The CDC’s childhood immunization schedule is being updated. Effected immediately, CDC now recommends a significantly reduced vaccination program, aligning it with peer nations like Denmark.
Before the holidays President Trump directed U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. to review international vaccine schedules. A month later, after a scientific assessment comparing U.S. policy to 20 other countries, the Centers for Disease Control and Prevention (CDC) has updated the U.S. childhood immunization schedule. The childhood vaccines will be cut from approximately 54 to 23, effectively halving the U.S. vaccine program.
“President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” Secretary Robert F. Kennedy Jr. said in a press release. “After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent. This decision protects children, respects families and rebuilds trust in public health.”
The scientific review of U.S. practices compared to 20 peer nations showed that countries without vaccine mandates still “had as high immunization rates as the U.S.” and as strong or stronger health. Particularly compared to Denmark, a country that recommends roughly half the vaccines as the U.S. while achieving similar or better health outcomes. The public health authorities are also struggling with a steep decline in public trust, from 72% to 40% between 2020 and 2024 alone, coinciding with public health failure during the pandemic, including COVID-19 mandates. This has led to a lowered uptake of vaccines as people now ignore CDC’s recommendations. The HHS recognize the need for less coercion and more information based parental choices.
The number of universally recommended vaccines will be reduced from covering 18 diseases to 11, with the total doses dropping from up to 72 by age 18 to around 23. Vaccines are now categorized as:
- Recommended for all children
The CDC continue to recommend that all children are vaccinated against diseases that cause serious morbidity or mortality to children and for which there is a concensus among peer nations. The updated childhood immunization schedule will include diphtheria, tetanus, acellular pertussis (whooping cough), Haemophilus influenzae type b (Hib), Pneumococcal conjugate, polio, measles, mumps, rubella, varicella (chickenpox) and one, not two, doses of human papillomavirus (HPV). - Immunizations Recommended for Certain High-Risk Groups or Populations
No longer universally recommended but available for at-risk individuals or via shared clinical decision-making with healthcare providers are vaccines for respiratory syncytial virus (RSV), hepatitis A, hepatitis B, dengue, meningococcal ACWY, and meningococcal B. - Immunizations Based on Shared Clinical Decision-Making.
Available, based on shared clinical decision-making, are vaccines for rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A, and hepatitis B.
HHS ensures that all the “diseases covered by the previous immunization schedule will still be available” for free to anyone who wants them. All vaccines, regardless of category, remain insurance-covered.
Del Bigtree, host of The HighWire and CEO of the Informed Consent Action Network (ICAN) – among many others – welcomes the shift. That chickenpox is not on Denmark’s schedule but is retained in the U.S. is due to concerns about abruptly removing it, he says. Bigtree explains that decades of vaccination may have eliminated natural maternal immunity passed to infants, potentially increasing risks for newborns if discontinued suddenly. Similarly, measles vaccine is kept for the same reason. Natural immunity for these benign childhood diseases, if treated correctly, may take some time to rebuild. HPV is included as it aligns with Denmark’s schedule, but Bigtree anticipates potential future adjustments pending the ongoing safety reviews of aluminum adjuvants in vaccines by the Advisory Committee on Immunization Practices (ACIP).
Accountability
Bigtree brings up one important implication of the reduced routine vaccination program; an increased accountability. Vaccines removed from the routine schedule lose liability protections under the 1986 National Childhood Vaccine Injury Act. Manufacturers of these vaccines can now face direct lawsuits if these injure or kill anyone, rather than claims being limited to only the Vaccine Injury Compensation Program.
Removal of Financial Incentives Tied to Vaccination Rates
The reduced childhood vaccine program comes at the same time as the HHS, through the Centers for Medicare & Medicaid Services (CMS) and the CDC, implements policy changes to eliminate financial and administrative incentives used to pressure healthcare providers to achieve high vaccination rates.Four immunization quality measures – including Childhood Immunization Status and Immunizations for Adolescents – have been removed from the mandatory Medicaid and CHIP Core Sets and states are no longer required to report vaccination rates to CMS. Federal payments will no longer be linked to performance on immunization quality measures. Administration fees for giving vaccines remain unchanged, but bonuses or penalties based on overall patient vaccination rates are removed.
Bonuses and rewards for physicians based on the number or percentage of patients vaccinated, previously could result in significant annual losses (over $1 million for large pediatric practices) when patients declined vaccines. It encouraged high-pressure tactics, such as doctors dismissing families who decline vaccines or avoiding unvaccinated patients to maintain high ratings. States are urged to discontinue similar incentives, though they may still offer them voluntarily.
Informed consent and parental choice
These policies aim to reduce coercion, foster ethical doctor-patient relationships and prioritize informed consent, parental choice and shared decision-making, empowering parents and physicians to tailor decisions based on individual risks.
HHS PRESS RELEASE: CDC acts Presidential Memorandum Update Childhood Immunization-schedule
HHS PRESS FACT SHEET: CDC Childhood Immunization Recommendations
