Routine Immunizations on the Precipice: Forestalling the Worst Outcomes in the Current Vaccine Landscape

Protecting the health of Americans means strong state and local-level immunization programs, coupled with initiatives that prioritize limiting the international importation of vaccine-preventable diseases. Adequately funded and well-managed immunization programs at home and abroad offer numerous benefits: They save lives, protect the health of children and adults, strengthen health systems, and serve as important resources that can be rapidly mobilized in responding to pandemics or outbreaks with pandemic potential. At the same time, robust routine immunization programs save money, support job creation, and generate a positive return on investment.

The recent history of measles, a highly transmissible viral infection, illustrates these points. Following the introduction of measles vaccines in the early 1960s, by the turn of the century, the United States was certified as having eliminated sustained domestic transmission of the virus. However, because measles cases and outbreaks can result from cross-border travel, the U.S. government has long guided and supported bilateral and multilateral programs to facilitate the purchase and delivery of vaccines in low- and middle-income countries, where immunization coverage may lag behind. Over the past 25 years, international collaboration, along with reasonably high domestic uptake of the measles vaccine, has helped prevent introduced cases from seeding sustained and expensive outbreaks. In the United States, two doses of the measles vaccine cost roughly $200, while a 2018 outbreak in New York City involving 649 confirmed cases cost an estimated $8.4 million to control. Data from the 2019 measles outbreak in Clark County, Washington, suggest that the overall costs associated with the public health response, productivity losses, and medical treatment for each case were more than $47,000.

The Trump administration’s steps to withdraw the United States from the World Health Organization (WHO); terminate support for Gavi, the Vaccine Alliance; and cut funding for innovative domestic and international vaccine-related research and development threaten health security at home and globally. The dismissal of the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) membership in favor of a new slate that includes vaccine skeptics and non-experts who have signaled their intent to review well-established vaccines, as well as the vaccination schedule, further pushes the United States to the edge of a dangerous precipice. In just the first half of 2025, there have been more than 1,300 measles cases and three deaths, the highest number since the elimination of domestic measles in 2000. In the absence of health programs to establish alternative pathways for protecting the population from vaccine-preventable diseases, these recent efforts will have long-term consequences that endanger the lives of children worldwide and undermine the economic security of the American people.

Congress has an opportunity to bring immunizations back from the brink and act to protect the health of American families within the new and politically complex vaccine landscape. With upcoming high-profile events, such as the 2026 World Cup games in multiple U.S. cities, Mexico and Canada, and the 2028 Summer Olympics in Los Angeles, global attention will be focused on the United States, underscoring the potential for the country’s loss of political influence, economic position, and reputation as a safe and desirable place to visit if vaccine-preventable diseases, such as measles, continue to proliferate.

The CSIS Working Group on Routine Immunizations and Health Security recommends the following actions:

