Science
More parents are delaying their kids’ vaccines, and it’s alarming pediatricians
As measles cases pop up across the country this winter — including several in California — one group of children is stirring deep concerns among pediatricians: the babies and toddlers of vaccine-hesitant parents who are delaying their child’s measles-mumps-rubella shots.
Pediatricians across the state say they have seen a sharp increase recently in the number of parents with concerns about routine childhood vaccinations who are demanding their own inoculation schedules for their babies, creating a worrisome pool of very young children who may be at risk of contracting measles, a potentially deadly yet preventable disease.
“Especially early on, when a parent is already feeling really vulnerable and doesn’t want to give something to their beautiful baby who was just born if they don’t need it, it makes them think, ‘Maybe I’ll just delay it and wait and see.’” said Dr. Whitney Casares, a pediatrician and author who has written on vaccination for the American Academy of Pediatrics. “What they don’t realize is if they don’t vaccinate according to the recommended schedule, that can really set their child up for a whole lot of risks.”
It is difficult to know how widespread such delays have become. California keeps careful track of the rate of kindergartners who have been vaccinated against measles, but does not have comprehensive data for children at younger ages.
Dr. Eric Ball has seen the shift firsthand. At his Orange County pediatric practice, Ball said, he has noticed an increase in parents asking about delays since the COVID-19 pandemic, as politicization of and misinformation about that vaccine has seeped into discussions about routine childhood vaccinations, including measles-mumps-rubella, known as MMR.
Dr. Eric Ball examines 9-month-old Noah at Southern Orange County Pediatric Associates in Ladera Ranch on Feb. 28.
(Christina House / Los Angeles Times)
Rather than an outright refusal, however, these vaccine-hesitant parents express a softer kind of reluctance, asking if it’s possible to use an “alternative schedule” of vaccines, rather than sticking to the Centers for Disease Control and Prevention’s recommendations. Sometimes they seek to delay the shots by a few months, and sometimes by several years.
“I have patients who have three kids, and they vaccinated the first two kids on schedule. And then since COVID, with their third kid, they are like, ‘I don’t know if this is safe. I want to wait until the kids are older’, or ‘instead of doing two shots today, I want to do one shot,’” said Ball. “It just prolongs the time where you have a child who’s unprotected and potentially can get sick from these diseases.”
He tries his best to explain to parents the importance and safety of vaccines, including MMR. He even brings out his own children’s vaccine records to prove his point, and he is often successful. But not always.
At Children’s Hospital Los Angeles, attending pediatrician Dr. Colleen Kraft said about half of parents are questioning the CDC’s recommended vaccine schedule — a significant increase since the pandemic.
“Even my most reasonable parents ask questions. So it’s definitely in the mainstream,” she said. She also worries about her patients who are behind on vaccines because they missed so many appointments during the pandemic and are only now returning to her office.
Karla Benzl holds her son, 15-month-old Marcus, before he gets vaccinated at Southern Orange County Pediatric Associates in Ladera Ranch on Feb. 28.
(Christina House / Los Angeles Times)
In Marin County, parents’ requests to delay vaccinations have become so frequent that Dr. Nelson Branco said last month his practice decided to tighten vaccine requirements as cases of both measles and pertussis have spread. Babies seen by doctors in the practice will need to have their first set of vaccines completed by 4 months of age. The primary series of vaccines against the most serious and common diseases, including measles, must be completed by 24 months.
If parents don’t agree, they must leave the practice.
“Kids are doing a lot of things that are high risk before they’re 5 and are required to be vaccinated to attend kindergarten, said Branco. “They’re getting on international flights, they’re going to Disneyland where there are lots of kids,” leaving young children vulnerable to measles when they could be protected.
The CDC recommends that the first dose of MMR be given when a baby is 12 to 15 months old. Usually this happens at a child’s 12-month well visit. A second dose is then given at 4 to 6 years of age.
At least 95% of people in a community must be vaccinated to achieve a level of “herd immunity” that protects everyone in a community, including those who cannot get the vaccine because they are too young or are immunocompromised, according to the World Health Organization.
