Ask any pediatrician who practiced forty years ago about polio, measles or bacterial meningitis. You’ll likely hear stories that many younger physicians have never experienced firsthand and a stark reminder how quickly things can change for the positive or negative. Some healthcare providers may spend their entire careers without ever treating these diseases, not because they disappeared, but because vaccines pushed them into the background. Ironically, that same blessing has slowly become a curse… Public health experts call this the vaccine paradox. The greatest victories in public health are often the ones we no longer notice because they are measured by the illnesses we’ve never seen firsthand.
The more successful vaccines become, the less visible the diseases they prevent. When parents no longer see children in iron lungs from polio or hospital rooms filled with measles complications, it’s natural to perceive those diseases as problems of the past.
What We Forgot
Once diseases become uncommon, it’s easy to forget just how devastating they once were. History tells a very different story. For most of human history, surviving childhood was not a given. At the start of the 20th century, infectious diseases including diphtheria, measles, pertussis, and diarrheal illness were the leading causes of death among American children. By 1998, after widespread childhood vaccination programs took hold, the share of US pediatric deaths caused by infectious disease had fallen from roughly 62 percent to 2 percent.
The impact extended far beyond childhood. US life expectancy rose from 47 years in 1900 to 77 years in 2000. Public health advances account for 25 of those 30 added years, and vaccination is among the most impactful of them. A 2024 study in The Lancet estimated that vaccines have saved 154 million lives worldwide since 1974. Ninety-five percent of those saved were children under five.
Herd Immunity Is a Shared Asset
Success can create complacency. When a disease becomes rare, our attention naturally shifts toward the potential risks of prevention rather than the disease itself. This is why maintaining high vaccination becomes more challenging over time.
Vaccination protects the person who receives it, but herd immunity protects everyone else. When enough of a population is immune, a pathogen cannot find a chain of susceptible hosts to move through, which shields the people who cannot be vaccinated: newborns too young for a first dose, patients on chemotherapy, people with compromised immune systems. That protection has a threshold, and measles, one of the most contagious diseases known, requires roughly 95 percent coverage to stop community transmission. Below that line, the shared asset degrades for everyone, not only the unvaccinated.
The Line Is Slipping
The vaccine paradox isn’t the only reason vaccination rates have shifted. The modern information landscape has changed dramatically. A fraudulent 1998 study that falsely linked the MMR vaccine to autism was later retracted, yet its influence continues decades later. Social media now allows misinformation to spread faster than ever before, while the COVID-19 pandemic introduced new political and cultural debates that expanded skepticism toward routine childhood immunizations.
The threshold matters because coverage is falling. Kindergarten MMR vaccination rates have dropped below 95 percent since the 2019 to 2020 school year. During the 2023 to 2024 school year, 39 states fell under that line, up from 28 states four years earlier. Nonmedical exemptions are rising in parallel. This is not a hypothetical erosion. It is the specific condition under which measles returns.
Why This Lands Hardest on Women and Children
Children are the primary target population for most vaccines because they carry the highest risk of severe disease ( ever notice how kids always bring home every bug). The benefit compounds for maternal and infant health. Maternal vaccination against influenza and pertussis passes antibodies to infants who are too young to be vaccinated themselves, covering the most vulnerable window of a newborn’s life. There is a longer historical thread here as well. Women were systematically underrepresented in clinical research for decades, which left real gaps in how interventions were understood across sexes. Immunization is one of the areas where the evidence base for women and children is now deep and well established. Ironically, one of the few clinically validated options for women and children are now vilified.
Where Pharmacists Fit
Access is the practical lever. Nearly 90 percent of Americans live within five miles of a pharmacy. For many families, the local community pharmacist is the most accessible healthcare professional they will see all year. Every conversation, every recommendation, and every vaccine administered at a pharmacy is one that did not require a separate appointment, a day off work, or a drive a patient could not make. This helps strengthen the protection that entire communities depend on. Coverage thresholds are met one dose at a time, and accessibility is what determines whether that dose happens.
Conclusion
Immunization is quiet infrastructure that works best when it is invisible, and it becomes visible again only when it fails. Perhaps the greatest compliment we can give vaccines is that many parents have never needed to fear diseases they prevent. The challenge today isn’t proving vaccines work but remembering why they mattered in the first place. Do your part. Is your pharmacy is running immunization services? What is working and where the access gaps still are.
Further Reading
The Lancet, global vaccine impact estimate (2024): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext
Center for American Progress, childhood vaccination and rising hesitancy: https://www.americanprogress.org/article/childhood-vaccination-has-saved-millions-of-lives-but-rising-hesitancy-could-reverse-decades-of-progress/
CDC, vaccines and immunizations: https://www.cdc.gov/vaccines/index.html
No posts
Comments
Nothing yet. Say the first thing.
Sign in to join the conversation.