February 21, 2026

Our government has three branches, but America has four. Congress writes the laws, the president enforces them, and the courts interpret them. That’s the structure. But structure alone is not what sustains a democracy.

There is a fourth branch that is unwritten, unelected, and absolutely essential: the people. The people sustain our democracy, especially when it’s under threat.

Civic muscle

We know the people can do that because we have seen people in action. We have witnessed the power of ordinary people in extraordinary moments. 

After the Tree of Life synagogue shooting, the community rose in solidarity and care. We saw that power during the winter storms that have buried Western Pennsylvania, when people cleared snow, shared warmth, and made sure no one was left alone.

That same civic muscle, that instinct to protect one another when systems strain, is what sustains our democracy.

It protects a free press when journalists continue reporting despite threats, and when citizens fund community newsrooms to prevent news deserts and preserve watchdog journalism. It defends the rule of law when civil servants testify truthfully under oath, even at personal cost, and when pro bono attorneys represent protesters, journalists, and vulnerable communities whose constitutional rights are threatened.

In moments of crisis, millions have marched peacefully to demand equal protection under the law, invoking First Amendment rights not as a slogan, but as a responsibility. This was on full display last October, when nearly seven million Americans peacefully poured into the streets for nationwide “No Kings” protests, drawing massive crowds in Pittsburgh and outlying towns. Allderdice students offered a vivid reminder in their recent walk out to protest ICE’s actions that the power of this republic does not belong to kings or rulers.

When ICE moved to disrupt protests and threaten the people standing for justice, ordinary Pennsylvanians rose to defend the Constitution. Many learned how to confront disruptors, sometimes armed with nothing more than a whistle and their phones. Jon Stewart calls them “weapons of mass illumination,” tiny lanterns of democracy. In our hands, they capture injustice, preserve truth, and shine a piercing light where power prefers shadow.

Rights and responsibilities

This is not about politics. This is about the survival of our democracy. Transparency is not optional. It is constitutional.

In Minneapolis, nurses went door to door to ensure patients received care without fear of immigration enforcement. They understood something fundamental: public health and civil liberties are intertwined. When fear keeps people from seeking care, the whole community suffers.

We attended a virtual vigil with nurses from WeCare in Minneapolis. Pittsburgh nurses also came together to honor Alex Pretti. They stood at the Fred Rogers Memorial because we must always find the helpers, and ask “are you okay?”

When misinformation spreads faster than truth, healthcare workers, parents, and grandparents push back in living rooms, churches, and community centers. Grandparents for Vaccines, for example, which we co-founded, tries to harness the moral authority, experience, and love of grandparents to promote the health, safety, and well-being of the next generation. That, too, is constitutional work, protecting the general welfare of our citizens.

Democracy is not self-executing. The Constitution does not defend itself. It depends on citizens who understand that rights and responsibilities travel together.

Freedom of speech means showing up and speaking. Freedom of the press means supporting journalism that holds power accountable. The duty of citizenship means rejecting violence, intimidation, and lies, even when they serve our preferred side.

The Fourth Branch is not red or blue. It is American. And right now, it is needed as much as ever.

Dependent on the Fourth Branch

History rarely hinges on presidents and judges. More often, it hinges on us.

The Fourth Branch has always been there, from citizens who insisted on civil rights, to those who defended free speech, to those who quietly uphold democratic norms when no one is watching.

Ordinary people. Extraordinary resolve.

The Constitution is not just a document we admire. It is not a structure we can take for granted. It will break down if we do that.

It the bedrock of a system we must sustain. Its future depends, as it always has, on the Fourth Branch: the people.

Donna A. Gaffney and Teri Mills are leaders in Nurses for America and members of Defend Public Health. Their previous article was "Vaccines save lives Mr. Kennedy.”

When we became grandparents, we expected to worry about school performance, scraped knees, first heartbreaks, and whether our grandchildren were getting enough sleep. We never expected to worry that diseases we once thought were gone might come roaring into their lives. Yet here we are.

We understand why some parents hesitate about vaccines. The internet is saturated with alarming stories and loud voices warning that vaccines may do more harm than good. When you love your child more than anything, even a small seed of doubt can grow quickly. Fear is powerful, especially when it comes fueled by emotional anecdotes rather than medical facts.

