Separating the MMR Vaccine Into Three Doses: Not in the Best Interest of Children
Published on: September 22, 2026
By Nanette Elster, JD, MPH, Kayhan Parsi, JD, PhD
John B. Francis Co-Chairs
Unlike previous administrations, this current administration has not created a formal bioethics council or commission. In fact, the current administration has paid little attention to bioethical issues such as AI, medical aid in dying, or reproductive rights. An exception, however, is vaccine policy as evidenced by the President’s Executive Order (EO) 14420, “Delivering Gold Standard Childhood Vaccine Recommendations for Americans.” One key recommendation in the EO is to change the vaccine regimen for children, asserting
that the combined measles, mumps, rubella (MMR) vaccine should be administered in three separate single-disease shots once such products are domestically available and that, to the maximum extent feasible, all childhood immunizations should be administered at separate medical visits.
Foundational Bioethics Principles Poorly Understood
In putting forth this recommendation the EO mentions two foundational bioethics concepts, personal autonomy and informed consent, without seeming to have a full understanding of either.
Specifically, the EO states the following:
EO 14420 invokes the language of bioethics, public health, and even child welfare while at the same time ignoring the basic tenets of all, not to mention established and substantiated data. Science should not be anathema, children should not be political pawns, and the health and well-being of society should not be jeopardized by the unfounded, dangerous beliefs touted by those without relevant expertise relying on unproven data.
Science is not exact and vaccines may not be completely safe for everyone in every instance. It’s clear, however, that childhood vaccines are one of the great public health victories of the past century. Iron lungs are no longer standard hospital equipment, smallpox is no longer ravaging communities, and until recently measles fatalities were minimal with current cases being at a 35 year high.
Parental Authority Not Synonymous with Personal Autonomy
While invoking the nomenclature of bioethics – “personal autonomy” and “informed consent” – this EO flies in the face of those long-established bioethical principles, using the terms in what seems to be a gratuitous way.
For instance, personal autonomy is exercised by adults with decision-making capacity. With regard to their children, parents are seen as being in the best position to determine what is best for their children, but this is seen as exerting parental authority which is not synonymous with personal autonomy. While changing the established vaccine regimen may seem to uphold the values of parental authority, parental authority is not absolute. The Supreme Court, in Prince v. Massachusetts acknowledged this, asserting that the interest of the State is not:
nullified merely because the parent grounds his claim to control the child’s course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. (citation omitted) The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.
This recognizes not only that children are seen as a vulnerable population but that others in the community (such as those who are immuno-compromised) not only benefit from herd immunity but survive because of it.
Valid Informed Consent Requires Medically Appropriate Options
The EO also invokes the bioethical concept of informed consent without a clear recognition of the process and intent of it. Typically, informed consent requires disclosing the risks, benefits, and alternatives to a proposed treatment. How the standards of informed consent are met here is not clear given that the data upon which the recommendation is based is not derived from the generalizable and replicated data nor from reputable experts but rather from influencers.
Even more insidious than the misinformation or disinformation upon which the EO is based is the recognition that those harmed the most by it are those who are most disadvantaged and that the impetus for such a harmful policy is to address “epidemic rates of autism”. Tellingly, in the transcript of remarks made while signing the EO, “autism” is mentioned 22 times, despite repeated studies demonstrating no causal link between vaccination and autism.
Valid informed consent requires “[t]ransparency with patients regarding all medically appropriate options of treatment is critical to fostering trust.” The EO and the rhetoric surrounding it seem to flout what are recognized as medically appropriate options and it completely ignores the children and their right to assent as well as their right to an “open future.” While parents are most often the ultimate decision maker for a child, the dignity and developing autonomy of the child must also be considered.
Healthcare Organizations Oppose MMR in Three Doses
The Centers for Disease Control (CDC) of the early naughts recognized vaccination as one of the greatest achievements of the 20th Century. Globally, vaccines are estimated to have saved over 150 million lives since 1974. If this is the case, how in 25 years did vaccines become so dangerous? How will breaking up the MMR vaccination into 3 separate shots improve the lives of parents who will now need to make 2 additional visits to get their children fully vaccinated? And, what happens in the interim, while pharmaceutical companies work to develop and manufacture 3 separate vaccines? Sowing the seeds of doubt in a public health intervention that has proven effective puts not only children at risk but the entire health care system.
Fortunately, over 200 healthcare organizations (led by the American Academy of Pediatrics) have issued a letter opposing the executive order. Even more telling, no state has changed its schools’ vaccine requirements. These are appropriate responses based on tenets of public health and ethics to protect the health of our children and our communities.
Authors
Nanette Elster, JD, MPH and Kayhan Parsi, JD, PhD are the John B. Francis Co-Chairs in Bioethics at the Center for Practical Bioethics.
