Childhood Immunization: A Pediatric NP’s Perspective

Vaccines are one of the most important achievements in human history. A landmark study by the World Health Organization found that global immunization efforts have saved an estimated 154 million lives over the past 50 years, equivalent to six lives every minute (WHO 2024). The majority of lives saved, approximately 101 million, were infants. 

Vaccines have transformed childhood infections that were once routine into uncommon or controllable elements. Prior to the proliferation of vaccination, three to four million Americans were infected with measles every year (CDC); in 2025, it infected around 2,000. Pertussis was once one of the most common childhood diseases and a major cause of childhood mortality in the US; since vaccination, cases have dropped by more than 90 percent. Smallpox control used to rely on deliberate exposure, which reduced mortality but still caused illness and risk; today, the disease is eradicated. 

But despite the availability of vaccines and the strong evidence of their efficacy, the 21st century has seen a rise in vaccine hesitancy: either a delay in the uptake or an outright refusal of safe vaccines. Recent changes in both policy and posture from the federal government have complicated the immunization landscape. As part of their role in ensuring all children have access to evidence-based preventative care, Pediatric Nurse Practitioners (PNPs) are a valuable resource for guidance around routine childhood vaccination.

Navigating Changes in Vaccine Recommendations

During his tenure as HHS Secretary, Robert F. Kennedy has amplified skeptical claims about vaccines that have been rejected by scientists and public health officials (KFF 2025). In 2026, following a presidential directive, HHS adjusted the government’s recommended vaccination schedule for children. Building upon changes made in 2025, it reduced the number of diseases targeted from 17 to 11 and the number of routine vaccinations from 13 to seven. 

The new schedule positions the US as an outlier among peer nations in routinely recommending so few vaccines for children. The changes mark a significant departure from the past, and further changes are signaled ahead. 

“The federal government’s changes to the routine childhood vaccination schedule have led to not only widespread confusion but decreased confidence in immunization overall,” Harmony says.

While HHS has cited decreased vaccine uptake and declining trust as reasons for changing pediatric vaccine recommendations, it is unclear whether these changes will address those issues, and they could have the opposite effect (KFF 2026). Any reduction in vaccination rates will lead to increased illness. More kids will miss school, and more parents will miss work. 

Vaccine-preventable diseases like measles and pertussis, which had become far less common in the US, are again seeing elevated case counts in some communities. Over two million children in the US have an immunocompromising condition that prevents them from receiving the full protection that vaccines provide, making them especially vulnerable when vaccine-eligible children and adults skip recommended vaccines. Harmony states,

Even one individual missing a vaccine can have a negative effect. For example, a grandparent not up to date on a booster of Tdap could pass pertussis onto their grandchild, leaving the newborn struggling to breathe. Last year in the US, 16 babies died from pertussis and 124 were hospitalized. 

Diseases like measles are incredibly contagious, and the contagious period is long, so even a small drop in the overall vaccination rate can have a significant impact. As immunization rates decline, we continue to top yearly case records; last year, 76 children were hospitalized from measles and three children died.

The Future of Childhood Immunization

Changing federal guidelines have led states to decouple their vaccine recommendations from the federal government. KFF found that 30 jurisdictions relied on non-federal sources for at least some childhood vaccine recommendations as of May 2026, up from a much smaller group in September 2025. Vaccine uptake could continue to diverge across states, and coverage and access may vary by geography. But data collection and analysis of the full effects may be complicated by recent cuts to public health funding (TFAH 2025). 

Vaccine hesitancy persists, but Harmony notes she’s also seen some parents interested in new vaccines. The new Lyme vaccine candidate, shown to be safe and effective in clinical trials, is of particular interest during tick season in endemic areas. As the social conversation around vaccines continues to evolve, it’s important that PNPs retain their commitment to science and to the patient. Vaccine science will outlast any individual administration; it lives with parents and patients their whole lives.

In closing, Harmony shares, 

As a pediatric nurse practitioner, I am passionate about supporting parents in raising healthy, well-adjusted children. Changes in cultural or political trends will not affect the way I practice, and I am passionate about helping parents and families understand the benefits of vaccines, which lead to longer, healthier lives for the children we care for. Pediatric healthcare providers will always advocate for children, whether regarding safety, education, or health; it’s part of the job description! 

We cannot completely control cultural shifts in health beliefs like the one we are in right now, but at the end of the day, I am hopeful, because families trust us. They know we have the same goal they do: a happy, healthy child.