Special thanks to Dial Hewlett, Jr., MD, FACP, FIDSA, for this guest blog post on the dangers of forgetting the history of children harmed by vaccine-preventable diseases. Hewlett is medical director of tuberculosis services at the Westchester County Department of Health Clinics, infectious disease consultant at Calvary Hospital in the Bronx, and adjunct associate professor at New York Medical College.
“Those who cannot remember the past are condemned to repeat it.”
— George Santayana, The Life of Reason (1905)
Efforts that undermine confidence in vaccines—or diminish the role of science and history in shaping public health—risk erasing hard-earned lessons about vaccine-preventable diseases. The consequences of that erosion are not evenly distributed. Communities already facing disparities in access and outcomes, including Black children in the United States, are at greatest risk of being disproportionately impacted.
A December 2025 study from KFF highlights persistent gaps in vaccine confidence. While most parents across racial and ethnic groups expressed confidence in the safety of vaccines such as those for measles-mumps-rubella (MMR) and polio, Black parents are at least 10 percentage points less likely than White and Hispanic parents to express confidence. A separate KFF/Washington Post survey found only 55% of Black parents report confidence in flu vaccine safety for children, compared to about 64% of White parents and nearly 70% of Hispanic parents.
These differences in confidence are reflected in vaccination rates. Just 64% of Black children in the KFF survey had received recommended immunizations by age 24 months—the second lowest rate among racial and ethnic groups. The KFF/Washington Post survey found that only 34% of Black parents identify as “pro-vaccine,” compared to 51% of White parents.
In this context, recent public comments from leadership of the Advisory Committee on Immunization Practices (ACIP) suggesting that measles and polio vaccination could be optional raise serious concerns. Such perspectives overlook the well-documented consequences of declining vaccination rates.
Before vaccines were available, these diseases caused widespread harm. In 1952 alone, the US recorded more than 21,000 cases of paralytic polio and more than 3,000 deaths. Before the measles vaccine, an estimated 4.5 million cases occurred annually, resulting in hundreds of child deaths each year, along with significant complications including vision and hearing loss.
Even in the modern vaccine era, outbreaks have demonstrated what happens when immunization coverage falls. Measles outbreaks in New York City in 1990 and Philadelphia in 1991 disproportionately affected Black and Hispanic children and resulted in multiple deaths—most among unvaccinated children. These events exposed gaps in access to vaccination and public health infrastructure that continue to have implications today.
Although recent measles outbreaks have not disproportionately affected Black communities, declining vaccination rates increase the risk that similar patterns could re-emerge. Research from the University of Minnesota School of Public Health underscores how gaps in access can contribute to vulnerability, particularly among underserved populations. Based on data from more than 310,000 children born in Minnesota between 2017-2021, investigators found that only 31% of Somali children and 64% of Ethiopian children in Minnesota had received the measles vaccine by age 24 months. Measles vaccination rates less than 92% place communities at significant risk for outbreaks.
The consequences of under-immunization are evident beyond measles. According to the Centers for Disease Control and Prevention (CDC), the 2024–2025 flu season was the deadliest for US children in more than a decade. Black children experienced the highest mortality rate and accounted for nearly one-quarter (23%) of pediatric flu deaths—most of which (89%) occurred in unvaccinated children.
Similarly, COVID-19 data show that vaccination significantly reduced the risk of hospitalization and death–saving up to 3 million lives in the US–but research published in the Journal of the Pediatric Infectious Diseases Society found that Black and Hispanic populations experienced disproportionately higher rates of COVID-19 cases and deaths.
There are also growing concerns about the potential return of infections once thought to be under control. Before the introduction of the Haemophilus influenzae type b (Hib) vaccine, about 20,000 US children developed severe disease each year, and approximately 1,000 died. Historically, Black children experienced rates of Hib disease several times higher than White children–3 to 4 times more. While vaccination dramatically reduced these cases, disparities persist and could widen if coverage declines.
Taken together, these data underscore a clear and urgent reality: vaccines are one of the most effective tools for preventing serious illness and death, but their benefits depend on sustained, equitable uptake.
Efforts to weaken routine immunization recommendations or move away from long-standing, evidence-based review processes risk reversing decades of progress. One would expect national public health leaders to be aware of the history of vaccine-preventable disease and the impact childhood vaccines have had on dramatically reducing severe illness and death in children.
The failure to understand the history of vaccine-preventable diseases in this country dooms our children to again suffer needlessly from preventable infections.
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