Amidst vaccine confusion, we must follow the evidence to protect against meningococcal disease

By Gary Puckrein, Ph.D. on behalf of Sanofi

For two decades, meningococcal (Men) vaccines have been powerful tools against invasive meningococcal disease (IMD) — a rare but potentially devastating illness that can cause life-threatening infections of the brain, spinal cord, and bloodstream.¹ An otherwise healthy teenager can develop vague symptoms in the morning and be in septic shock by the evening. Case-fatality remains roughly 10 to 15 percent even with modern intensive care, and about one in five survivors is left with permanent sequelae such as hearing loss, limb amputation, or cognitive injury.¹ When it comes to protecting the health of our adolescents, the science remains clear: Routine vaccination against IMD is essential to sustaining immunity during the years when young people are at greatest risk.² 

Learning from science in action.

Routine vaccination against the A, C, W and Y serogroups of the bacteria Neisseria meningitidis (MenACWY) was first recommended in the United States in 2005 for those aged 11-12 years. A booster ACWY dose at age 16 was added to the schedule in 2010, along with a MenB dose in 2014, to sustain protection through later adolescence and into young adulthood. This schedule has worked: Since 2005, the incidence of IMD caused by serogroups C, Y and W has decreased by over 90%.³ 

But recent events and vaccination trends should have us concerned about the future of IMD protection. Despite the dangers of IMD and abundant evidence supporting the value of routine immunization for all adolescents, the U.S. Centers for Disease Control and Prevention (CDC) moved MenACWY and B vaccinations from routine to “recommended for certain high-risk groups or populations” or based on “shared clinical decision-making” in its updated childhood vaccination schedule. The initial policy change and the subsequent ruling by a Federal judge temporarily blocking it in March has increased confusion, compounding the difficulties healthcare providers and families face navigating guidance and combating vaccine hesitancy and distrust. 

With vaccine guidance in turmoil, clinicians and families have been left with more questions than answers. Why did Federal agencies recommend these changes? What did high risk mean when it came to that guidance? Does high risk apply to every young person who will be in close quarters with others, for example at school, sleepaway camp, and college? Should everyone get the meningococcal vaccine? 

Hopefully, families seek reputable information from major medical associations, including the American Academy of Pediatrics (AAP), which continue to recommend routine two-dose vaccination for IMD.⁴ But likely, the burden will continue to fall on healthcare providers to have these important conversations with families and promote the value of routine vaccination, before we miss a critical window of opportunity. In a recent study published in Vaccine, one model predicted that moving from a two-dose schedule to a single dose at age 16 years, even if vaccine coverage was (optimistically) 90%, would result in 934 additional IMD cases across all ages, including 135 deaths, from 2025 to 2035.⁵  This scenario could be an 86% increase from the current rate of 503 U.S. cases reported in 2024, which was already the largest number of cases reported since 2013.⁶ 

Why timing and conversation matter.

The 11-12-year-old annual doctor's visit plays an essential part in ongoing care for pre-teens, becoming a platform for continuity — a predictable point where clinicians can check growth and development, reinforce standards of care, administer vaccinations, and engage families in conversations about health. 

As adolescents age, those touchpoints diminish.⁷ Many teens stop visiting a doctor altogether, and the data tell the story: MenACWY vaccination rates drop from roughly 90% for the first dose at age 11-12 to about 61% for the booster at age 16.⁸ Immunity from the initial dose wanes over time, so touchpoints with older adolescents can be critical for ensuring a second dose.⁹ Research supports that the drop-out rate is higher among low-income adolescents and those whose mothers did not have college education.¹⁰ But waning antibody is only part of the story: The early dose establishes the immunologic memory that the age 16 booster reinforces — a prime-boost architecture that a single late dose cannot replicate.⁹

Staying focused on our goals.

Routine immunization against IMD is important not only to protect our progress, but to help level the playing field of equitable access. As president and CEO of the National Minority Quality Forum (NMQF), I have maintained that any society's healthcare infrastructure goal should be to encourage healthy practices that help people live longer and better lives. From a public health perspective, vaccines are not just about individual protection — they're important for protecting communities. 

When more young people are fully vaccinated, outbreaks are less likely to occur — and communities benefit.¹¹ It should be a critical public health priority to educate on the risks of illness, and the value that vaccines can offer for protection, while also working to remove barriers for people seeking vaccines, especially those already facing low vaccination rates or greater exposure to the bacteria that cause IMD in congregate settings. These decisions do not stop at the clinic door. Any changes to the immunization schedule can cause public distrust, which can take years to rebuild.

This is why I continue to advocate for routine administration with two doses of the meningitis vaccine, which has been validated with a high evidentiary bar over the last two decades.³

Taking action, together.

Over the last two decades, routine vaccination with the two-dose MenACWY schedule has been a public health success story.³ Now, it is up to those on the frontlines to cut through the noise and confusion and give clear guidance to families to ensure that our progress isn’t lost. In a sea of confusion, we must continue to follow and guide families with the evidence that vaccination against IMD works. Together, we can ensure that every young person — no matter where they live or their race — has the protection against IMD they deserve.

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1. U.S. Centers for Disease Control and Prevention. Meningococcal disease symptoms and complications. https://www.cdc.gov/meningococcal/symptoms/index.html. Accessed April 24, 2026.
2. U.S. Centers for Disease Control and Prevention. Recommended vaccines for preteens and teens. https://www.cdc.gov/meningococcal/vaccines/preteens-teens.html. Accessed April 24, 2026.
3. Shoukat, A., Wells, C.R., Shin, T., Potter‑Schwartz, L., Galvani, A.P., and Moghadas, S.M. (2025). Assessing the impact of revising MenACWY vaccination schedule for adolescents in the United States: A modeling study. Lancet Regional Health – Americas, 44, 101033. https://doi.org/10.1016/j.lana.2025.101033
4. American Academy of Pediatrics. AAP vaccination schedule. https://publications.aap.org/redbook/resources/15585/. Accessed March 11, 2026.
5. Shaw, J., et al. (2025). Risks of removing the age 11–12-year meningococcal vaccine dose from the U.S. immunization schedule. Vaccine, 61. https://doi.org/10.1016/j.vaccine.2025.127428
6. U.S. Centers for Disease Control and Prevention. Meningococcal disease surveillance and trends. https://www.cdc.gov/meningococcal/php/surveillance/index.html. Accessed March 16, 2026.
7. Johns Hopkins Medicine. (January 2026). Johns Hopkins Children’s Center study tracks declines in annual checkups as teens become young adults. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2026/01/johns-hopkins-childrens-center-study-tracks-declines-in-annual-checkups-as-teens-become-young-adults
8. U.S. Centers for Disease Control and Prevention. “Vaccination Coverage Among Adolescents Aged 13–17 Years — National Immunization Survey‑Teen, United States, 2024.” Morbidity and Mortality Weekly Report, vol. 74, no. 30, 2025, https://www.cdc.gov/mmwr/volumes/74/wr/pdfs/mm7430a1-H.pdf.
9. U.S. Centers for Disease Control and Prevention. “Types of Meningococcal Vaccines.” Centers for Disease Control and Prevention, Mar. 30, 2026, https://www.cdc.gov/meningococcal/vaccines/types.html.
10. Wells, C.R., et al. Racial and ethnic disparities in meningococcal vaccination coverage and disease burden among U.S. adolescents. Journal of Adolescent Health, 78(2), 308–314.
11. U.S. Department of Health and Human Services. Immunization: Vaccines protect your community. https://www.hhs.gov/immunization/basics/work/protection/index.html. Accessed March 11, 2026.