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If the US CDC follows a new White House order directing the agency’s advisers to align the childhood immunization schedule with “peer nations,” it will likely trigger new legal action, according to an attorney representing medical organizations that are currently in litigation over the administration’s vaccine policies.

The order said the CDC and its Advisory Committee on Immunization Practices (ACIP) should use as a “guiding resource” a much-criticized assessment conducted by an ex-FDA official that claimed that American children received more vaccines than children in other developed nations.

The American Academy of Pediatrics (AAP), the lead plaintiff in the ongoing lawsuit, has debunked that assessment, noting the scientific, cultural, and geographical reasons why the US schedule is different.

Richard Hughes IV, an attorney representing AAP, said the order is “promoting a deceptive vaccine policy narrative,” and that it appears to be encouraging what he called “the same unlawful changes” to the childhood and adolescent immunization schedule.

“In that sense, it flies in the face of the judge’s order in our case,” Hughes said. “Any further actions that match the previous unlawful patterns of appointments and recommendations are going to be met with legal action,” he said.

A federal judge in March ruled that the majority of ACIP members were not qualified to serve, and that prior changes to the immunization schedule were not valid. The judge temporarily blocked the panel from meeting or making vaccine recommendations. So far, Department of Health and Human Services has appealed but it has not appointed a new panel. It did issue a revised charter in May spelling out what would be required of new ACIP members. The ACIP’s next scheduled meeting is June 24-26, but no agenda has been posted.

Dorit Rubinstein Reiss, a professor at the University of California College of the Law in San Francisco, wrote in a blog post that the order may not change much when ACIP eventually does meet again. “There is nothing in the executive order that suggests any change to ACIP’s usual functioning; in fact, the language suggests that ACIP will take steps to update the schedule, and there is reference to the scientific review process,” she wrote.

Reiss wrote that the order also does not “suggest the CDC director has a bigger role than in the past.”

It would be unlawful for the CDC director to make unilateral changes to the vaccine schedule, said Hughes. The federal judge ruled that while the director can adopt or reject the ACIP recommendations, he or she is obligated to consult with the panel, he told Medscape Medical News.

Medical organizations have expressed dismay with the White House order.

“There is no credible scientific evidence to support changing the current childhood vaccine schedule,” said American Medical Association President Bobby Mukkamala, MD, in a statement. Changes without evidence-based justification “risks continued confusion for parents and patients, undermining trust in vaccines, and ultimately lowering vaccination rates,” he said.

American College of Physicians President Jan Carney, MD, MPH, said in a statement that the group was “deeply concerned” by the order. “This is the second time the administration has attempted to unilaterally substitute vaccine guidance from other countries to replace the US vaccine schedule which was developed for the specific needs of the US population,” said Carney.

“The changes that this executive order directs cannot be allowed to move forward,” she said.

The order ultimately seemed to acknowledge that CDC might be constrained, stating that it should take steps to update the childhood and adolescent vaccine schedule “to the extent permitted by law.”

But Hughes said that with the ongoing litigation, nothing is settled.

“What is and is not lawful surrounding the immunization schedule is very much a live question,” he said.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.