The United States is teetering on the edge of a life-threatening precipice as the number of unvaccinated people has reached a dangerously high level, putting people at risk for preventable deaths, health officials warn.

A new commentary, written by Food and Drug Administration Commissioner Dr Robert Califf and FDA vaccine regulator Dr Peter Marks, warned that vaccine rates are approaching the level at which there are not enough healthy vaccinated people to protect those who can’t get their shots because they are vulnerable.

The commentary comes as four states are dealing with a measles outbreak and school vaccination rates plummet, with a record high number of families applying for vaccine exemptions. 

The commentary said: ‘The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines.’

The above map shows states with measles cases (red) or warnings over measles exposures (yellow) with no cases yet detected. The Children's Hospital of Philadelphia (top right) is where the first case in the outbreak was detected

The above map shows states with measles cases (red) or warnings over measles exposures (yellow) with no cases yet detected. The Children’s Hospital of Philadelphia (top right) is where the first case in the outbreak was detected

The above map shows the state by state rates of vaccination exemptions for the 2022-2023 school year, highlighting the top five states with the highest percentages of exemptions

The above map shows the state by state rates of vaccination exemptions for the 2022-2023 school year, highlighting the top five states with the highest percentages of exemptions

For the 2022-2023 school year three percent of kindergartners had a vaccine exemption from one or more required vaccines. This is an increase from 2.6 percent during the 2021-2022 school year and the highest the US has ever recorded

The team said vaccination was ‘one of the most highly effective public health interventions,’ adding vaccines have saved millions of lives, undergo rigorous testing to ensure safety and efficacy and are continuously monitored via safety surveillance systems. 

Effective vaccine campaigns have eradicated deadly diseases in the US like smallpox and polio. 

Measles was similarly eliminated but cases of the disease among unvaccinated people who contract it overseas and return to the US have been on the rise. 

This month, four states have reported measles outbreaks. Officials in Pennsylvania, Virginia, New Jersey and Delaware reported nine infections, eight among people who have never received the measles vaccine. 

An additional 30 people are being monitored for the disease. Measles is one of the most contagious viral illnesses – several more times contagious than Covid. 

The FDA officials wrote: ‘Regrettably, pediatric vaccine hesitancy now has been responsible for several measles outbreaks in the US.’

Experts attribute the decline in vaccinations to widespread misinformation, complacency, vaccine mandates and vaccine fatigue. 

Recent data from the Centers for Disease Control and Prevention shows a quarter million kindergartners are entering school without their recommended childhood vaccines – and the number of kids with vaccine exemptions has hit a high.

Additionally, for the 2022-2023 school year three percent of kindergartners had a vaccine exemption from one or more required vaccines – an increase from 2.6 percent during the 2021-2022 school year and the highest the US has ever recorded. 

As the antivax movement has grown, so have the number of parents requesting vaccine exemptions for their children. 

Each state has different guidelines for vaccine requirements and exemptions. While some require all vaccines for kindergarten admission, others may only require a handful at the time, postponing others to future grades.

When getting vaccine exemptions, there are two types: medical and non-medical and exemptions can be from one, multiple or all required childhood vaccines

Medical exemptions are allowed when a child has a medical condition that prevents them from receiving a vaccine. Non-medical exemptions include those based on religious or philosophical beliefs.

While rules differ state by state, in most cases, parents must receive documentation from a medical doctor stating a child should be exempt from vaccinations.

The exemptions are then reviewed and granted by the child’s school.

Drs Califf and Marks highlight the flu, Covid-19 and respiratory syncytial virus vaccines as crucial in protecting people – as the US struggles with one of the worst winter cold seasons health workers have ever seen.

The above shows the mortality rate of Covid-19 in April across different age groups among people are how vaccinated and unvaccinated against the disease

The above shows the mortality rate of Covid-19 in April across different age groups among people are how vaccinated and unvaccinated against the disease

For Covid vaccines among senior care residents, Vermont, New Hampshire, Minnesota, Iowa, Alaska and Hawaii had highest rates, with between 45 and 60 percent of residents vaccinated

For Covid vaccines among senior care residents, Vermont, New Hampshire, Minnesota, Iowa, Alaska and Hawaii had highest rates, with between 45 and 60 percent of residents vaccinated

RSV vaccine coverage among senior care residents was the lowest and nearly three dozen states reported between one and 15 percent of residents vaccinated

RSV vaccine coverage among senior care residents was the lowest and nearly three dozen states reported between one and 15 percent of residents vaccinated

The officials say that vaccination against these three viruses is ‘inadequate’ and ‘distressing,’ especially among the elderly who are high risk of severe infection and death. 

In the US, just one-third of senior care home residents were up to date with their Covid vaccine and just 10 percent had received a vaccine for RSV.

A higher share – 72 percent – had received their flu vaccine, as of a December 10 CDC report.

Older residents in nursing homes are at heightened risk of severe illness and death from any one of the three viruses due to their weakened immune systems.

During the 2021-2022 flu season, the death rate for people 65 years and older was around 7.4 per 100,000 population, compared to 0.1 per 100,000 people among those aged 18 to 49 years.

Drs Califf and Marks wrote in their commentary that it is difficult for people to take action when their own risk of a bad outcome is relatively low, even when possible consequences are high and the population-wide risk is severe. 

Making a comparison to the argument for seatbelts, they wrote: ‘In situations such as with seat belts, however, the discussion ultimately has led to almost uniform use, and vaccination use had similarly been almost uniformly accepted. 

‘The current reversal of vaccine acceptance has already resulted in hundreds of thousands of excess deaths from COVID-19 and concern about the re-emergence of previously conquered infectious diseases.’ 

Experts have partly attributed the decline of vaccination rates in the US to Covid-19.

While the Covid vaccine is not mandated in the US, it is believed to be a contributing factor in the rise of vaccine hesitancy.

America’s top infectious disease expert Dr Anthony Fauci admitted Covid vaccine policies were ‘counterproductive’ and turned vaccine skeptics off of vaccinations rather than gain their favor.

Last year, he told The New York Times: ‘Man, I think, almost paradoxically, you had people who were on the fence about getting vaccinated thinking, why are they forcing me to do this?

‘And that sometimes-beautiful independent streak in our country becomes counterproductive. And you have that smoldering anti-science feeling, a divisiveness that’s palpable politically in this country.’

And the FDA officials wrote in their commentary they found vaccine hesitancy for children has been found highest in clusters among middle- to high-income areas of parents with at least a college degree who preferred narratives seen on social media rather than evidence-based vaccine information provided by doctors. 

Drs Califf and Marks said vaccine complacency has also driven unvaccinated numbers up: ‘Unfortunately, with the success of pediatric vaccination campaigns to date, increasing numbers of people have become complacent and underestimate the actual risk of forgoing vaccination.’

To counter the rising antivax movement, the authors strongly urge healthcare professionals double their efforts to provide accurate and clear information regarding the benefits of vaccination.

They added: ‘Such information is now needed because vaccines have been so successful in achieving their intended effects that many people no longer see the disturbing morbidity and mortality from infections amenable to vaccines.

‘We believe that the best way to counter the current large volume of vaccine misinformation is to dilute it with large amounts of truthful, accessible scientific evidence. 

‘To reduce deaths, hospitalization, and the burden on families and the health care system, all those directly interacting with individuals in a health care setting, ranging from front office staff to retail pharmacists to primary care physicians, need to focus at every appropriate opportunity on helping to ensure that individuals have the necessary information to make informed choices regarding vaccination, considering the benefits and risks.

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