COVID-19, Measles, and the New Vaccine Order: What Parents Should Know

As the US records its highest number of measles cases in more than 3 decades, parents heading into fall are also navigating a federal overhaul of childhood vaccine guidance.¹

An August executive order narrowed the list of diseases that all children should be vaccinated against from 18 to 11, moving influenza, COVID-19, hepatitis A and B, rotavirus, and meningococcal disease to shared clinical decision-making or risk-based recommendations. At the same time, measles, mumps, and rubella (MMR) vaccination coverage among kindergartners slipped to 92.4% in the 2025-2026 school year, while exemptions reached a record 4.2%.²

In an interview with The American Journal of Managed Care^® (AJMC^®), Tammy Lundstrom, MD, JD, senior vice president and chief medical officer at Trinity Health, discussed what these changes mean for families, why she sees single-dose MMR shots as an access problem, and how clinicians can build trust with hesitant parents.

This interview has been lightly edited for clarity.

AJMC: The August executive order narrows the list of diseases that all children are recommended to be vaccinated against to 11. It moves flu, COVID-19, hepatitis A and B, rotavirus, and meningococcal disease to shared clinical decision-making or risk-based recommendations. What does that mean for a parent trying to decide what their child needs this fall?

Lundstrom: We're still following the previous recommendations and following the science. I think we've always, at least in my estimation, had shared decision-making for vaccines as providers, discussing with our patients the risks and benefits and the risks of not getting vaccinated, which are consequential, especially now with the measles outbreaks that we're seeing.

Really, it's talking to parents about that. With hepatitis B for infants, I am old enough to have practiced in the era when we didn't have these vaccines, and I saw a lot of chronic liver disease in babies whose moms were hepatitis B carriers. Really, it's about having that conversation so that people truly understand from a scientific perspective what the risks and benefits are.

AJMC: The order also calls for childhood vaccines to be given as single-disease shots rather than combination products when feasible, starting with splitting the MMR vaccine into 3 separate shots. From a clinical and access standpoint, what's your take on that?

Lundstrom: I think from an access standpoint, it's problematic. We already know there's difficulty with getting access, and if you're talking about 3 visits instead of 1, that's taking parents away from work, trying to get 3 different appointments versus 1. I think the IDSA [Infectious Diseases Society of America] and American Academy of Pediatrics would agree that there's no benefit, from a scientific perspective, of getting 3 different injections versus 1.

I think most pediatricians and most infectious disease doctors are still recommending getting the combined dose. The separate doses aren't even available in the US right now, so that complicates access and the recommendations. Even if parents wanted to do that, it's impossible right now. I think it's problematic.

AJMC: The US is seeing its highest number of measles cases in more than 30 years, and nonmedical exemptions among kindergartners rose to 4.0% in the 2025-2026 school year. How worried are you about pockets of undervaccinated children, and what should a parent do if their child may have been exposed to measles?

Lundstrom: I'm very worried about that, because I just saw data today from KFF showing that 92.4% of kindergartners are now vaccinated for MMR. And measles is one of the most contagious diseases that we have. We need at least 95% vaccination rates to provide herd immunity.² That is very scary and problematic, especially in light of what I just heard today: Pennsylvania is nearing 800 cases, which is very, very concerning.⁴

I think if children are behind in vaccinations, now is a good time to get caught up. And if they've been exposed to measles, communicating with either public health or your primary care provider about the best options to try to prevent disease is the way to go.

AJMC: You've led Trinity Health's pandemic response and spoken at town halls to counter misinformation. What approach works best when a hesitant parent comes to you with questions, and how do you keep trust when federal guidance and groups like the American Academy of Pediatrics are giving different advice?

Lundstrom: It's really about the conversation, trying to understand people's fears. What are they afraid of? Do they understand the consequences if their child or somebody in their family gets one of these vaccine-preventable diseases? Many people are young enough that they haven't experienced the terrible consequences that can happen with some of these vaccine-preventable illnesses.

Having factual conversations and trying to lay out the facts and the science is the best way to go forward. And then, like I said, try to understand the individual fear and address that. And myth-bust, too. We've done town halls, and we have myth-busting. A lot of what’s on social media isn’t scientifically accurate, so we’re trying to make sure people have the right information to make their decision.

References

1. Measles cases and outbreaks. CDC. September 18, 2026. Accessed September 23, 2026. https://www.cdc.gov/measles/data-research/index.html
2. McCrear S. Back-to-school vaccines: what clinicians need to know in 2026. AJMC. August 27, 2026. Accessed September 23, 2026. https://www.ajmc.com/view/back-to-school-vaccines-what-clinicians-need-to-know-in-2026
3. McCrear S. Trump childhood vaccine order: what it means for parents and payers. AJMC. August 11, 2026. Accessed September 23, 2026. https://www.ajmc.com/view/trump-childhood-vaccine-order-what-it-means-for-parents-and-payers
4. Pennsylvania Department of Health provides statewide update on measles outbreak as cases reach 792 in 39 counties. Pennsylvania Department of Health. September 21, 2026. Accessed September 23, 2026. https://www.pa.gov/agencies/health/newsroom/pa-department-of-health-provides-statewide-update-on-measles-out4