Medical schools must update approach to vaccine-preventable diseases

I went through medical school, residency, and a fellowship in the United States in an era when vaccine-preventable diseases were treated as history. Measles, tetanus, pertussis, and mumps appeared on exams, not in hospital wards. Vaccines — a victim of their own success — have worked so well that most clinicians in my generation have never seen these illnesses firsthand.

But I have.

In Haiti, I cared for a patient with tetanus, an agonizing disease marked by muscle spasms, respiratory failure, and suffering that is difficult to witness and even harder to forget. I have watched patients in India die from meningitis caused by Neisseria meningitidis, a disease entirely preventable with routine vaccination. I also worked on Ebola wards in Sierra Leone, where I saw countless people die from a virus once almost uniformly fatal. Today, I have witnessed that same disease stopped in its tracks and lives saved through vaccination and coordinated public health response.

These diseases are not abstract. To me, they are faces, families, and lives cut short due to lack of access to lifesaving interventions.

They are also the diseases we now risk reintroducing into routine U.S. medical practice.

Recent changes to the childhood vaccine schedule by the Department of Health and Human Services — made without meaningful input from clinicians, public health experts, independent advisory bodies, or patients — will effectively reintroduce vaccine-preventable diseases into everyday clinical settings at a time when many clinicians have not been trained to recognize, manage, or counsel patients about illnesses vaccines had largely eliminated.

Most medical trainees have never seen measles or its complications, muscle rigidity from tetanus, or an infant struggling to breathe from pertussis. Unless they are in their 60s or older, many attending physicians haven’t, either. Medical education evolved as these diseases became rare.

Now educators must prepare trainees for a world we deliberately worked to leave behind.

For years, teaching and training U.S. clinicians and public health officials about vaccine-preventable diseases was mostly about memorizing immunization schedules or identifying rashes for multiple-choice exams.

That can no longer suffice. Today’s trainees must learn how these diseases present in real patients, how rapidly they progress, and how catastrophic the outcomes can be: neurologic injury, prolonged intensive care, infertility, lifelong disability, and death.

When I teach, I share stories of patients I have cared for. Not to frighten trainees, but to ground their learning in real-world examples.  Once you have seen these diseases up close, you understand how devastating they are and what is at stake.

Traditional medical education relies on exposure: Learners see what comes through the door of the hospital or clinic. When diseases are rare or newly reemerging, passive exposure is no longer enough.

We need to teach differently.

Simulation-based training can allow trainees to manage measles outbreaks, neurologic complications of meningitis, or pediatric pertussis resuscitations in realistic, high-stakes settings. Longitudinal case-based curricula can follow an unvaccinated patient from clinic visit to hospitalization so trainees can learn about disease identification, infection prevention and control measures, clinical management, contact tracing, and public-health response, reinforcing that these diseases affect entire communities, not just individuals.

Artificial intelligence-driven simulations can expose trainees to rare but high-consequence infectious diseases they may never otherwise encounter. Adaptive learning tools can identify gaps in knowledge and reinforce early recognition and management. AI-assisted role-play can help trainees practice vaccine conversations, with feedback before they ever sit across from a hesitant parent.

Used responsibly, AI can help scale high-quality education at a moment when the stakes are rising.

But it’s not enough. One of our most underused educational resources is global expertise. In many parts of the world, clinicians never stopped caring for measles, meningitis, hepatitis, tetanus, diphtheria, or mumps. They carry experience that cannot be learned from textbooks. Much of my own understanding comes from working alongside colleagues in settings where outbreaks are routine and vaccine access is fragile.

U.S. medical education must engage these colleagues as equal partners through shared case conferences, virtual teaching, and bidirectional mentorship. Our trainees have as much to learn from global clinicians as they have to share, especially about what happens when vaccination coverage and confidence erode.

Perhaps the most dangerous gap in training today is not clinical but conceptual. In an environment where vaccine policy can shift without transparent scientific justification, trainees must learn how to critically evaluate evidence. They need to understand study design, bias, uncertainty, and how science can be distorted to support predetermined conclusions.

We must teach them not just what guidelines say, but how guidelines should be made through rigorous evidence review, independent advisory processes, post-marketing surveillance, and ethical deliberation. Without this foundation, future clinicians will struggle to explain changing recommendations to patients who are already confused and distrustful.

Equally important is how we teach communication. Too many trainees enter practice unprepared for vaccine conversations, trained to correct rather than connect. As we have learned, trust is not built through data alone. Medical and public health schools need to teach vaccine communication the same way we teach breaking bad news: through coaching and mentorship. That means role-playing difficult conversations, learning how to listen without judgment, and practicing how to meet patients where they are without abandoning scientific integrity.

Medical education does not exist in a vacuum. When vaccine policy is reshaped without transparency or accountability, the consequences do not stop at regulatory agencies. They land in exam rooms, hospital wards, and classrooms.

If vaccine-preventable diseases continue to reemerge, today’s trainees will become tomorrow’s frontline responders. Whether they are prepared should not depend on whether they happened to train during an outbreak.

Policy decisions about vaccines are also decisions about medical education, clinical preparedness, and patient safety.

Vaccines transformed public health because policy followed science. If we abandon that principle, we will not only see old diseases return but we will face them with clinicians less prepared to stop them.

That is a policy failure we cannot afford.

Krutika Kuppalli is an infectious diseases physician in Dallas. Her work focuses on emerging infectious diseases, outbreak response, vaccine policy, and clinical care of complex infections. She has extensive experience with Covid-19, mpox, and Ebola through collaborations with numerous global partners, including the World Health Organization.