As grandparents, we’ve lived long enough to remember what those fears leave out.

We remember measles, polio, and whooping cough, as real and frightening illnesses that often hospitalized children, causing lasting disabilities, and sometimes took young lives. Many parents today have never seen these diseases firsthand. That is a testament to the success of vaccines, but it has also made the dangers feel distant, even imaginary. When a threat feels invisible, protection can feel optional.

It isn’t.

Diseases do not disappear on their own. They disappear because communities choose to protect one another. When vaccination rates fall, preventable diseases return, and the consequences fall first and hardest on the most vulnerable, infants, medically fragile children and older adults.

That reality is why Grandparents for Vaccines was formed. This grassroots organization grew out of concern from grandparents across the country who were alarmed by declining vaccination rates and the growing influence of misinformation. Many of us raised our own children in a time when vaccines were understood as a public good, something that protected not just individual families, but entire communities. Our mission is simple: to use our lived experience, our voices, and our love for the next generation to advocate for routine childhood immunization and to ensure that preventable diseases do not reclaim a foothold in our grandchildren’s lives.

Grandparents for Vaccines does more than raise awareness. We take action. Members host community conversations and educational events, partner with pediatricians and public health experts, and share personal stories about what life was like before vaccines were widely available. With an emphasis on storytelling campaigns and a growing YouTube channel, grandparents speak directly to parents in a voice rooted not in politics, but in care, memory, and lived experience. These stories are not meant to frighten, but to remind us what is at stake and what we stand to protect.

On the Grandparents for Vaccines YouTube channel, one grandmother describes her 4 year old sister contracting measles before a vaccine was available, recalling how quickly this childhood illness resulted in permanent cognitive impairment, changing her entire family’s life forever. In another video, a grandfather speaks about his grandson, born prematurely and too young to be fully vaccinated, and his fear that declining community vaccination rates could expose the baby to life-threatening infections. A grandmother shares the heartbreak of losing her perfectly healthy 2 year old grandson from meningitis. These are not abstract debates; they are lived realities that connect past and present.

We frequently hear parents say they are overwhelmed with immunization information. The vaccine schedule feels complicated. The instructions are dense. One doctor’s visit doesn’t always leave room for every question. When answers feel rushed or confusing, uncertainty can harden into hesitation.

That is not a failure of parents. It is a failure of our systems to communicate clearly and compassionately.

As grandparents, many of us feel a responsibility to speak up, not to shame or lecture, but to share perspective. We have seen what happens when vaccines are absent. We understand that “natural” exposure often means very real suffering. Today’s questions deserve respect, but so do yesterday’s consequences.

Vaccines are not about blind trust. They are about decades of evidence, constant monitoring, and a simple goal: giving children the chance to grow up healthy and safe.

We want our grandchildren to grow up in a world where parents don’t have to learn the hard way what previous generations fought so hard to prevent. Choosing vaccination is not just a medical decision. It is an act of love, protection, and hope for the future.

As grandparents, we owe our grandchildren nothing less.

Donna A. Gaffney of Pacific Palisades, Calif., and Teri Mills of Tualatin, Ore., are medical

professionals and co-founders and board members of Grandparents for Vaccines.

In The Wizard of Oz, authority was created through spectacle. Smoke, sounds, and illusion mask the absence of substance, until the curtain is pulled back and the truth is revealed. It is a story about deception, but also about courage, especially the courage it takes to name what is happening when appearances no longer match reality.

That moment arrived on January 5th 2026 in American public health.

Federal health officials announced sweeping revisions to the U.S. childhood immunization schedule, reducing the number of diseases covered by routine vaccination and circumventing the detailed, evidence-based review process that has guided national recommendations for decades. Issued jointly by the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention, the decision represents a profound shift in how this country protects its children.

As grandparents, we are speaking out because we have lived long enough to know what this kind of shift can mean. We remember the world before vaccines quietly transformed childhood. We remember polio wards and iron lungs. We remember measles outbreaks that closed schools, influenza seasons that filled pediatric wards, and families forever changed by diseases that are now largely preventable. Especially memorable, were children suffering the consequences of hepatitis B infections, specifically chronic liver disease. Vaccines did not erase risk entirely, but they changed the landscape of childhood in ways that saved lives and spared suffering.

