A few years ago, pre-pandemic, I gave a presentation to a room full of doctors. My first slide was a series of graphs—they showed a series of curves twining and overlapping as if crudely hand drawn falling from a peak. I asked three questions: What is this? What are these peaks and troughs? And what does it mean? My questions were not fair: only the shape of the curves was consistent, the print small, the key illegible. I paused momentarily, admitted I was an epidemiolo­gist—which drew a few laughs—then explained this was a graph of the leading causes of death in the United States. Each line and color represented a different year. I asked a fourth question: What do you see? The room paused until someone offered, “The curves are alike.” Nothing has changed, which was my point.

Heart disease, cancer, and stroke continue to claim the lives of our parents, siblings, friends, and neighbors. In the years since 2020, COVID-19 has entered the top three; with the opioid epidemic, unintentional deaths—motor vehicle accidents, falls, and overdoses—round out the top five causes of mortality. The precursor conditions to these causes of death are the very conditions that crowd our exam rooms: high blood pressure, overweight, diabetes (a top 10 cause of mortality in its own right), tobacco use, and low access or uptake of preventive health care, including testing, screening, vaccinating, coaching, counseling, and prescribing.

As a pediatrician, I have seen vaccination steadily change the curves, especially with campaigns dating from the 1950s forward. As more vaccines directed against the most common causes of childhood illness were introduced year after year, our battle call became “no missed opportunities.” Whenever a parent and child entered our offices, for whatever chief complaint, if they were deficient in age-appropriate immunizations we were to offer them immediately—not at some future appointment likely to be missed. This issue of the journal persuades us to cry “no more missed opportunities” when it comes to cancer, stroke, and heart disease in North Carolina and beyond.