Low vaccination rates have led to measles outbreaks in several states over the last decade, most recently in Florida.
Nationally, the rate of kindergartners fully immunized against the measles dropped from 95% in the 2019-20 school year to 93% in 2022-23, according to the CDC.
But there is overall good news in California. Since the state’s 2015 ban on parents’ personal beliefs as a reason to skip vaccinating children before school, the measles vaccination rate for kindergartners has grown from 92% in the 2013-2014 school year to 96.5% in 2022-2023.
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But those postponing vaccinations have created a potential vulnerability gap in a child’s first four years.
One in 5 unvaccinated people who get measles in the U.S. will be hospitalized. Since there is no good treatment for measles, doctors can often do little more than offer supportive care. One in 1,000 children with measles will develop brain swelling that can leave a child deaf or with an intellectual disability; 1 to 3 children in 1,000 will die, according to the CDC.
Measles is so contagious that 90% of people close to an infected person will catch it if they are not immune, according to the CDC. The virus can remain contagious in a room or on a surface for up to two hours after the infected person has left.
In the Children’s Hospital Orange County primary care network, which has more than 130 pediatricians, the share of 15-month-olds with an MMR vaccine has been dropping consistently over the past last few years, from 98% in 2019, down to 93.5% in 2023.
For years in the early 2000s, anti-vaccine sentiment was at an all-time high after the publication of a now-debunked and retracted study that falsely tied the MMR vaccine to autism. In December 2014, an unvaccinated 11-year-old was hospitalized with measles following a visit to Disneyland. Over the next few months, measles spread to 125 people across seven states.
The outbreak helped galvanize support for vaccination nationwide. A year after the Disneyland outbreak, California passed its ban on personal exemption.
“The pendulum swung back the other way, and we had a few years where vaccination rates were really high,” said Ball. But the rumors and rhetoric surrounding the COVID vaccines have caused the pendulum to swing in the other direction. “We’re back to dealing with conspiracy theories, things that people heard on the internet, or something that their cousin’s neighbor’s roommate said. It’s really hard.”
Noah, who is 9 months old, gets his measurements taken by medical assistant Shellee Rayl at Southern Orange County Pediatric Associates in Ladera Ranch on Feb. 28.
(Christina House / Los Angeles Times)
A Pew Research poll conducted in March 2023 found that 88% of Americans are confident that the benefits of an MMR vaccine outweigh the risks, a percentage that has remained fairly consistent since before the pandemic.
But support for all school-based vaccine mandates has fallen; 28% now say that parents should be able to decide not to vaccinate their children, even if it causes health risks for others, up from 16% in October 2019. Among Republicans, the share has more than doubled, from 20% in 2019 to 42% in 2023.
Support for the MMR vaccine was lower among parents with young children, the poll found. About 65% of parents with children under age 5 reported that the preventative health benefits of MMR were high — compared to 88% of all adults — and 39% said the risk of side effects was either medium or high; half said they worried about whether all childhood vaccines are necessary.
Tara Larson, a former ER nurse who lives in Santa Monica, said she became concerned about childhood vaccination when she was pregnant last year. She started watching anti-vaccine documentaries, reading vaccine safety inserts, and following several social media accounts “to make us an informed vaxxer. We’re not anti-vax,” she said.
Larson decided that she wanted to delay vaccinating her son until he was 3 months old, to limit him to just three vaccines in his first year that she felt were essential, and to spread them out so that he would only get one shot per month. “By the time he starts playing on the playground and goes to school, he’ll need to start his course of Hep B, but why overload his course of vaccines right now?” she said.
The first pediatrician she saw refused to follow her requested schedule. But, Larson said, “in my gut, I just felt like this is the right thing to be doing for our baby, and I left.” After weeks of searching, she found a holistic provider who charges a $250 monthly fee and agreed with her approach.
She said she hasn’t yet decided whether to give her son, who is now 8 months old, the MMR vaccine when he becomes eligible. “I think some doctors will say to wait until they’re 3, but that was when there wasn’t a resurgence of measles,” she said. “That’s my next thing to dive into.”
