| August is the time to start stocking up on pencils, backpacks and new clothes for the return to school. It’s also the time for parents to take stock of their school’s required immunizations. The start of this school year comes at an unprecedented time for the shots. Vaccination rates for kindergarteners are falling. Exemption rates have climbed, according to the US Centers for Disease Control and Prevention data. More states this year have introduced legislation to loosen restrictions on exemptions. Health and Human Services Secretary Robert F. Kennedy Jr. pulled the Covid vaccine recommendation for healthy kids. Kennedy fired the CDC’s influential vaccine panel in June and replaced them with vaccine skeptics. That panel, called the Advisory Committee on Immunization Practices, or ACIP, decides which vaccines will be covered by insurance or offered for free under the Vaccines for Children Program. The Food and Drug Administration is considering pulling the emergency use authorization for Pfizer’s Covid shot for children under 5 years old. That would leave only Moderna’s Covid-19 vaccine, which is approved for children as young as 6 months old with at least one underlying health condition. The new ACIP committee vowed to reexamine the childhood vaccine schedule and professional organizations are now analyzing vaccine data to publish their own immunization schedules. It’s information overload for parents. “We are going to probably live in a moment where there is more questioning,” says American Academy of Pediatrics President Susan Kressly. Clinicians should encourage conversations in order to keep children healthy, she added. Most states require entering kindergarteners to be vaccinated against diseases like measles, polio, chicken pox and diphtheria. With rising exemption rates for school-aged kids, Kressly said the US could see a comeback of some diseases as the academic calendar starts. The US reached a level of measles infections not seen in three decades earlier in the summer. At least 15 states introduced bills this year to either restrict the use of mRNA technology or ban the immunization requirements, according to a Bloomberg Law analysis. HHS announced mRNA research grants for vaccines would be cancelled, stalling potential breakthroughs. Kennedy’s pullback from vaccine policy has caused some parents to seek out early immunizations for their children over fears that costs could increase as access shrinks. But deviating far from the vaccine schedule can make some pediatricians nervous. Providing shots before the recommended ages can pose unknown risks, too. Kressly’s advice for parents is to rely on a trusted physician or advisor to navigate the shifting environment at the beginning of the school year. AAP will update its own vaccine recommendations later this year, Kressly says, a practice the organization has done since the 1930s. – Jessica Nix | 
