As the world grapples with the lingering effects of the COVID-19 pandemic, a new and troubling pattern is emerging: declining vaccination rates among children, rising nonmedical exemptions, and renewed threats from some of the world’s deadliest infectious diseases. From Texas to Papua New Guinea, and even as far as South Africa, the battle against preventable illnesses is being fought not just in clinics and hospitals, but also in the halls of government, on social media, and within families wrestling with difficult decisions.
In the United States, the start of the 2024-2025 school year has brought a sharp focus on vaccination rates among kindergarteners. According to USA TODAY, 17 states now report that more than 5% of their kindergarteners are claiming nonmedical vaccine exemptions—a significant jump from previous years. To put this in perspective, just five years ago, only three states reported that less than 90% of their kindergarteners were vaccinated against measles, mumps, and rubella. By the last academic year, that number had ballooned to 16 states. The consequences of these trends are beginning to materialize, with outbreaks of diseases once thought to be largely under control.
Becca Harkleroad, executive director of the Texas School Nurses Organization, has seen the shift firsthand. "It never occurred to me until I was a school nurse that immunizations could be such a controversial topic," she told USA TODAY. The controversy has only grown more divisive in recent years, she said, as more parents seek exemptions for religious or philosophical reasons. For school nurses, the extra workload of managing exemptions and navigating heated conversations often falls squarely on their shoulders. "What we try to do is prepare our nurses as much as possible to have those hard conversations… To hear what parents say and respond in a nonjudgmental way," Harkleroad explained. "A kid is a parent’s most absolute precious treasure. Of course, they’re going to question everything they do."
In Texas alone, about 4.3% of kindergarteners opted out of receiving vaccines for nonmedical reasons during the 2024-2025 school year. This is especially concerning given the recent measles outbreak in West Texas, which ended on August 18, 2025. The outbreak resulted in 762 cases—two-thirds of them in children—and two deaths of school-aged children since late January. More than 94% of those affected were unvaccinated, according to the Texas Department of State Health Services.
Health experts warn that if the trend continues, Texas may fall short of the 95% vaccination rate needed to achieve herd immunity and prevent future outbreaks. Dr. Sapna Singh, chief medical officer at Texas Children’s Pediatrics, shared her concerns: "It’s extremely concerning and it’s a discussion I’ve been having more and more with families." The challenge is compounded by a new Texas law, effective September 1, 2025, which allows parents to download vaccine exemption forms online, rather than requesting them by mail. While supporters argue the change modernizes a burdensome process, critics worry it will make exemptions too accessible, especially for families in rural areas with limited healthcare access.
The story is similar in other states. In Pennsylvania, for example, parents can also write a letter to opt out of mandated vaccines, contributing to a 6% exemption rate among kindergarteners this year. Holly Verderame, president of the Pennsylvania Association of School Nurses and Practitioners, noted, "School nurses, in general, are always concerned about an outbreak of any kind. It’s part of our surveillance." The rise in exemptions is fueled not only by legislative changes but also by persistent misinformation on social media and mixed messages from health authorities.
Dr. Philip Huang, director of the Dallas County Health and Human Services, pointed out that conflicting guidance from federal officials has made matters worse. On August 19, 2025, the American Academy of Pediatrics (AAP) released its own vaccine recommendations, urging all children between six months and 23 months to receive the latest COVID-19 vaccine. This move came after Health and Human Services Secretary Robert F. Kennedy Jr. announced in May that the Centers for Disease Control and Prevention (CDC) was no longer recommending the shot for healthy children. "What’s disturbing are these mixed messages... that are not consistent with the science and are coming from the highest levels of Health and Human Services," Huang said to USA TODAY. The confusion has left many parents unsure whom to trust, leading to further declines in vaccination rates.
Meanwhile, the threats posed by infectious diseases are not confined to the United States. In the Indo-Pacific region, the situation is no less urgent. According to the Global Fund’s Indo-Pacific regional impact report released on August 18, 2025, Papua New Guinea (PNG) recorded 11,000 new HIV cases in 2024 and declared a national HIV crisis in June 2025. Fiji, too, declared an HIV outbreak in January 2025 after almost 1,600 new infections the previous year. Tuberculosis remains PNG’s leading cause of death, prompting the health minister to declare "a war" on TB in June.
Lady Ros Morauta, chair of the Global Fund to fight AIDS, tuberculosis, and malaria, visited Australia in August 2025 to urge lawmakers to boost the nation’s contribution to the fight against these diseases. She highlighted the vital role Australia plays in supporting its neighbors and the extraordinary impact of the Global Fund. "Over the last two decades, the Global Fund partnership has saved 65 million lives and cut the combined death rate from AIDS, TB and malaria by 61 per cent," Lady Ros told the Australian Associated Press. She emphasized the fund’s country-led, performance-driven approach: "If you say you’re going to distribute half a million mosquito nets, you have to distribute them for the next lot of money to come." Australia, which pledged $266 million for 2023-2025, is now being asked to increase its commitment to $330 million for the next funding cycle.
The urgency is echoed in South Africa, where cuts to U.S. aid in 2025 are threatening HIV programs and putting hard-won progress at risk. Health officials there warn of potential setbacks in treatment and prevention efforts, as reported by Mid-Day on August 25, 2025. The loss of funding could undo years of advances in controlling the epidemic, jeopardizing the health of millions.
Back in the U.S., school nurses and pediatricians remain on the front lines, striving to counter misinformation and encourage parents to make informed decisions. Dr. Singh, for one, urges families to reach out to their pediatricians: "Most pediatricians, we’re in this field of medicine because we genuinely care about preventative health for children, their growth and development and keeping them safe. Vaccines have historically been a big part of that prevention effort," she told USA TODAY.
As the world faces a resurgence of infectious diseases, the importance of vaccination, international cooperation, and sound public health policy has rarely been clearer. Whether in the classrooms of Texas, the villages of Papua New Guinea, or the clinics of South Africa, the stakes are high—and the choices made today will shape the health of generations to come.