Karla Benzl of Mission Viejo comforts her 15-month-old son, Marcus, after he received his vaccinations.
(Christina House / Los Angeles Times)
But there’s no scientific basis and no known benefits to delaying vaccines except in very rare medical circumstances, said Casares, whose pediatric practice is in Oregon.
Casares said the problem is that parents have an “exposure bias.” They often consume an onslaught of information on social media about the risks, but very little about the benefits of vaccines or the enormous risks of the diseases themselves. She said in a country such as the United States, where vaccination rates are fairly high, most people don’t see the ravages that the diseases can cause if rates fall.
This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.
For the last few years, the Marine Mammal Center has been testing any patients with bird-flu-like symptoms, which include respiratory and neurological problems, for the virus.
California lawmakers are taking aim at proposed rules to implement a state law aimed at curbing plastic waste, saying the draft regulations proposed by CalRecycle undermine the letter and intent of the legislation.
In a letter to Gov. Gavin Newsom and two of his top administrators, the lawmakers said CalRecycle exceeded its authority by drafting regulations that don’t abide by the terms set out by the law, Senate Bill 54.
“While we support many changes in the current draft regulations, we have identified several provisions that are inconsistent with the governing statute … and where CalRecycle has exceeded its authority under the law,” the lawmakers wrote in the letter to Newsom, California Environmental Protection agency chief Yana Garcia, and Zoe Heller, director of the state’s Department of Resources Recycling and Recovery, or CalRecycle.
The letter, which was written by Sen. Catherine Blakespear (D-Encinitas) and Sen. Benjamin Allen (D-Santa Monica), was signed by 21 other lawmakers, including Sen. John Laird (D-Santa Cruz) and Assemblymembers Al Muratsuchi (D-Rolling Hills Estates) and Monique Limón (D-Goleta).
CalRecycle submitted informal draft regulations two weeks ago that are designed to implement the law, which was authored by Allen, and signed into law by Newsom in 2022.
The lawmakers’ concerns are directed at the draft regulations’ potential approval of polluting recycling technologies — which the language of the law expressly prohibits — as well as the document’s expansive exemption for products and packaging that fall under the purview of the U.S. Department of Agriculture and the Food and Drug Administration.
The inclusion of such blanket exemptions is “not only contrary to the statute but also risks significantly increasing the program’s costs,” the lawmakers wrote. They said the new regulations allow “producers to unilaterally determine which products are subject to the law, without a requirement or process to back up such a claim.”
Daniel Villaseñor, a spokesman for the governor, said in an email that Newsom “was clear when he asked CalRecycle to restart these regulations that they should work to minimize costs for small businesses and families, and these rules are a step in the right direction …”
At a workshop held at the agency’s headquarters in Sacramento this week, CalRecycle staff responded to similar criticisms, and underscored that these are informal draft regulations, which means they can be changed.
“I know from comments we’ve already been receiving that some of the provisions, as we have written them … don’t quite come across in the way that we intended,” said Karen Kayfetz, chief of CalRecycle’s Product Stewardship branch, adding that she was hopeful “a robust conversation” could help highlight areas where interpretations of the regulations’ language differs from the agency’s intent.
“It was not our intent, of course, to ever go outside of the statute, and so to the extent that it may be interpreted in the language that we’ve provided, that there are provisions that extend beyond … it’s our wish to narrow that back down,” she said.
These new draft regulations are the expedited result of the agency’s attempt to satisfy Newsom’s concerns about the law, which he said could increase costs to California households if not properly implemented.
Newsom rejected the agency’s first attempt at drafting regulations — the result of nearly three years of negotiations by scores of stakeholders, including plastic producers, package developers, agricultural interests, environmental groups, municipalities, recycling companies and waste haulers — and ordered the waste agency to start the process over.
Critics say the new draft regulations cater to industry and could result in even higher costs to both California households, which have seen large increases in their residential waste hauling fees, as well as to the state’s various jurisdictions, which are taxed with cleaning up plastic waste and debris clogging the state’s rivers, highways, beaches and parks.
