The CDC has decreased the number of recommended vaccines for children and relegated some to "shared clinical decision-making," likely causing confusion for patients, and ultimately reducing the number of US children who will receive once-recommended vaccines. Under the new childhood immunization schedule, the CDC now recommends 11 of the prior 17 vaccinations.

The current list of recommended childhood vaccinations include measles, mumps, and rubella (MMR), polio, chickenpox, and human papillomavirus, while RSV, meningococcal disease, hepatitis B, and hepatitis A now are recommended only for children who are at higher risk for these infections.

In a change for the flu, COVID-19, and rotavirus childhood vaccinations, the CDC now recommends “shared clinical decision-making.” This category also includes vaccination against hepatitis A and B and meningococcal disease for children not considered to be at high risk.

In a January 5 press release, the Department of Health and Human Services (HHS) referred to the changes as new categorizations. The changes follow a December 5 Presidential Memorandum that directed federal health officials to revisit how other developed countries handle childhood vaccination, specifically looking at the recommended immunizations against 10 diseases for children in Denmark, according to the HHS statement.

All currently recommended vaccines will continue to be fully covered by insurance, according to the statement.

Expect Confusion in the Clinic

“The new recommendations will most likely increase vaccine hesitancy and confusion that currently exists among parents,” said Shirin Mazumder, MD, an infectious diseases specialist and associate professor at the University of Tennessee Health Science Center in Memphis, Tennessee, in an interview.

The resurgence of many vaccine-preventable illnesses is likely to increase in the wake of the new recommendations if vaccine uptake continues to decline, Mazumder said.

Regarding the focus on high-risk patients for certain recommended vaccines, clinicians know that both high-risk children as well as those with no underlying medical conditions can develop RSV, meningococcal disease, and hepatitis A or B infections, Mazumder told Medscape Medical News. “Excluding groups from universal vaccination will most likely increase the incidence and complications of these infections and also lead to potential outbreak situations,” she said.

Disparities May Deepen

The revised recommendations may widen existing healthcare disparities in the US, said Mazumder. The new vaccine schedule recommendations used Denmark’s vaccine policy as a blueprint; however, Denmark has a robust universal healthcare system paid for by their government, she noted. The US population is 50 times larger than that of Denmark, and we lack the free universal healthcare to ensure appropriate and regular medical care for babies and children, she said. “Populations with preexisting healthcare disparities will likely be harder hit with the removal of vaccine recommendations,” she noted.

The lack of a definitive recommendation for flu and COVID vaccination may lead to more cases, and flu and COVID complications can lead to hospitalizations and deaths, Mazumder told Medscape Medical News. “For those that do not develop severe outcomes, infections can still cause undesirable effects, such as long COVID and other lingering symptoms, not to mention time missed from school, work, or social functions,” she said.

Nearly 90% of the pediatric deaths during the 2024-2025 flu season occurred in children who had not received flu vaccinations, said Mazumder. “Currently, we are in the midst of one of the highest rates of flu activity on record. Without universal recommendations for flu and COVID vaccines, broad-level population-based immunity may be compromised,” she said.

Additionally, with lower vaccination rates, “there is a possibility we could see harsh respiratory virus seasons in the future coupled with more people developing severe complications,” she said.

Mazumder’s advice to fellow clinicians is to stick to evidence-based medicine when counseling families on preventative health. “Our previous pediatric vaccine schedule had been in place for decades and rooted deeply in scientific evidence,” she said.

“Vaccines are the pinnacle of medical research and the cornerstone of preventative healthcare; not recommending the utilization of vaccines in the way they were intended could turn back the hands of time and upend public health advancements,” Mazumder emphasized.

Vaccination Rates Expected to Drop

Simply put, the latest reinvention of the childhood immunization schedule for children in the US makes no sense, said Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, Philadelphia, in an interview. 

“What problem are we trying to solve? Have we prevented too many diseases?” Offit questioned.

Even though some vaccines, such as MMR, chickenpox, and polio, remain recommended for all children, Offit predicted that overall childhood vaccination rates will continue to erode, as confusion and misinformation persist among parents. Rates of vaccine-preventable diseases have already risen in response to declining vaccination for measles, pertussis, and hepatitis, he said. In addition, the current flu season is the worst since the H1N1 flu pandemic of 2009, with a total of nine pediatric deaths in the US this season so far, Offit added.

The recommendation for shared clinical decision-making will also contribute to lower rates because deciding not to vaccinate a child is still a decision, whether or not it is well-informed, Offit said.

Clinicians seeking guidance should no longer look to the CDC or its Advisory Committee on Immunization Practices, as they have ceased to exist in the way they were originally intended, Offit told Medscape Medical News. “Ignore them,” he said.

Instead, refer to groups such as the American Academy of Pediatrics (AAP) or American College of Obstetricians and Gynecologists, or to state coalitions that maintain science-based alternative recommendations for vaccination of children and adults, Offit advised.

AAP, ACP, and NFID Condemn Schedule Changes

In response to the CDC’s changes, the AAP issued a statement that it would continue to publish its own childhood vaccine recommendations, which include hepatitis A and B, rotavirus, RSV, flu, and meningococcal disease for all children. 

“At a time when parents, pediatricians, and the public are looking for clear guidance and accurate information, this ill-considered decision will sow further chaos and confusion and erode confidence in immunizations,” AAP president Andrew D. Racine, MD, said in the statement. 

“The longstanding, evidence-based approach that has guided the US immunization review and recommendation process remains the best way to keep children healthy and protect against health complications and hospitalizations,” he said.

Also, in response to the CDC move, Jason M. Goldman, MD, MACP, president of the American College of Physicians (ACP), shared in a statement that ACP “is vehemently opposed to the administration’s attempt to throw out the US vaccine schedule and unilaterally substitute guidance from other countries.”

Goldman went on to point out that such a move ignores decades of scientific research. “The US childhood immunization schedule is the result of decades of rigorous, transparent scientific review designed to prevent illness, hospitalizations, outbreaks, and death in a large, diverse population with uneven access to care,” said Goldman in a statement.

Robert H. Hopkins, Jr, MD, medical director of the National Foundation for Infectious Diseases (NFID), pointed to the change from universal vaccination to “shared clinical decision-making” for respiratory viruses during the peak of the season as a potentially risky change.

“As we are already seeing signs of a severe respiratory season, this is not the right time to make changes that are not supported by clear evidence. Last flu season, 280 US children died from influenza — the highest toll in more than a decade,” Hopkins said in a statement. 

“RSV remains the most common cause of hospitalization among US infants. The NFID strongly recommends annual flu vaccination for everyone aged 6 months and older, and RSV vaccination for all infants whose mothers did not receive an RSV vaccine during pregnancy. Adopting an immunization schedule designed for another country could put US children at risk for serious, preventable diseases.”

Mazumder and Offit reported no relevant financial relationships.