Back-to-School Vaccines: What Clinicians Need to Know in 2026

As families prepare for the start of a new school year, President Donald J. Trump signed an executive order directing the federal government to overhaul childhood vaccine recommendations, narrowing the vaccines recommended for all children from 17 to 11.¹

Alongside the president’s and CDC’s upheaval of the childhood immunization schedule and the spread of misinformation, diseases previously eliminated have resurged, and routine vaccination refusals have increased.^2,3 In early January 2026, the CDC announced changes to the childhood immunization schedule, reducing the number of vaccines recommended for all children from 17 to 11.² However, the CDC’s changes were stayed by a US district judge in mid-March, reverting the childhood immunization schedule to that of July 2, 2025.⁴

Despite the standing recommendations, numerous states are witnessing a resurgence in vaccine-preventable diseases like measles and now pertussis, William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, said in an interview with The American Journal of Managed Care^® (AJMC^®).

“A lot of this has come from, unfortunately, the federal government, and that information has now gotten garbled and confusing and has even been interpreted as discouraging vaccinations,” Schaffner said. “So, it makes it more difficult for pediatricians and family doctors to actually reach out to parents and provide them with good information.”

Childhood Vaccine Recommendations and School Immunization Requirements

Historically, school immunization standards helped enforce adherence, with study data supporting positive associations between increased vaccine uptake and new or tightened school mandates.⁵

“Once we oblige children to be vaccinated before they attend daycare, kindergarten, and school, then these vaccine-preventable diseases plummeted,” Schaffner said. “And measles, we got down to 0 cases in the United States, so school immunization requirements are critical.”

But there are exemptions from these mandates. Medical exemptions are permitted in all states, while nonmedical exemptions based on religious or philosophical beliefs vary by state. However, many parents, Schaffner said, may take advantage of the exemption to fit their personal beliefs for not vaccinating their children.

“[And now] we are accumulating, particularly in certain communities, a rather large group of children who are unvaccinated,” he said.

For the 2011-2012 school year, the rate of nonmedical exemptions was 1.0% among US kindergarteners. For 2024-2025, the nonmedical exemption rate was 4.0%, a significant jump from just 3.7% for 2023-2024 and 3.2% for 2022-2023, according to the CDC’s SchoolVaxView.⁶

“Now, in certain schools, you can have a substantial proportion of unvaccinated children; maybe only 70% or 80% of children are vaccinated, which leaves 20% or 30% of children unvaccinated,” Schaffner explained. “And if that germ, such as the measles virus, gets into that group of children, there will be widespread illness."

The US is experiencing its largest measles outbreak it’s seen in the past 30 years, with over 2465 cases so far in 2026 and 3 deaths since the beginning of 2025.⁷ Paul Offit, MD, director of the vaccine education center at the Children’s Hospital of Philadelphia, attributed the resurgence of measles in part to declining vaccination coverage and changes in federal vaccine policy.

“You can't put a vaccine onto the schedule until you prove, before you do that, that it doesn't interfere with the safety or immunogenicity profile of existing vaccines and that those vaccines don't interfere with the safety or immunogenicity profile of your vaccine,” Offit explained. “It is a well-tested, well-honed schedule, [and] it brought the rate of diseases dramatically down in this country because it worked.”

Vaccine Myths and Childhood Vaccine Hesitancy

KFF associated heightened mistrust in vaccines—surrounding multiple unsupported claims—as an influencing factor in parents’ decision not to vaccinate their children. A KFF national polling sample found vaccine hesitancy to be associated with a higher likelihood of believing vaccine myths. For example, claims such as the “measles, mumps, rubella (MMR) vaccine cause autism in children” and “the measles vaccine is more dangerous than being infected with measles.”⁸

Although these claims are unfounded and repeatedly disproven by science, 57% of parents surveyed who’d already delayed or skipped the childhood vaccine believed or leaned toward this MMR-autism myth.⁸ The findings underscored the limits of relying solely on health care providers to close gaps in vaccine knowledge, Schaffner said.

“Most of us think of this in terms of a clinical problem and a public health problem, but it is an educational problem,” Schaffner said, underscoring the awareness gap associated with vaccine-preventable diseases.

