaving the program vulnerable to political manipulation. Though it has long enjoyed bipartisan support, it now finds itself stalled in a deeply divided legislative environment.
“We know what works,” Ratevosian said. “We have the tools — a once-daily pill that saves lives and stops transmission. But it only works if we deliver it. Delays cost lives. Silence costs lives.”
Experts are urging stronger leadership and science-based policy. They warn that without action, recent gains in infectious disease control could be reversed.
“Public health doesn’t run on autopilot,” Schaffner said. “It requires investment, trust, and vigilance. We can’t afford to lose what we’ve built.”