Vaccines in the U.S.: Understanding the Crisis of Public Trust and Its Impact - critical summary review

Measles is one of the most contagious viruses known. It spreads through the air, sends nearly one in five infected people to hospital, and can be fatal in one to three cases per thousand. It can also cause pneumonia and brain swelling. There is a vaccine, the MMR, which protects against measles, mumps and rubella: one dose is 93% effective against measles, a second dose raises that to 97%, and the immunity lasts for life. To stop outbreaks, at least 95% of a community has to be vaccinated.

That threshold is the whole story. The United States declared measles eliminated in 2000, and for the quarter-century that followed averaged just 180 cases a year nationwide. This year the country has recorded nearly 3,900 cases, according to the Centers for Disease Control and Prevention, its worst year since 1991.

Two things happened this week, and whether they are connected is itself in dispute. On Monday, New York Governor Kathy Hochul declared a state disaster emergency over a measles outbreak spreading from rural areas, the first such declaration by a US state since cases began surging in 2025. The same week, the Department of Health and Human Services launched a research centre dedicated to vaccine injuries, a longstanding priority of Health Secretary Robert F. Kennedy Jr., who co-founded and helped lead the group Children's Health Defense before stepping away to run for president. HHS rejects any link between its policies and the outbreak, attributing the resurgence to routine vaccinations interrupted during the pandemic; that dispute is laid out below.

What has changed in federal vaccine policy

Kennedy unveiled the new vaccine injury research centre on Monday during a visit to the National Institutes of Health, where the programme will be housed. "Vaccine injury is an invisible disease, and it is purposely invisible," he said at the event, according to footage shared by HHS. "We have not done the studies that need to be done to understand who's vulnerable to those kind of injuries." The announcement came with proposals to reform the federal adverse-event reporting system and to reimburse doctors who report suspected vaccine injuries, which HHS said would encourage health workers to file reports.

The CDC states on its website that there is a "very remote chance" of vaccines causing serious reactions, injuries or death. Dr. Peter Hotez, co-director of the Texas Children's Hospital Center for Vaccine Development, told CNN the existing system already works, pointing to its detection of rare side effects during the pandemic, such as myocarditis in young men who received mRNA vaccines, at a rate of roughly one in 20,000. Dr. Paul Offit, of the Children's Hospital of Philadelphia, told CNN the new initiative gives Kennedy a platform to create studies that fit his own bias.

Separately, no vaccines have been removed from the childhood schedule, but six of 17 have been moved to an optional category called "shared decision-making", in which each family decides with its doctor. Even that shift has been frozen by a federal judge. Siri & Glimstad lawyer Aaron Siri, who has worked closely with Kennedy, told Rolling Stone: "They should have just made all vaccines shared decision-making and left it at that."

The outbreak behind the emergency

New York has reported 108 cases this year through 3 October, up from one in 2023, 15 in 2024 and 48 in 2025. Of those, 92 have appeared since 15 July in under-immunised rural communities across 18 counties. The emergency order expands who can administer MMR shots: registered nurses may order tests, pharmacists may vaccinate children as young as two, and all MMR doses must be reported to state registries within 72 hours. It runs through 4 November.

Neighbouring Pennsylvania is the centre of the outbreak, having passed 1,000 cases with five deaths and 198 hospitalisations, the largest state outbreak in more than three decades. New York, Pennsylvania and Ohio all have sizeable Amish populations, which tend to be undervaccinated.

The federal government rejects the link between its policies and the resurgence. HHS spokesperson Emily Hilliard told Rolling Stone that attributing it to President Trump or Kennedy "fundamentally misrepresents when and why" it began, pointing to pandemic-era disruptions to routine vaccination that started years before they took office. HHS officials and Pennsylvania authorities have also publicly disputed how measles deaths should be counted.

How far trust has actually fallen

Americans' trust in the CDC has fallen amid Kennedy-led shake-ups at the agency, according to KFF polling in February. Pew Research Center polling last autumn found most voters across parties felt confident in the childhood vaccine schedule, though that was before Kennedy launched a narrowed immunisation schedule in December and reintroduced it this summer. A new Annenberg Public Policy Center survey found fewer than one in four Americans, 23%, view Kennedy favourably.

Kindergarten vaccination rates have dropped more than two percent since Kennedy became secretary in February 2025, and requests for religious or philosophical exemptions for school entry have climbed to four percent, according to Rolling Stone. An AP-KFF survey found 68% of rural supporters of the Make America Healthy Again movement said Trump's health policies had a negative effect or no impact on health where they live.

Where trust is rebuilt: a clinic in Amish country

The Central Pennsylvania Clinic, in Belleville, cares for children and adults with genetic disorders common among the Amish and broader Plain community. Dr. Katherine Mascia told CNN that in her five years there she had never seen so many patients admitted to hospital in so few weeks.

Lower vaccination rates among Plain people are not about inherent opposition, Mascia said. Consistency is what works: the clinic states its recommendation, and if a family declines, repeats it and says it will be there if they change their mind. Any sense of coercion, she said, would make patients disengage from health care altogether. A neighbour's experience or a relative's advice carries more weight than a journal paper, said Dr. Helge Hartung, who joined the clinic last year. New patient visits are blocked for two hours; every visit after that gets an hour.

That foundation shows in numbers. More than two dozen people were vaccinated at a pop-up clinic the practice hosted in mid-August, and 73 at a second in mid-September, with interest rising sharply after a death in Mifflin County was reported. The state health department told CNN that vaccinating a hundred people in Belleville "is considered very successful", and credited the clinic's decade of lasting relationships.

The legal front

A parallel fight runs through the courts. Only five states, including West Virginia, do not allow religious or philosophical exemptions to school vaccination. In August, Trump issued an executive order directing the attorney general to take legal action against them. West Virginia's compulsory-vaccination law dates to 1937; Governor Patrick Morrisey issued an executive order in January 2025 directing the state health department to allow religious exemptions, and the state Board of Education voted 9-0 to enforce the law as written. Siri's firm sued on behalf of a mother denied the exemption. A county judge ruled against the board in late November 2025; the Supreme Court of Appeals of West Virginia paused that ruling and, as of Rolling Stone's publication, has not decided.

Siri holds no government role. He told the magazine his position is that "everybody should be free to get as many vaccines as they want, but at the same token, everybody should be free to be able to decline a vaccine", and denies advising Kennedy on legal or regulatory matters. Del Bigtree, whose group has funded the litigation, said reaching the US Supreme Court is "absolutely the goal".

What to do with this information

Follow the formal decisions rather than the political scoreboard. Four markers will say more than any statement: what the new HHS research centre actually publishes and whether it reopens the childhood-schedule debate; the next moves on which vaccines sit in the "shared decision-making" category, now frozen by a federal judge; the pending ruling from West Virginia's Supreme Court of Appeals, and whether a religious-exemption case reaches the US Supreme Court; and the outbreak bulletins from the CDC and state health departments, which track cases, deaths and vaccination coverage against that 95% threshold.

If you live near an affected area, the practical question is coverage, not polling. Vaccination status, the second MMR dose and local case counts are checkable with a clinic or a state health department. The Belleville clinic suggests how slowly that conversation moves and how little it has to do with Washington.

In your own circle, who makes vaccination decisions on information from a doctor they have known for years, and who is making them on what they read about the fight in Washington?