Gaps in intergenerational knowledge may also erode public confidence in vaccine safety and efficacy, as some parents and grandparents may not have witnessed the severity of vaccine-preventable diseases firsthand.⁹

“If we don't teach [high schoolers] about these illnesses and what a vaccine is and how important it is, why are we surprised that when they become parents, they come with a lot of questions?” Schaffner said. “We need to join with our educational colleagues and recruit them to help us provide that information going forward.”

Offit shared Schaffner’s sentiments, emphasizing the importance of self-education, while encouraging pediatricians to consider an alternative approach to the conversation with parents.

“Pediatricians need to make it clear that a choice not to get a vaccine is not a risk-free choice,” he said. “It's a choice to take a different risk, and this is what that different risk looks like.”

Vaccine Communication and Public Trust

HHS Secretary Robert F. Kennedy Jr's overhaul of the CDC’s Advisory Committee on Immunization Practices (ACIP) and public statements on vaccines have raised concerns among vaccine experts. Offit said these developments, combined with changes to the federal vaccine schedule, may have contributed to parental vaccine refusals.¹⁰

Offit continued to encourage clinicians and parents alike to refer to the American Academy of Pediatrics’ childhood immunization practice, as it reflects the previous ACIP recommendations, based on decades of compelling evidence.

“All these vaccines are recommended because they all help prevent serious and occasionally fatal illnesses, and they have been well tested,” he said.

As parents and children continue to prepare for back-to-school season, public health officials and experts like Schaffner and Offit encourage parents to consult with their primary care physician and educate themselves on the importance of child immunization recommendations.

“Your one job as a parent, frankly, is to put your child in the safest position possible, and that's what vaccines do,” Offit said.

References

1. Delivering Gold Standard Childhood Vaccine Recommendations for Americans. Executive Order. The White House. August 10, 2026. Accessed August 11, 2026. https://www.whitehouse.gov/presidential-actions/2026/08/delivering-gold-standard-childhood-vaccine-recommendations-for-americans/

2. Grossi G. CDC reduces US childhood immunization schedule from 17 to 11 diseases. AJMC^®. January 5, 2026. Accessed August 10, 2026. https://www.ajmc.com/view/cdc-reduces-us-childhood-immunization-schedule-from-17-to-11-diseases

3. Grossi G. ACIP changes disrupt vaccine coverage pipeline, raise cost concerns. AJMC. April 7, 2026. Accessed August 10, 2026. https://www.ajmc.com/view/acip-changes-disrupt-vaccine-coverage-pipeline-raise-cost-concerns

4. Jeremias S. Federal judge puts brakes on RFK Jr’s vaccine agenda. AJMC^®. March 17, 2026. Accessed August 10, 2026. https://www.ajmc.com/view/federal-judge-puts-brakes-on-rfk-jr-s-vaccine-agenda

5. Greyson D, Magnuson CV, Bettinger AJ. Impact of school vaccination mandates on pediatric vaccination coverage: a systematic review. CMAJ Open. 2019 Aug 6;7(3):E524–E536. doi:10.9778/cmajo.20180191

6. Vaccination coverage and exemptions among kindergartners. Centers for Disease Control and Prevention. July 31, 2025. Accessed August 10, 2026. https://www.cdc.gov/schoolvaxview/data/index.html

7. Measles cases and outbreaks. Centers for Disease Control and Prevention. August 7, 2026. Accessed August 10, 2026. https://www.cdc.gov/measles/data-research/index.html

8. Atta H. Provider trust, social media use can shape vaccine myth belief. AJMC. July 14, 2026. Accessed August 10, 2026. https://www.ajmc.com/view/provider-trust-social-media-use-can-shape-vaccine-myth-belief

9. McCrear S, Felzer JR. Rebuilding trust amid rising misinformation and disease resurgence: Jamie R. Felzer, MD, MPH. AJMC. May 22, 2026. Accessed August 10, 2026. https://www.ajmc.com/view/rebuilding-vaccine-trust-amid-rising-misinformation-and-disease-resurgence-jamie-r-felzer-md-mph

10. McCormick B. Experts warn that the CDC childhood immunization schedule revisions could reduce uptake and erode public trust. AJMC. January 27, 2026. Accessed August 11, 2026. https://www.ajmc.com/view/experts-warn-cdc-childhood-immunization-schedule-revisions-could-reduce-uptake-erode-public-trust