Earlier this year, Dr. Kirk Milhoan, a pediatric cardiologist and the Trump administration’s choice to lead the Centers for Disease Control and Prevention’s vaccine advisory committee, argued on a podcast that the necessity of vaccines for diseases like measles and polio should be re-evaluated today because modern medical care and sanitation have improved infection and survival rates.
“We take care of children much differently,” he said, comparing care today with what it was in the 1960s. He mentioned that there are now more children’s hospitals and pediatric intensive care units to treat children with measles.
In my research on parents who reject vaccines, I regularly hear them describe their willingness to seek out medical care and hospitalization when their children get sick, or give them treatments like antibiotics, even if they view vaccines as unnecessary. But the assumption that hospitals can easily absorb an increase in vaccine-preventable diseases is flawed and dangerous.
Pediatric emergency medicine and intensive care are struggling. Children’s hospitals are facing work force shortages and a critical lack of funding. Unlike in the era Dr. Milhoan refers to, many doctors today have never seen a measles or polio case in their practice.
The erosion of public confidence in vaccines alongside the increasing strain on hospitals may lead to catastrophic results for children and their families. Measles has already been seen in at least 30 states in 2026, with an estimated 92 percent of cases in people who are unvaccinated. In 2025, 11 percent of the 2,284 people infected with measles were hospitalized, and three died. As a result, the United States is at risk of losing its measles elimination status, a designation given to countries that haven’t had continuous spread of the disease for over a year.
Caring for children who are very sick requires providers who are trained in pediatric care and health care facilities with the capacity to treat them. This combination is becoming increasingly scarce. From 2008 to 2022, the United States lost about 30 percent of its pediatric inpatient units, with rural communities disproportionately affected. This is in part because of the high costs and low revenue associated with caring for kids. Medicaid — which insures many American children, including about half of children with special health care needs — pays less than Medicare and private insurance. The economics of caring for children don’t make sense for many hospitals.
There’s also a growing shortage of pediatric health care workers. Hospitals are struggling to hire enough staff in key specialties for child patients, including neurology and respiratory and physical therapy. In 2025, only around 78 percent of pediatric specialty training spots were filled, with almost half of infectious disease spots left vacant. These specialists typically earn less than their peers who treat adults do, and must undergo longer training, making the work unappealing. Yet demand for this expertise will increase if there are growing complications from vaccine-preventable diseases.
Parents should know that health care workers practicing today may not be familiar with treating illnesses like measles, polio or Haemophilus influenzae Type B (Hib), once a leading cause of meningitis. Complications from these diseases can last for years or appear even decades after infection. An estimated 25 percent to 40 percent of polio survivors are expected to develop post-polio syndrome, which causes muscle weakness and symptoms ranging from extreme fatigue and joint pain to trouble swallowing and breathing. Hepatitis B causes long-term liver disease and can cause cognitive decline.
As a recent case in South Carolina illustrates, children with measles-related brain swelling may require intensive rehabilitation to regain the ability to speak or walk, and may even need lifelong support. Yet many communities lack the capacity to provide this level of care, and few families can afford it.
We’ve already seen how shortages in pediatric beds and staffing affect all children. In the fall of 2022, the “tripledemic” of Covid-19, flu and RSV resulted in a record number of sick children, longer emergency department wait times, overwhelmed intensive care units and postponed surgeries. This could become increasingly common.
A federal judge recently ruled that the Trump administration’s decisions to change vaccine policy and dismiss all previous C.D.C. vaccine advisory committee members and replace them with individuals such as Dr. Milhoan most likely violated federal law. This decision may preserve some vaccine protections for now. But it doesn’t change the fact that more U.S. children are remaining unvaccinated for longer periods, and that parents feel increasingly unsure about the safety and importance of vaccines. If these trends continue, the strain on pediatric care will only intensify.
Jennifer Reich is a professor of sociology at the University of Colorado Denver. She is the author of “Calling the Shots: Why Parents Reject Vaccines” and “Fixing Families: Parents, Power, and the Child Welfare System.”
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