Minoritized, Low-Income Families May Be Disproportionately Affected By MMRV Vaccine Withdrawal

A new analysis published in JAMA Network Open is raising questions about the equity implications of the Advisory Committee on Immunization Practices’ (ACIP) September 2025 decision to stop recommending the combined measles, mumps, rubella, and varicella (MMRV) vaccine for children younger than 4 years—a decision unfolding just as the United States confronts its most severe measles activity in more than 30 years.^1-3

What the Study Found

Investigators from Public Health–Seattle & King County analyzed 11 years of immunization records from the Washington State Immunization Information System, examining vaccine selection among 213,445 King County children born between 2014 and 2021 who received a measles- or varicella-containing vaccine dose between 12 and 47 months of age.¹

At first receipt, 64% of children (n = 136,084) received coadministered MMR and varicella vaccines as 2 separate injections; 18% (n = 37,938) received MMR alone; 15% (n = 31,430) received the combined MMRV formulation; and 4% (n = 7,993) received the varicella vaccine alone. Notably, MMRV uptake remained essentially flat across the entire 11-year period, even as coadministration of separate MMR and varicella vaccines rose from 61% among children born in 2014 to 67% among those born in 2021.¹

The 15% of MMRV recipients, however, was not evenly distributed across the population. Children who received MMRV as their first dose were significantly more likely to be receiving a catch-up dose between 16 and 47 months, rather than at the routine 12- to 15-month visit. They were also more likely to be Hispanic (25.3% vs 13.4% of non-Hispanic children), Black (23.2%), American Indian or Alaska Native (20.0%), Native Hawaiian or Pacific Islander (28.5%), or multiracial (19.5%).¹

Geography played a role too, with children in South King County receiving MMRV at a rate of 25.6%, compared with just 6.9% in the Central region. This pattern was consistent in program eligibility and clinic settings as well—children eligible for the federal Vaccines for Children (VFC) program received MMRV at a rate of 32.0%, compared with 9.2% among noneligible children, and children vaccinated at safety-net clinics received it at a rate of 35.9%, versus 10.9% at non–safety-net clinics.¹

The study also found that 95% of children overall received both a measles- and varicella-containing vaccine before 4 years of age. That said, the starting vaccine mattered, as children who began with varicella vaccine alone were significantly less likely to complete both series (69%) than those who started with MMR alone (78%).¹

A Policy Vote Without an Equity Analysis

The study’s authors noted that the September 2025 ACIP vote to remove the MMRV recommendation and its VFC coverage for children younger than 4 years allegedly occurred without substantial discussion of which populations might be affected. They also noted that the panel did not apply the Evidence to Recommendations framework, which has typically accompanied ACIP decisions since the panel first restricted MMRV as a preferred first dose in 2009 over febrile seizure concerns.¹

The contentious 8-3 vote—which was taken by a newly reconstituted panel that included 5 members appointed just days earlier—reversed 15 years of policy and was followed by a confusing same-week revote on VFC alignment. The American Academy of Pediatrics publicly broke from the panel’s guidance, stating it would continue recommending that families be offered a choice between MMRV and separately administered MMR and varicella vaccines.^2-4

A Sobering Measles Backdrop

The debate over MMRV access comes as measles transmission in the US continues to intensify. As of July 2, 2026, the CDC has confirmed 2170 measles cases nationwide, which is already within striking distance of the 2289 cases reported for all of 2025 and is the highest annual total since 1991. Ninety-three percent of 2026 cases have been linked to active outbreaks, and roughly a fifth of cases nationally have occurred in children younger than 5 years of aged, a group that also faces the highest hospitalization rates.⁵

Implications for Pharmacy Practice

The findings suggest that pharmacists involved in immunization counseling should be prepared for uneven effects as MMRV access narrows. Because VFC-eligible families and those served by safety-net clinics historically relied more heavily on the combination vaccine to simplify scheduling and reduce visit burden, pharmacists may need to proactively address logistical questions about receiving MMR and varicella vaccines as 2 separate injections, reassure caregivers about the modest and largely self-limited nature of febrile seizure risk, and flag patients who may need additional support completing both vaccine series on time. With measles circulating actively in dozens of states, reinforcing the importance of on-time, complete MMR vaccination—regardless of formulation—remains one of the most consequential things a pharmacist can do at the counter.

“Pharmacists have played an important role in expanding access to vaccines, are trusted health care providers in the community, and have a long track record of improving immunization uptake. In this moment, individuals may turn to their local pharmacist with questions around vaccine recommendations, availability, cost, and safety,” Eric J. Chow, MD, MS, MPH, chief of communicable disease epidemiology and immunization at Public Health–Seattle & King County and an author of the study, said in an interview with Pharmacy Times.

REFERENCES

1. Fagalde MS, Page LC, Marder EP, et al. Measles-containing vaccine use for children aged 12 to 47 months, 2015 to 2025. JAMA Netw Open. 2026;9(7):e2622734. doi:10.1001/jamanetworkopen.2026.22734

2. Schnirring L. New CDC advisers scale back recommendations on MMRV vaccine in young kids. CIDRAP. September 18, 2025. Accessed July 10, 2026. https://www.cidrap.umn.edu/childhood-vaccines/new-cdc-advisers-scale-back-recommendations-mmrv-vaccine-young-kids

3. Bendix A, Edwards E, Lovelace B, Szabo L. CDC advisory panel recommends restricting access to the MMRV vaccine. NBC News. September 18, 2025. Accessed June 10, 2026. https://www.nbcnews.com/health/kids-health/cdc-panel-measles-chickenpox-vaccine-recommendation-rcna231986

4. Jenco M. AAP breaks from federal vaccine panel, continues to recommend MMRV vaccine for children under 4. AAP News. September 19, 2025. Accessed July 10, 2026. https://publications.aap.org/aapnews/news/33401/AAP-breaks-from-federal-vaccine-panel-continues-to

5. Measles cases and outbreaks. News release. Centers for Disease Control and Prevention. Updated July 10, 2026. Accessed July 10, 2026. https://www.cdc.gov/measles/data-research/index.html