As millions of children around the country start another school year, they’ll be confronting new classes, new teachers, and, inevitably, a new slate of germs. And this fall, they’ll be more vulnerable to infectious disease than children have been in decades.Earlier this month, President Trump signed yet another executive order insisting that the United States shrink its schedule of recommended vaccines—federal guidance that currently guards Americans against 17 diseases with safe, effective shots. He also demanded that the U.S. split the MMR vaccine into three separate courses for measles, mumps, and rubella, without citing solid scientific evidence or acknowledging the infeasibility of such a system. (Scholars have already questioned whether the order has legal power.) Days later, the CDC released new data showing that, under Trump, the nationwide vaccine-exemption rate among kindergartners has reached a record high.The new exemption rate of 4.2 percent is a relatively modest bump, up from the previous school year’s 3.6. The national numbers, though, paper over widening gaps among states. Roughly 98 to 99 percent of West Virginia kindergartners, for instance, are still getting routine shots. Meanwhile, in Idaho, the percentage of kindergartners who are up-to-date on vaccines that guard against diseases such as polio, chickenpox, and measles has tumbled to about 75 percent—well below the estimated thresholds for reliably staving off such outbreaks. These numbers reflect what Thomas Patterson, the president of the American Academy of Pediatrics’ Idaho chapter, has been seeing and hearing in the hospitals and clinics where he works: more families expressing skepticism, more families refusing or delaying shots, and more families opting out of his care after he reveals that he supports all of the vaccines that the AAP recommends. (The professional society has sued Trump’s Department of Health and Human Services over its attempts to pare down vaccine recommendations.) Idaho also bans employers, schools, and day cares from requiring medical interventions, including vaccines. Its vaccine-exemption rate is now 17.5 percent, the highest in the nation.National polls show that the majority of Americans still think vaccines work well to prevent disease, and that at least two-thirds support requiring vaccines in schools. Those sentiments remain especially common in Democratic strongholds. Jennifer Shu, a pediatrician in Atlanta, told me that in the past year and a half, she and her colleagues have been flooded with calls from families who are worried that the vaccines they want for their children could soon be taken away. In response to a request for comment, Kush Desai, a White House spokesperson, told me in an email, “None of the Trump administration’s actions undermine access to or insurance coverage of any vaccine—they instead create an environment that fosters parents making informed decisions together with physicians and public health officials who are supposed to guide and support, not force, crucial vaccinations to ultimately ensure that American children do not suffer from serious vaccine preventable infections.” (HHS did not respond to a request for comment.)At the same time, surveys show that national confidence in vaccine safety has eroded, especially among Republicans, who are also far less likely to support school requirements for shots. Since the start of the coronavirus pandemic, the partisan split around vaccine attitudes has been widening. The second Trump administration has exacerbated those tensions, pediatricians around the country told me—and top health officials’ inaccurate portrayals of vaccine side effects seem to have emboldened more people to push back against standard medical advice. Elizabeth Hawse, a pediatrician in Lexington, Kentucky, told me that many of her patients have begun asking whether she’s aware of any new research to indicate that vaccines need to be newly restricted. Those questions tend to follow federal vaccine news: administration officials’ suggestions that the U.S. should mirror Denmark’s trimmer vaccine schedule, or Health Secretary Robert F. Kennedy Jr.’s handpicked vaccine advisory committee’s elimination of the long-standing recommendation for universal hepatitis B vaccination at birth. Hawse’s answer is blunt: Nothing has changed.Faced with doubts that tend to be informed more by politics than by scientific evidence, pediatricians have only so many tools. Sometimes, they can convince families with facts—reassuring them, for instance, that decades of studies have debunked the notion that vaccines cause autism, or correcting Trump’s recent statement that vaccines are the “size of a bottle of soda poured into a little child’s body” (most vaccines are about a tenth of a teaspoon). Other parents respond more to common emotional ground: Hawse tells them that she gave these vaccines to her own children, the oldest of whom is 26. Caitlyn Neltner, another doctor at the same practice as Hawse, told me that she shows patients her own vaccination record from the 1990s. Families seem comforted by the shared experience, Hawse said—and by the fact that the pediatrician-recommended vaccine schedule has remained mostly