With measles cases climbing and deaths mounting across the United States, local health officials are stepping in where the federal government has abandoned its traditional role as a trusted, science-based source of vaccine guidance.
In Yeadon, Pennsylvania, dozens of families stood in line outside a clinic on an early September morning. It was “exclusion day,” the deadline by which students without complete immunizations are barred from returning to class. Instead of turning families away, school district leaders partnered with the county health department to vaccinate kids nearby so they could go back to their desks. That day, 42 middle and high school students were vaccinated.
“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 National Crisis
Measles cases climbed to 693 in Pennsylvania as of September 14, claiming the lives of four residents this year. The push in Pennsylvania is a local answer to a national problem.
The country’s top public health official, Robert F. Kennedy Jr., has spent his time in office questioning the efficacy of vaccines and undermining vaccine science. That culminated in a recent Trump executive order that seeks to break apart the measles, mumps, and rubella shot and shrink the list of vaccines recommended for American children.
“The administration’s claims about vaccine safety are not just false, but are actively costing lives,” advocates said.
The Executive Order
As children got up to date on their immunizations before the start of the school year, Trump signed the “gold standard childhood vaccine recommendations” executive order. It calls to reduce the number of universally recommended childhood vaccines from 17 to 11 and to split the MMR shot into three separate injections, delivered across additional doctor’s visits. The order arrived with no new scientific evidence behind it.
Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said the MMR vaccine has been used safely in the US for about 60 years. Manufacturers have made clear they have no plans to split it into separate formulations, since doing so would offer no safety benefit.
State-by-State Pushback
Because the federal government has abandoned its traditional role, the responsibility has fallen to state lawmakers, health departments, local public health officials, and doctors.
Following RFK Jr’s appointment as health secretary, some state legislators examined their statutes on vaccines and removed references to the CDC. Now, 30 states report relying on a source other than the CDC for information about childhood vaccines, such as the American Academy of Pediatrics.
Fifteen states sued the Trump administration earlier this year over its changes to the childhood vaccine schedule. California, Oregon, Washington, and Hawaii formed the West Coast Health Alliance, and 15 states formed the Northeast Public Health Collaborative.
The Human Cost
Hawaii governor Josh Green, a physician who formed the West Coast Health Alliance, said he treats vaccine communication “like a family physician,” sharing granular, local data with the public rather than vaccine mandates.
Green’s urgency is shaped by his experience as a volunteer doctor during Samoa’s catastrophic 2019 measles outbreak, which killed 83 people, most of them young children. Kennedy, as part of his career as an anti-vaccine activist, visited Samoa in 2019 to study the MMR vaccine 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?'”
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.
Filling the Information Vacuum
Countering federal misinformation has fallen disproportionately on doctors and nurses who never expected to be doing that kind of work.
“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 Protect Our Care.
In Pennsylvania, county health departments have taken on the burden. Delaware county was the largest county in the country without a health department until the pandemic, when the community built its own from scratch. Today, 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,” said city council member Monica Taylor.
The Bottom Line
Measles cases are rising across the US, with Pennsylvania reporting 693 cases and four deaths this year. The Trump administration’s executive order on childhood vaccines and RFK Jr’s undermining of vaccine science have created a vacuum that local officials are filling. Thirty states now rely on sources other than the CDC for vaccine guidance. Fifteen states have sued the administration. Doctors and health departments are mounting urgent campaigns to reassure parents and maintain immunization rates. In Pennsylvania, healthcare providers administered more than 46,000 MMR doses in August, compared with roughly 31,000 the same month last year.