The law is molded on a series of legislative efforts described as Extended Producer Responsibility laws, which are designed to shift the cost of waste removal and disposal from the state’s jurisdictions and taxpayers to the industries that produce the waste — theoretically incentivizing a circular economy, in which product and packaging producers develop materials that can be reused, recycled or composted.
As promised, federal health officials have dropped longstanding recommendations that healthy children and healthy pregnant women should get the COVID-19 vaccines.
“The COVID-19 vaccine schedule is very clear. The vaccine is not recommended for pregnant women. The vaccine is not recommended for healthy children,” the U.S. Department of Health and Human Services said in a post on X on Friday.
In formal documents, health officials offer “no guidance” on whether pregnant women should get the vaccine, and ask that parents talk with a healthcare provider before getting the vaccine for their children.
The decision was done in a way that is still expected to require insurers to pay for COVID-19 vaccines for children should their parents still want the shots for them.
The new vaccine guidelines were posted to the website of the U.S. Centers for Disease Control and Prevention late Thursday.
The insurance question
It wasn’t immediately clear whether insurers will still be required under federal law to pay for vaccinations for pregnant women.
The Trump administration’s decision came amid criticism from officials at the nation’s leading organizations for pediatricians and obstetricians. Some doctors said there is no new evidence to support removing the recommendation that healthy pregnant women and healthy children should get the COVID vaccine.
“This situation continues to make things unclear and creates confusion for patients, providers and payers,” the American College of Obstetricians and Gynecologists said in a statement Friday.
Earlier in the week, the group’s president, Dr. Steven Fleischman, said the science hasn’t changed, and that the COVID-19 vaccine is safe during pregnancy, and protects both the mom-to-be and their infants after birth.
“It is very clear that COVID-19 infection during pregnancy can be catastrophic,” Fleischman said in a statement.
Dr. Susan Kressly, president of the American Academy of Pediatrics, criticized the recommendation change as being rolled out in a “conflicting, confusing” manner, with “no explanation of the evidence used to reach their conclusions.”
“For many families, the COVID vaccine will remain an important way they protect their child and family from this disease and its complications, including long COVID,” Kressly said in a statement.
Some experts said the Trump administration should have waited to hear recommendations from a committee of doctors and scientists that typically advises the U.S. Centers for Disease Control and Prevention on immunization recommendations, which is set to meet in late June.
California’s view
The California Department of Public Health on Thursday said it supported the longstanding recommendation that “COVID-19 vaccines be available for all persons aged 6 months and older who wish to be vaccinated.”
The changes come as the CDC has faced an exodus of senior leaders and has lacked an acting director. Typically, as was the case during the first Trump administration and in the Biden administration, it is the CDC director who makes final decisions on vaccine recommendations. The CDC director has traditionally accepted the consensus viewpoint of the CDC’s panel of doctors and scientists serving on the Advisory Committee on Immunization Practices.
Even with the longstanding recommendations, vaccination rates were relatively low for children and pregnant women. As of late April, 13% of children, and 14.4% of pregnant women, had received the latest updated COVID-19 vaccine, according to the CDC. About 23% of adults overall received the updated vaccine, as did 27.8% of seniors age 65 and over.
The CDC estimates that since October, there have been 31,000 to 50,000 COVID deaths and between 270,000 and 430,000 COVID hospitalizations.
Here are some key points about the CDC’s decision:
New vaccination guidance for healthy children
Previously, the CDC’s guidance was simple: everyone ages 6 months and up should get an updated COVID vaccination. The most recent version was unveiled in September, and is officially known as the 2024-25 COVID-19 vaccine.
As of Thursday, the CDC, on its pediatric immunization schedule page, says that for healthy children — those age 6 months to 17 years — decisions about COVID vaccination should come from “shared clinical decision-making,” which is “informed by a decision process between the healthcare provider and the patient or parent/guardian.”