• Take immediate actions to depoliticize immunizations and vaccine science through the establishment of an independent, nonpartisan panel of experts committed to determining the reasons for intense polarization around vaccines and identifying positive steps that can be taken to restore trust in them. The utility of innovative and lifesaving vaccines is directly related to how well they are delivered and whether or not people will receive them if offered. In 2019, the WHO named vaccine hesitancy a major threat to global health, and since 2020, confidence in vaccines has been further shaken thanks to disruptions during the Covid-19 pandemic and the circulation of antivaccine sentiment on social media. Despite a clear trend of increased requests for nonmedical vaccine exemptions in the United States since Covid-19, in February, the administration cut grants for behavioral science research on vaccine use and vaccine hesitancy, noting that the “studies no longer aligned with the administration’s priorities.” In June, Secretary of Health and Human Services Robert F. Kennedy, Jr., raised questions about the safety and efficacy of the measles vaccine, in use in this country since the 1960s, before dismissing all members of the ACIP and suggesting that “a clean sweep is necessary to reestablish public confidence in vaccine science.” For countries that have previously looked to the United States for leadership and guidance on preventing disease outbreaks, these moves risk greater erosion of trust in vaccines across multiple regions. To restore trust in vaccines and U.S. decisionmaking with respect to health, Congress could establish and fund an independent task force or commission. Members themselves could play a role in facilitating dialogues on the value of immunization programs in their districts, possibly by supporting the use of new communications tools to convene coalitions representing diverse perspectives and creating meaningful opportunities for parents to seek accurate information and converse in an honest and informed way about vaccine safety and efficacy.
• Recognize that immunization programs and vaccine-related research are engines of U.S. economic growth. By preventing illness and hospitalizations, vaccines enable children to remain in school, allowing family members to work and engage in income-generating activities. A recent study of the economic impact of the U.S. Vaccines for Children program showed that for the cohort born over 30 years between 1994 and 2023, vaccines prevented more than 500 million illnesses and more than 1 million deaths, leading to $540 billion in direct savings and broader societal savings of nearly $3 trillion. At the same time, vaccine research and development by U.S.-based companies has driven enormous progress in reducing disease and mortality associated with infectious pathogens. The Essential Program on Immunization was launched with a handful of vaccines for children in the 1970s, but over the intervening decades it has grown to offer 13 vaccines, including those for adolescents and adults, and against viruses that are now understood to lead to chronic diseases, including human papilloma virus and hepatitis B virus, as well as regionally-focused vaccines for Japanese encephalitis and malaria. Universities, the National Institutes of Health, the pharmaceutical industry, and nonprofit organizations collaborate in doing basic research, conducting clinical trials, and bringing new products to market. At congressional hearings in April, Gavi CEO Sania Nishtar noted that between 2012 and 2023, Gavi supported the purchase of $4 billion from U.S.-based vaccine manufacturers, with operations in Pennsylvania, New Jersey, and New York, among other locations. Cuts in federal funding for vaccine-related research at universities and the private sector will diminish support for innovations in product development and delivery, not to mention squander the training and expertise of a generation of scientists dedicating their professional lives to preventing infectious diseases that threaten the health of children and adults and can lead to destabilizing outbreaks. As argued in a recent publication by the CSIS Bipartisan Alliance for Global Health Security, by taking steps to preserve funding for vaccine research, including fellowships and professional pathways, Congress can slow the brain drain and reignite the engines of biomedical innovation, job creation, and economic growth.
• Ensure continued U.S. influence and strategic leadership in international disease prevention and control efforts. The dismantling of the U.S. Agency for International Development and the integration of remaining foreign assistance programs into the Department of State leaves few bilateral immunization initiatives in place. While it had earlier appeared that the Centers for Disease Control and Prevention (CDC)’s Global Immunization Division had survived the first round of cuts to the agency, reports on the administration’s budget proposal submitted to Congress in early June suggest the agency’s global health work, including more than $230 million in immunization support, is set to be eliminated. Over several decades, CDC personnel have developed deep relationships with country ministries of health and provide technical assistance and advice regarding the implementation of effective programs focused on eradicating polio, responding to measles outbreaks, and preventing other outbreaks of vaccine-preventable disease. Even if Atlanta-based programs are shuttered, it will be important for the CDC to maintain core capabilities related to addressing vaccine-preventable outbreaks through the country offices that remain to help countries requiring assistance ensure the most effective delivery of vaccines to their populations in a context of reduced external support. Congress could provide funding to extend the reach of well-regarded Field Epidemiology Training Programs, perhaps through expanded use of cost-effective online or digital platforms, to strengthen training and networks with country experts. It could also support the CDC in providing training to enable country health officials to use state-of-the-art data analysis and artificial intelligence to more precisely identify the communities where there are pockets of unvaccinated children and which threaten to seed a costly and difficult-to-control outbreak. Given the recent data from the World Health Organization–UNICEF Estimates of National Immunization Coverage (WUENIC), it is clear that countries in multiple world regions are still struggling to restore coverage to pre-Covid-19 levels. As it works to reauthorize the Department of State, Congress has an opportunity to assess how foreign affairs programs can improve support for bilateral immunization programs while also placing a high priority on training diplomats posted overseas to engage with counterparts and encourage investments in national immunization programs, along with broad societal dialogue regarding vaccination costs and benefits.