Emory Launches Interactive Map Projecting Health, Economic Costs of Declining Vaccine Coverage

NOTE: This article was initially published February 11, 2026. It was updated to reflect three additional diseases added to VaxImpactMap.

Researchers at Emory University's Rollins School of Public Health have developed a new interactive tool that projects the disease and economic impacts created when vaccination rates decline. The launch comes as U.S. immunization coverage faces unprecedented challenges from shifting federal guidance and increased misinformation about vaccine safety and efficacy.

VaxImpactMap uses epidemiological models and state-level data to project the additional disease cases, hospitalizations, deaths, missed workdays, and health care costs that would occur at different levels of declining vaccination coverage.

Six major vaccine-preventable childhood diseases are featured on VaxImpactMap: rotavirus (diarrheal disease), pertussis (whooping cough), pneumococcal disease (serious bacterial infection), varicella (chickenpox), Haemophilus influenzae type b (Hib), and pediatric RSV. These vaccine preventable diseases have a relatively predictable relationship between vaccine coverage and their corresponding disease burden. The researchers plan to add additional vaccine-preventable diseases to the tool in the future.

“The sudden changes to the national vaccine guidelines threaten to reduce coverage of several key vaccinations across the country. In response, we developed VaxImpactMap, an easy-to-use, interactive tool that shows what the health and economic impacts can be in your state if vaccine coverage declines. These are the real consequences of policy changes for individuals, for vulnerable children, for public health, and for our health care system,” says Benjamin Lopman, PhD, professor of epidemiology and global health at the Rollins School of Public Health.

A key feature of VaxImpactMap is its ability to provide state-level projections because impacts will vary across states due to different factors like the current levels of vaccine coverage.

For example, if vaccine coverage declines by 20% for each of the six diseases over five years:

• Rotavirus: In states with high vaccine coverage, like Massachusetts, there will be approximately 46 additional hospitalizations and $400,000 in associated hospitalization costs per 100,000 children 5 years old and younger in 2030. In states with medium levels of current coverage, like Missouri, there will be 84 additional hospitalizations and $700,000 of hospitalization costs per 100,000 children in 2030.
• Pertussis: A 20% decline in vaccination coverage among infants would result in an additional 2,768 hospitalizations and 27 deaths among U.S. children under the age of 15, and $183 million in costs nationally in 2030. And states with the highest current coverage—such as Texas, Tennessee, and California—would be most affected.
• Pneumococcal conjugate vaccine: Coverage decline would result in the greatest impact due to the severity of invasive pneumococcal disease. A 20% decline of vaccination coverage among infants would result in an additional 3,844 hospitalizations and 142 deaths among U.S. children under age 5, and $81 million in costs in 2030. And even at a 1% decline over one year, highly populated states like California and New York show a projected increase in deaths.
• Varicella: Coverage decline would result in approximately 817,000 additional cases annually, 10,100 additional hospitalizations, 82 additional deaths, and $1.8 billion in additional annual health care and productivity costs nationwide.
• Haemophilus influenzae type b: A 20% decline in coverage would result in about $1.2 million in additional annual health care and productivity costs nationwide, as well approximately 39 additional cases, 37 additional hospitalizations, and two more deaths each year.
• RSV: Coverage decline would result in approximately 158,800 additional cases, 9,500 additional hospitalizations, and 22 additional deaths nationwide. There would also be about $381.1 million in additional annual health care and productivity costs nationwide. Reflecting differences in population, birth rates, current coverage, and disease burden by state, the tool projects Florida would experience 559 additional RSV hospitalizations each year, compared with 57 additional hospitalizations in New Mexico.

In January, acting Centers for Disease Control and Prevention (CDC) Director Jim O’ Neill signed a decision memorandum ordering the CDC to adopt an updated vaccine schedule for the United States. The new schedule removed rotavirus and five other diseases from the list of universally recommended vaccines. 

“We know the rotavirus vaccine prevents approximately 40,000-45,000 hospitalizations a year, so reducing coverage would be totally unnecessary and harmful,” Lopman says. “We’re also seeing a resurgence in outbreaks of diseases like pertussis now, so we fear that the changes in vaccine policy are creating a culture that will result in lower coverage, exacerbating the avoidable burden of other diseases.”