Q&A: How Pharmacists Can Help Prevent Missed MMR Vaccinations in Children

In an interview with Pharmacy Times®, epidemiologist Nina Masters, PhD, MPH, senior applied research scientist at Truveta and senior study investigator, explains new research highlighting that delayed early vaccines—specifically at 2 and 4 months—significantly increase the likelihood of children missing their first measles, mumps, and rubella (MMR) vaccine dose by age 2, with delays linked to 7-fold and 6-fold higher odds, respectively. Masters notes that vaccine hesitancy often appears very early in life, making early intervention critical. Pharmacists can play a pivotal role by counseling parents, providing education on vaccine safety and effectiveness, and helping identify children at risk of falling behind.

Pharmacy Times: Can you explain why early schedule adherence is such a critical factor for later MMR vaccination?

Nina Masters, PhD, MPH: Our study found that from 2018 to 2025, only 78.4% of children with regular access to care received their first MMR vaccination on time. In that time, the proportion of children who did not receive an MMR vaccine by 2 years of age was small but increased from 5.3% in 2020 to 7.7% in 2024—a worrying signal of ongoing vaccination decline. As we tried to understand more about this trend, we found that children who received their 2-month vaccines late had 7 times the odds of missing their MMR vaccination at 2 years, and children who received their 4-month vaccines late had 6 times the odds of missing MMR vaccination by 2 years.

This is troubling because the underlying timeliness of these early vaccines also declined over the study period, by about 2 percentage points for children born from 2019 to 2023. This indicates that parents are expressing vaccine hesitancy and delay very early in their children’s lives, even as early as the first routine vaccine. The window for intervention—to engage parents about their hesitancy and provide more education about the safety and effectiveness of these vaccines—has to happen very early. This may be challenging, as parents perhaps have yet to really forge a strong bond with their child’s providers. But it highlights the importance of pediatric providers—pediatricians and pharmacists alike—having vaccination discussions and building trust very early in the care pathway for infants.

Pharmacy Times: For pharmacists who counsel parents on vaccine schedules, what messaging strategies would you recommend that emphasize the importance of sticking to the recommended timetable for early childhood vaccines and the first MMR dose?

Masters: There is a vast amount of research showing the safety and effectiveness of pediatric vaccines, and these vaccines have helped us to eliminate many of these dangerous and potentially deadly diseases. Our study found that children who received their 2-month vaccines late had 7 times the odds of missing their MMR vaccination at 2 years, and children who received their 4-month vaccines late had 6 times the odds of missing MMR vaccination by 2 years.

When parents adhere to the recommended timetable for early vaccines, they are more likely to ensure their children receive all vaccinations to protect them from preventable disease.

Pharmacy Times: How might pharmacists help identify children at risk of falling behind and intervene? Are there specific tools or reminders you see as most effective?

Masters: We saw that children who adhered to the American Academy of Pediatrics well-visit schedule were more likely to receive their MMR vaccines on time, showing the importance of trusted relationships with a child’s providers as an important predictor of vaccination. Pharmacists can engage parents of young children to address questions or encourage follow-up with their pediatricians.

Pharmacy Times: What should pharmacists know about how parents’ attitudes toward early vaccines might translate into later decisions about MMR, and how can they help counter misinformation?

Masters: Surprisingly, this study indicated that parents are expressing vaccine hesitancy and delay very early in their children’s lives, even as early as the first routine vaccine. The window for intervention—to engage parents about their hesitancy and provide more education about the safety and effectiveness of these vaccines—has to happen very early.

Engaging parents in their questions about the safety and effectiveness of these recommended pediatric vaccines can help to counter the misinformation.

Pharmacy Times: Is there anything else you might want to add that our readers would find informative?

Masters: I’ve studied pediatric vaccines for over a decade—through my PhD and time in federal public health. Throughout these years, I’ve responded to measles and polio outbreaks and modeled the impact of interventions, and every analysis and field deployment has the same conclusion: vaccination is essential to prevent and control outbreaks. Seeing evidence of further decline in vaccination coverage and timeliness is really troubling.

This study takes on new meaning for me both as a vaccine researcher and now as a new parent. My daughter is 3 months old, and I raced to get her 2-month vaccines as soon as I could to protect her from preventable illnesses. While I’ve studied measles and vaccines for most of my research career, having an infant makes the findings of this study all the more salient—and terrifying—for me as I think about my own daughter getting sick and how I would do absolutely anything I could to protect her.

At Truveta, using real-world data to explore time trends in childhood vaccination has been extremely meaningful and heartbreaking, especially to see how pediatric vaccinations have continued to decline consistently since the COVID-19 pandemic, putting more children at risk. This new research shows that delayed or missed early vaccinations have a long-term impact on a child’s vaccine trajectory, which should further empower clinicians to engage earlier with parents and caregivers in an effort to address hesitancy, questions, and education.