Virginia health officials say President Donald Trump's new executive order on childhood vaccines doesn't change the state's policies.
However, doctors warn that Trump's order presents a troubling issue: It could sow doubt about vaccines and increase risks for children as measles cases continue to rise.
Trump's order recommends fewer routine vaccines for children and that "to the maximum extent feasible," all of their immunizations be done separately.
It also calls for the measles, mumps, rubella (MMR) vaccine to be separated into three different shots, a regimen that is currently not possible because the vaccines are administered in a combined formula.
"As measles cases reach a 35-year high in the U.S. and with cold and flu season quickly approaching, today's executive order on vaccines is not only disheartening but dangerous," said Dr. Andrew Racine, president of the American Academy of Pediatrics, in an Aug. 10 statement.
States have authority over their vaccine policies; the Virginia Department of Health says it will continue to recommend that children are vaccinated in line with the AAP's immunization schedule instead of federal recommendations.
The AAP schedule typically encourages immunizations against 18 diseases.
Trump's order advocates for shots protecting against 11 diseases, while only recommending vaccines for infections such as hepatitis A and B to high-risk groups.
It also advises that "shared clinical decision-making" should be applied for select vaccines — hepatitis A, hepatitis B, rotavirus, meningococcal disease, influenza and COVID-19 — so parents can decide if they want their children to be immunized against those diseases.
Vaccines for MMR, rotavirus, hepatitis A and B are on the list of required immunizations to attend a public school or daycare in Virginia. State law offers medical and religious exemptions, but not for philosophical reasons.
The executive order does not change any vaccine recommendations or school immunization requirements in Virginia.
Trump's order also directs the US attorney general to take legal action against any states with laws at odds "with parental authority, religious freedom, disability accommodations, and equal protection under the law."
Virginia Attorney General Jay Jones' office did not respond to a request for comment on whether it considers Trump's direction a potential threat against the state's vaccine exemption laws.
"There's no new evidence to justify significant changes to the childhood immunization guidance," said Christy Gray, director of VDH's immunization division.
Gray told VPM News that the science backing the health department's recommendations is extensive, and that the agency remains "confident that following it is the best way to protect children in Virginia from serious preventable diseases."
Trump's administration has tried to alter the US Centers for Disease Control and Prevention's immunization schedule, but a federal judge blocked that effort in March. The Advisory Committee on Immunization Practices develops federal vaccine recommendations for the CDC director to approve.
The day after Trump's Aug. 10 order, VDH publicly reaffirmed its "commitment to vaccines as an essential tool in protecting the health of children, their families, and their communities."
"It's a very confusing environment right now, but we wanted to make sure that parents knew that the executive order does not change any vaccine recommendations or school immunization requirements in Virginia," Gray explained.
Gray and other public health experts have said there isn't evidence that spacing out the MMR shot has health benefits — that it would instead leave children vulnerable as they wait for another shot and more medical visits.
Dr. Racine, with AAP, and Republican Sen. Bill Cassidy of Louisiana criticized the Trump administration for suggesting that vaccines can lead to autism spectrum disorder. Multiple studies have found no link between the two.
"I'm a doctor. This executive order is wrong. The President does not have the expertise to make these changes," Cassidy wrote on X. "Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines DO NOT cause autism."
In his statement, Racine said Trump's order wouldn't do anything to help advance the understanding of autism.
"The only purpose of this announcement is to sow confusion so that more people doubt the importance of vaccines," he said. "Delaying or skipping shots is risky, especially as measles continues to spread and children go back to school."
Like many other states, Virginia has seen a massive uptick in measles cases due to outbreaks this year.
There have been 177 confirmed cases as of Aug. 13 compared to just five in 2025, state data shows. Children 12 and under make up 51% of that group, and 95% of the cases involve someone who is unvaccinated, per VDH.
Racine said that pediatricians urge parents to vaccinate their children at certain ages to ensure that their immune system will respond well and "when they are most vulnerable to certain diseases."
The Virginia Department of Health encourages parents to ask their child's pediatrician questions about vaccines, and reach out to their local health department if they don't have one.
"We're so fortunate in this day and age to have vaccines because we often forget why we have them," Gray told VPM News, "because we don't see the diseases they protect against, and that way vaccines are often the victim of their own success."
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