These children are not abstractions to us. Dr. Danielle Dunetz, a pediatrician in New Hampshire, recalls an 18-year-old girl she met on her first day of residency. Just weeks after graduating high school, this young woman was hospitalized with anorexia nervosa. Further testing revealed liver cancer with metastases. She had never received the hepatitis B birth dose. She hoped to become a teacher. She died from a preventable disease just weeks before entering college. 

The rollback of routine recommendations for vaccines protecting against illnesses such as influenza, RSV, hepatitis A and B, rotavirus, and meningococcal disease places children at unnecessary risk and creates confusion for parents seeking clear guidance. Vaccine recommendations were not created casually. For decades, they were shaped by pediatricians, immunologists, and public health experts who reviewed data carefully and transparently, always with the goal of protecting children in the real-world conditions of the United States.

That process has now been disrupted.

Supporters of the changes point to other countries as models, particularly Denmark. But the United States is not Denmark. Our population is vastly larger and more diverse. Our classrooms are more crowded. Our climate, healthcare access, and disease exposure risks differ significantly. Importing another country’s immunization schedule without accounting for these realities does not strengthen public health. It destabilizes a system that parents, clinicians, schools, and communities have relied on for generations.

When national guidance becomes unstable, trust erodes. And when trust erodes, vaccination rates fall. History has shown us this repeatedly. Confusion is not neutral. It is dangerous.

Let us be clear about one critical point. These vaccines are not banned. Parents can still protect their children. Pediatricians can still recommend these vaccines, and families can still request them. Insurance coverage remains in place. What has changed is the clarity and strength of federal guidance that families have long depended on.

In moments like this, trusted medical relationships matter more than ever. Grandparents for Vaccines urges parents to turn to the immunization schedule recommended by the American Academy of Pediatrics and to speak directly with their child’s pediatrician. Ask questions. Seek evidence. Rely on clinicians whose careers are grounded in caring for children, not on shifting political winds.

Grandparents carry a unique form of authority. Ours is not rooted in ideology, but in memory. We know what happens when preventable diseases return, because we lived through those eras. We know that public health gains, once lost, are hard to reclaim. And we know that children pay the price when adults fail to act with care, humility, and responsibility.

We are raising our voices now, before the consequences fully unfold, to say this plainly, “Do not play politics with the health of our grandchildren. Protect them.”

America’s grandmothers and grandfathers are standing up so the nation can hear our plea. Across generations, we share one responsibility: to ensure that children are protected by evidence, not illusion. Grandparents for Vaccines will continue to speak, advocate, and stand with families and pediatricians to keep all our grandchildren safe.

Donna A. Gaffney and Teri Mills (Co-founders of Grandparents of Vaccines and Leaders in Nurses for America)

The critical role of immigrant workers in healthcare is underscored by your recent article about the death of nurse Muthoni Nduthu, the nurse who perished with two others in an explosion at Silver Lake Nursing Home in Bucks County.
Ms. Nduthu and her family emigrated from Kenya to Philadelphia two decades ago. Like many immigrants — some, yes, undocumented — she worked long hours and put herself through school to become part of the huge share of foreign-born workers in the healthcare sector — 28% of the overall direct care workforce for long-term care, and 32% of workers in home care settings, according to a 2025 analysis by KFF.

What would the steadily growing U.S. aging population do without these men and women?

As a nurse myself, and recently having family members in other rehabilitation centers, I can attest to the important roles of immigrants and people of color in providing care. It is tough work, with a median annual wage of $16,800, according to a brief prepared for the SCAN Foundation. Consequently, there isn’t a clamor for these jobs by native-born Americans.
The Trump administration’s immigration policies and U.S. Immigration and Customs Enforcement deployments are having a chilling effect on immigrants seeking employment in healthcare — something we absolutely don’t need as our aging population demands more care.
We need more people committed to helping others like Nduthu. Let’s honor her memory by welcoming newcomers to our country, thoughtfully reforming immigration laws, and realizing that adequate healthcare can’t be achieved without immigrants.

Pat Ford-Roegner, Glen Mills.  Pat is a Core Leader for Nurse for America.