unchanged for decades.Some doctors told me that they’ve started spending far longer discussing vaccines with families, and that some conversations stretch across hours or multiple visits—heavy workloads that can sap the time and resources that small practices could otherwise offer to other patients. Benjamin Dowse, a pediatrician in southern Utah, where vaccination rates remain low, told me that, in a few cases, turning a “no” on vaccines into a “yes” has been possible only over the course of several years. Sometimes, the work seems unlikely to ever pay off. Patterson, in Idaho, has learned to pick his battles: Families who buy heavily into conspiracy theories or are adamant that vaccines have harmed their loved ones aren’t likely to be easily persuadable.Several of the pediatricians I spoke with, especially those in larger cities, told me that they insist their patients follow the AAP-recommended vaccine schedule. But in rural areas, telling families to seek care elsewhere is not really an option, Dowse said. If he pressures people too much about vaccines and they leave his care entirely, they may end up without any pediatrician, which would put their kids at risk of all sorts of preventable health problems.In places where vaccination rates are not high enough to prevent outbreaks, disease itself can make a powerful argument. Lately, the U.S. has been battling its worst measles resurgence in the past 35 years; just this morning, Pennsylvania announced two measles-associated deaths in unvaccinated residents. A few pediatricians told me that the arrival of the virus in their community has spurred an interest in vaccines, even from previously skeptical families. Lisa Costello, a pediatrician in West Virginia, told me that the grandparents in her community are some of the biggest advocates for vaccines: Many of them can still remember a time before routine polio immunization, when the disabling disease ran rampant, and never want to return to it. Even so, fear of disease isn’t always enough. Vaccination rates have ticked up only slightly in South Carolina, the epicenter of the largest recent measles outbreak—and exemption rates have risen too.As federal guidance on vaccines softens, states’ ability to require shots is one of the most effective strategies to keep protections against diseases in place. West Virginia—where some counties lack any pediatricians at all and many families must drive long distances to seek care, including vaccines—has maintained some of the highest childhood-vaccination rates in the country for many years because it does not allow nonmedical exemptions. States that have followed West Virginia’s lead, including California, have seen vaccination rates increase as well. Meanwhile, some of the most obvious drops in protection have played out in states where vaccination laws have slackened. Prior to 2023, Mississippi forbade nonmedical exemptions, too, and its kindergarten-vaccination rate was the nation’s highest; more than 99 percent of children met school requirements. But since a federal judge eliminated that restriction, eight counties in the state have dropped below 95 percent, potentially putting them at risk for measles outbreaks.Last July, citing concerns about falling vaccination rates, the AAP recommended the elimination of all nonmedical exemptions to school-immunization requirements. But in the current political environment, vaccine policies seem more likely to further degrade. In his recent executive order, Trump explicitly embraced liberal exemption policies, citing a need for “maximizing parental choice over childhood vaccines.” Politicians—most of them Republican—and anti-vaccine activist groups have continued to push for the elimination of vaccine requirements in several states as well. In March, before South Carolina’s recent measles outbreak had officially been declared over, state lawmakers killed a Democrat-sponsored bill that would have eliminated religious exemptions for the MMR vaccine for kids in public schools.Kennedy has told Americans to consult their doctors about vaccination; he’s also urged them to distrust experts and do their own research. Many Americans are, in effect, now being asked to choose between the advice of their preferred politicians and their longtime health-care providers. Anita Henderson, a pediatrician in southern Mississippi, told me that she recently encountered a family who had vaccinated all of their older children but, on the mother’s insistence, were declining shots for their new baby. As they were leaving the appointment, Henderson said, the mother turned back “and made the comment, I’m so glad President Trump made that law changing the vaccine schedule. I’m glad he is bringing to light all the problems that we’re seeing with vaccines.”By the time that baby is old enough to attend public school, Henderson expects that many more schoolchildren in her state will lack the vaccine safeguards they need. In Mississippi, she said, health department officials have logged more than 7,000 religious exemptions among kids 4 or younger. The more young children who join that poorly protected cohort, the more vulnerable everyone in the community will be the next time a dangerous virus arrives.