On January 5, the Department of Health and Human Services (HHS), under Secretary Robert F. Kennedy Jr., reduced the number of diseases targeted on the childhood immunization schedule from 17 to 11. The schedule is recommended by the Centers for Disease Control and Prevention (CDC) and is a timeline for administering vaccines to children through age 18.
The changes come after President Trump issued a Presidential Memorandum directing the HHS and CDC to review the schedules of other developed countries due to false claims pushed by him and Kennedy that the number of vaccines for U.S. children could be linked to chronic health conditions or autism. Although other countries may recommend fewer vaccines, this is because of many factors, including different disease threats, costs, and national health systems.
No other high-income country has made its vaccination decisions based solely on those of another country. The updated schedule also reflects a change in the traditional process of making major vaccine policy changes, which involves a formal review of data involving CDC experts and public health leaders. However, the recent changes were announced outside of that established framework, and without prior public discussion.
What are the changes?
Under the revised schedule, the CDC divides childhood vaccines into three categories:
Category 1
- Immunizations recommended for all children
- Diphtheria, tetanus, acellular pertussis (DTaP, Tdap)
- Haemophilus influenzae type b (Hib)
- Pneumococcal conjugate (PCV)
- Inactivated poliovirus (IPV)
- Measles, mumps, rubella (MMR)
- Varicella (VAR)
- Human papillomavirus (HPV)
In the first category, the CDC will continue to recommend vaccines for diphtheria, tetanus, pertussis, Haemophilus influenzae type B, pneumococcal disease, polio, measles, mumps, rubella, varicella, and human papillomavirus. For human papillomavirus, the recommended dose was changed from two or three to one.
DTap and Tdap protect against diphtheria, tetanus (lockjaw), and pertussis (whooping cough); Hib against meningitis, pneumonia, and epiglottitis; PCV against meningitis, pneumonia, blood infections, and ear infections; IPV against polio; VAR against chickenpox; and HPV against genital warts as well as cervical, anal, and throat cancer.
Categories 2 and 3
- Immunizations recommended for certain high-risk groups
- Respiratory syncytial virus (RSV-mAb)
- Hepatitis A (HepA)
- Hepatitis B (HepB)
- Dengue
- Meningococcal ACWY
- Meningococcal B
- Immunizations based on shared clinical decision-making
- Rotavirus (RV)
- COVID-19
- Influenza (Flu)
- Hepatitis A (HepA)
- Hepatitis B (HepB)
- Meningococcal ACWY
- Meningococcal B
In the second and third categories, vaccines against respiratory syncytial virus, hepatitis A and B, dengue, meningitis, rotavirus, COVID-19, and influenza are now only recommended for children based on certain risk criteria or after shared clinical decision-making. Shared clinical decision-making involves a conversation between the provider and patient to determine whether taking the vaccine is appropriate. All vaccines recommended in any of the three categories will remain covered by insurance.
RSV-mAb protects against respiratory syncytial virus infection, which can cause bronchiolitis and pneumonia in infants; HepA and HepB against liver inflammation; Dengue against a mosquito-borne illness; Meningococcal ACWY and B against types of bacteria that infect the brain, spinal cord, or blood; and RV against rotavirus, which can cause severe diarrhea and dehydration in infants.
How will the schedule change affect childhood health?
Despite these changes, states can still set their own vaccine policies. However, CDC guidance strongly influences state decision-making. Although some states have departed from federal guidelines, others have taken this opportunity to push for looser vaccination requirements and more exemptions in schools.
In the context of already declining childhood vaccination rates and current influenza and measles outbreaks, public health experts see no reason to justify the change. The HHS cites decreased vaccination rates and declining trust as additional reasons for changing the recommendations, but it is not clear how these changes will take effect. Just three of the six vaccines no longer recommended (hepatitis A, hepatitis B, and rotavirus) have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years.
Why are vaccines important beyond disease prevention?
Secretary Kennedy has continued to attack vaccine mandates, claiming that children receive “too many vaccines”, installing vaccine skeptics on the CDC vaccine advisory committee, and slashing funding for vaccine development using mRNA technology. Vaccines help to offset gaps from the lack of a universal healthcare system in the U.S. by preventing diseases before they occur and reducing the high costs of treating infections, a potential burden for many families.
Vaccines are also highly cost-effective, as every $1 spent on general childhood immunization saves about $11 in societal costs, which includes treatment and lost productivity when parents take time off work to care for a sick child. Vaccines also protect children from illnesses that would otherwise keep them out of school, which affects their learning, social development, and childcare arrangements.