President Donald Trump’s attempt to remake the nation’s childhood vaccination system is barely a week old, but Washington, D.C., has already positioned itself to go its own way.
That could make the nation’s capital an early test of how far states and local governments can protect their residents from a rapidly changing federal vaccine policy.
Trump’s executive order calls for separating combination vaccines like the measles, mumps and rubella vaccine into individual injections and spacing vaccinations farther apart when possible. These changes could dramatically increase the number of shots and doctor visits children need.
Dr. James Campbell, interim head of pediatric infectious disease at the University of Maryland School of Medicine, said there is no medical justification for portraying the MMR vaccine as dangerous.
“It’s absolutely false,” Campbell told NPR when asked about Trump’s suggestion that the vaccine could be lethal. “There’s no evidence of lethality from the MMR vaccine. But of course, all of those diseases that it protects against can be lethal.”
Campbell said the president’s proposal faces a more basic obstacle. The separate vaccines Trump calls for do not exist in the United States.
“There are no, what we call, monovalent or individual vaccines for measles, mumps and rubella, so it would be impossible to follow the order,” Campbell said. He added that the three vaccines have been administered together in the United States since 1971, with no difference in safety or effectiveness from administering them separately.
But months before Trump issued the order, D.C. quietly put a legal escape hatch into place.
The Community Health Amendment Act of 2026, which became law this spring, ended the District’s exclusive dependence on federal vaccine recommendations. Instead, D.C. health care providers may order and administer vaccines based on recommendations from the CDC’s Advisory Committee on Immunization Practices or another competent medical or public health organization designated by the director of the D.C. Department of Health through public notice.
The change also applies to the District law governing vaccination of minors, explicitly permitting vaccines recommended according to either ACIP guidance or recommendations from a medical or public health organization selected by the D.C. health director.
In practical terms, D.C. has created an alternative route. If legislators change the federal vaccine rulebook, the District does not have to follow.
The law passed the D.C. Council overwhelmingly. The final vote on Jan. 6 was 11-0, with one member not voting. Mayor Muriel Bowser signed the legislation Jan. 27; it cleared congressional review and became effective March 24 as D.C. Law 26-105.
What once seemed an obscure change in the District’s health code now looks much more consequential.
“The attacks on DC Home Rule are very real and they persist,” D.C. Council member Christina Henderon, chair of the legislative body’s health committee, wrote in a newsletter, after the first iteration of the bill passed in late 2025. “I have to admit the state of American politics right now is very depressing. It’s transactional; deliberations are not ‘Is this good policy?’ but rather ‘Can this be used against me in an ad?’ This imposition of policy without the participation of those being governed should be an affront to anyone who believes in democracy.
‘Fearmongering About Vaccines’
Trump’s order has thrown one of the most established rituals of American childhood medicine into uncertainty. For generations, parents have taken babies and young children to pediatric offices, rolled up tiny sleeves, and relied on a vaccine schedule designed to prevent several diseases safely and efficiently, with fewer needles whenever possible.
The president wants to change that.
The MMR vaccine is currently given in two combined doses. Separating measles, mumps, and rubella into individual vaccines would turn those two injections into six.
White House spokesman Kush Desai said separating and changing the timing of MMR vaccination would give families “more options on timing and frequency” and ultimately increase vaccination against all three diseases.
Another problem cannot be solved by rewriting a federal recommendation: individual measles, mumps, and rubella vaccines are not available in the United States. FDA-approved vaccines against the three diseases are combination vaccines, an approach used here since the 1970s.
Drugmakers might have to resurrect products abandoned decades ago, conduct new studies, and build or modify manufacturing facilities. Industry experts cited by the Associated Press said designing, building, and obtaining federal approval for a new vaccine plant typically takes about five years. Each separate vaccine could also require individual FDA review and licensing.
For families, the consequences could be far more immediate.
Instead of two MMR injections, children could need six. Spacing other vaccinations could mean more trips to pediatricians, more time away from work for parents, additional insurance costs, and more chances for children to miss doses altogether.
The criticism grew louder Sunday when it came from inside Trump’s own party.
Sen. Bill Cassidy, R-La., a physician and chairman of the Senate Health, Education, Labor and Pensions Committee, called the president’s policy “a stupid thing to do” during an appearance on ABC’s “This Week.”
“Now, instead of your child getting two shots, she has to get six shots,” Cassidy said. “Instead of … you missing work to take your child to the doctor two times, you’re doing it six times.”
Cassidy said the change would increase costs and inconvenience families while subjecting children to more injections. The reason MMR vaccines were combined in the first place, he said, was “to make it more convenient for the parent, to make fewer jabs for the child.”
Campbell went further in describing what he believes the president’s rhetoric could do to parents already trying to make sense of conflicting information about childhood vaccines.
“It’s just sowing chaos,” Campbell said. “It’s a way of sort of fearmongering about vaccines.”
‘The American People Have Been Poorly Served’
A June report from the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health found that the District’s MMR vaccination coverage is roughly comparable with the national rate and that its non-medical exemption rate among kindergartners is below the U.S. median.
In 2024, fewer D.C. 2-year-olds were fully vaccinated with all four recommended DTaP doses against diphtheria, tetanus, and pertussis than the year before, leaving the District below the Healthy People 2030 target of 90%.
The Johns Hopkins chart clearly shows the decline. The District’s DTaP coverage, which was roughly 85% in 2020, fell to about 63% in 2024, well below Maryland, Virginia, and the national rate.
The picture for measles is better. MMR coverage among D.C. kindergartners rose in 2024-25 compared with the year before, reaching roughly 93% according to the Johns Hopkins chart. But that still leaves the District below the Healthy People 2030 goal of 95%.
D.C.’s non-medical exemption rate among kindergartners was 2.5% in the 2024-25 school year, compared with a U.S. median of 4%, although the District’s rate increased slightly from the previous school year.
Still, the Trump administration argues its approach will give parents greater control.
The executive order cannot by itself force the transformation Trump envisions.
Neither the White House nor the FDA can compel pharmaceutical manufacturers to develop separate vaccines. States retain legal authority over vaccination requirements for schoolchildren. Trump’s order advises states to consider revising their laws to reflect his administration’s approach.
D.C. has moved in the opposite direction.
Rather than tying District vaccination policy more tightly to Washington’s federal bureaucracy, the Council loosened that connection. Johns Hopkins’ review of state vaccination policy describes D.C.’s new law as allowing providers to administer vaccines recommended by non-federal organizations, including groups like the American Academy of Pediatrics.
However, the confrontation could become larger than vaccines as D.C. may be among the first places to provide an answer.
Cassidy, who helped secure the confirmation of Health and Human Services Secretary Robert F. Kennedy Jr. after receiving assurances about protecting established vaccine policy, said Sunday that commitments made to him included assurances that the ACIP vaccination schedule would not be disrupted.
Now it has been.
“There are guarantees that were given to me and guarantees that were supposedly going to be enforced by the White House,” Cassidy said. “So, people can draw their own conclusions, but it’s pretty evident. The point is that the American people have been poorly served.”