“Where the parent presents with a desire for their child to be vaccinated, children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a healthcare provider and personal preference and circumstances,” the CDC says.
The vaccine-skeptic secretary of Health and Human Services, Robert F. Kennedy Jr., contended in a video posted on Tuesday there was a “lack of any clinical data to support the repeat booster strategy in children.”
However, an earlier presentation by CDC staff said that, in general, getting an updated vaccine provides both children and adults additional protection from COVID-related emergency room and urgent care visits.
Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert, said he would have preferred the CDC retain its broader recommendation that everyone age 6 months and up get the updated vaccine.
“It’s simpler,” Chin-Hong said. He added there’s no new data out there that to him suggests children shouldn’t be getting the updated COVID vaccine.
A guideline that involves “shared decision-making,” Chin-Hong said, “is a very nebulous recommendation, and it doesn’t result in a lot of people getting vaccines.”
Kressly, of the American Academy of Pediatrics, said the shared clinical decision-making model is challenging to implement “because it lacks clear guidance for the conversations between a doctor and a family. Doctors and families need straightforward, evidence-based guidance, not vague, impractical frameworks.”
Some experts had been worried that the CDC would make a decision that would’ve ended the federal requirement that insurers cover the cost of COVID-19 vaccines for children. The out-of-pocket cost for a COVID-19 vaccine can reach around $200.
New vaccine guidance for pregnant women
In its adult immunization schedule for people who have medical conditions, the CDC now says it has “no guidance” on whether pregnant women should get the COVID-19 vaccine.
In his 58-second video on Tuesday, Kennedy did not explain why he thought pregnant women should not be recommended to get vaccinated against COVID-19.
Chin-Hong, of UCSF, called the decision to drop the vaccination recommendation for pregnant women “100%” wrong.
Pregnancy brings with it a relatively compromised immune system. Pregnant women have “a high chance of getting infections, and they get more serious disease — including COVID,” Chin-Hong said.
A pregnant woman getting vaccinated also protects the newborn. “You really need the antibodies in the pregnant person to go across the placenta to protect the newborn,” Chin-Hong said.
It’s especially important, Chin-Hong and others say, because infants under 6 months of age can’t be vaccinated against COVID-19, and they have as high a risk of severe complications as do seniors age 65 and over.
Not the worst-case scenario for vaccine proponents
Earlier in the week, some experts worried the new rules would allow insurers to stop covering the cost of the COVID vaccine for healthy children.
Their worries were sparked by the video message on Tuesday, in which Kennedy said that “the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule.”
By late Thursday, the CDC came out with its formal decision — the agency dropped the recommendation for healthy children, but still left the shot on the pediatric immunization schedule.
Leaving the COVID-19 vaccine on the immunization schedule “means the vaccine will be covered by insurance” for healthy children, the American Academy of Pediatrics said in a statement.
How pharmacies and insurers are responding
There are some questions that don’t have immediate answers. Will some vaccine providers start requiring doctor’s notes in order for healthy children and healthy pregnant women to get vaccinated? Will it be harder for children and pregnant women to get vaccinated at a pharmacy?
In a statement, CVS Pharmacy said it “follows federal guidance and state law regarding vaccine administration and are monitoring any changes that the government may make regarding vaccine eligibility.” The insurer Aetna, which is owned by CVS, is also monitoring any changes federal officials make to COVID-19 vaccine eligibility “and will evaluate whether coverage adjustments are needed.”
Blue Shield of California said it will not change its practices on covering COVID-19 vaccines.
“Despite the recent federal policy change on COVID-19 vaccinations for healthy children and pregnant women, Blue Shield of California will continue to cover COVID-19 vaccines for all eligible members,” the insurer said in a statement. “The decision on whether to receive a COVID-19 vaccine is between our member and their provider. Blue Shield does not require prior authorization for COVID-19 vaccines.”
Under California law, health plans regulated by the state Department of Managed Health Care must cover COVID-19 vaccines without requiring prior authorization, the agency said Friday. “If consumers access these services from a provider in their health plan’s network, they will not need to pay anything for these services,” the statement said.
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