On an early September morning, dozens of families stood in line outside a clinic in Yeadon, Pennsylvania.
asserted
dozens → stand → Yeadon
It was “exclusion day”, the deadline by which students without complete immunizations are barred from returning to class.
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students → bar → 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.
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they → turn → desks
That day, 42 middle and high school students were vaccinated to protect against tetanus, pertussis and meningitis, among other diseases.
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students → vaccinate → diseases
“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.
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Werner → do → department
The vaccination day is one piece of the county’s back-to-school immunization campaign, as measles cases climbed to 693 in Pennsylvania as of 14 September and this year so far claimed the lives of four residents.
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cases → climb → residents
The campaign includes a mobile vaccine clinic – a 33ft traveling RV that brings vaccinations to pop-up community events – school district partnerships and vaccination data transparency, all to keep immunization rates from sliding.
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that → include → rates
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, culminating in a recent Trump executive order that seeks to break apart the measles, mumps and rubella (MMR) shot and shrink the list of vaccines recommended for American children.
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that → spend → children
The administration’s claims about vaccine safety are not just false, but are actively costing lives, advocates said.
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advocates → cost → lives
With federal guidance no longer reliable, the responsibility for reassuring parents and caretakers has shifted downward to governors and state legislatures, state health departments, healthcare advocacy groups and the doctors on the frontlines.
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responsibility → reassure → frontlines
Across the country, they’re mounting an urgent campaign to defend childhood vaccines against a wave of misinformation.
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they → mount → misinformation
“Our responsibility is to demonstrate what the science shows and put out a [vaccine] schedule that people can depend upon that is science-based and evidence-based,” said Andrew Racine, president of the American Academy of Pediatrics.
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Racine → demonstrate → Pediatrics
“Measles is a canary in the coal mine and we have to now worry about other vaccine-preventable diseases, which is why the local effort at the state level is so critical.”
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effort → have → level
Executive order creates chaos
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order → create → chaos
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, calling 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.
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Trump → get → visits
The order arrived with no new scientific evidence behind it.
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order → arrive → it
Paul Offit, director of the Vaccine Education Center at Children’s hospital of Philadelphia, trains doctors to share with their patients that the MMR vaccine has been used safely in the US for about 60 years.
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vaccine → train → years
Manufacturers have made clear they have no plans to split it into separate formulations, since doing so would offer no safety benefit, he said.
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he → make → benefit
Experts have also noted that more doctor’s visits would lead to more opportunities for missed appointments.
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visits → note → appointments
For many of the doctors and officials fighting the disinformation, the executive order is the latest development in a pattern set by Kennedy since he was confirmed.
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he → fight → Kennedy
Offit recalled when Kennedy went on Fox News last year and falsely claimed the measles vaccine causes blindness and death.
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vaccine → recall → blindness
“Could he be more dangerously irresponsible?” said Offit.
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Offit → say → ?
“He should have been fired right there, but he wasn’t.
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he → fire → ?
And that’s when he knew: I can say whatever I want with impunity.”
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I → ’ → impunity
Vaccine misinformation has led to vaccine hesitancy, Racine said.
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Racine → lead → hesitancy
CDC data shows that the number of kindergarteners claiming vaccine exemptions for the 2025-26 school year hit a record high, while vaccination rates for kindergarteners decreased from the year before.
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rates → show → year
Hesitancy is higher in certain rural areas, he said, and states that once had the highest vaccination rates in the country
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that → say → country
have fallen as they expanded vaccine exemptions.
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they → fall → exemptions
“This is the last thing parents wanted on their back-to-school list, to be confused about the childhood vaccine schedule or to be worried about their child coming home with measles,” said Shaughnessy Naughton, the founder of the non-profit advocacy group 3.14 Action.
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Naughton → want → group
“It’s why so many doctors and health professionals are now stepping up and fighting back against these dangerous actors”
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doctors → ’ → actors
The pushback is state by state, doctor by doctor
Because the federal government has abandoned its traditional role as a trusted, science-based source of vaccine guidance, that responsibility has fallen to state lawmakers and health departments, local public health officials and doctors.
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responsibility → abandon → lawmakers
Following RFK Jr’s appointment as health secretary, some state legislators examined their statutes on vaccines and removed references to the CDC.
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legislators → follow → CDC
In January, dozens of states announced that they would reject the CDC’s guidance.
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they → announce → guidance
Now, 30 states report relying on a source other than the CDC, such as the American Academy of Pediatrics and the American Academy of Family Physicians, for information about childhood vaccines.
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states → report → vaccines
Fifteen states sued the Trump administration earlier this year over its changes to the childhood vaccine schedule and the dismantling of the CDC’s vaccine advisory panel.
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states → sue → panel
They’ve also banded together.
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They → band → ?
California, Oregon, Washington and Hawaii formed the West Coast Health Alliance, and 15 states - including Connecticut, Maine, New York and Massachusetts – formed the Northeast Public Health Collaborative, two voluntary coalitions to strengthen regional awareness and preparedness on infectious diseases.
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states → form → diseases
Racine said that clear and consistent communication and maintaining vaccine access are key in building trust with the public.
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communication → say → public
That’s why states are reassuring practitioners of the standard vaccine schedule, regulating insurance to make sure companies continue to cover vaccines and launching public service announcements to communicate the importance of getting measles vaccines.
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companies → ’ → vaccines
For example, the Pennsylvania health department says it is ensuring that residents understand the risks of remaining unvaccinated by sharing videos and infographics that explain how contagious the disease is.
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disease → say → videos
…and 31 more, not listed.
The Aporia
