US overhauls childhood vaccine schedule to recommend fewer shots

By Sarah Owermohle, CNN

(CNN) — The US Department of Health and Human Services is recommending fewer vaccines for most American children, health officials said Monday.

Health officials will continue to recommend the measles, mumps and rubella vaccines and immunizations against polio, chickenpox, HPV and others, but they are narrowing recommendations for vaccination against meningococcal disease, hepatitis B and hepatitis A to children who are broadly at higher risk for infections.

They recommend that decisions on vaccinations against flu, Covid-19 and rotavirus be based on “shared clinical decision-making,” which means people who want one must consult with a health care provider.

HHS said that its recommendations for immunizations against respiratory synctytial virus, or RSV, remain unchanged and that infants born to mothers who did not receive the vaccine should have one dose.

The changes come amid a sharp increase in flu cases across the country. The US Centers for Disease Control and Prevention has reported nine pediatric deaths from flu this season.

HHS said that all insurers will still cover these vaccines without cost-sharing. However, the changes could present new hurdles for parents who need to consult with doctors about immunizations no longer recommended for healthy children.

‘Public health is not one size fits all’

The new US schedule of childhood vaccines more closely resembles that of other developed nations such as Denmark, as CNN reported last month.

Denmark does not currently recommend childhood vaccinations against rotavirus, hepatitis A, meningococcal, flu or chickenpox.

US health officials initially planned to announce the changes in December, weeks after Dr. Tracy Beth Hoeg, newly named acting director of the US Food and Drug Administration’s Center for Drug Evaluation and Research, gave a presentation on the Danish vaccine schedule to the CDC’s panel of vaccine advisers.

The panel, the Advisory Committee on Immunizations Practices, was reconstituted last year with a new group of members after US Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine skeptic, dismissed all previous appointees.

The overhaul comes one month after President Donald Trump ordered the health department to review the childhood vaccine schedule.

“It is ridiculous!” Trump wrote in a Truth Social post in December, after his executive order. “That is why I have just signed a Presidential memorandum directing the Department of Health and Human Services to ‘FAST TRACK’ a comprehensive evaluation of Vaccine Schedules from other Countries around the World, and better align the U.S. Vaccine Schedule.”

In a post on X, Kennedy responded: “Thank you, Mr. President. We’re on it.”

The new vaccine schedule is a “far more reasonable” one that protects children against “11 of the most serious and dangerous diseases,” Trump wrote in a Truth Social post Monday night. “Parents can still choose to give their children all of the Vaccinations, if they wish, and they will still be covered by insurance.”

In a separate post, Trump signaled that he still wanted to see more changes: Namely, the separation of the measles, mumps and rubella vaccine into three separate shots.

Several public health experts warned that the changes announced Monday could fuel outbreaks of preventable diseases.

“I think that a reduced schedule is going to endanger children and lay the groundwork for a resurgence in preventable disease,” said Dr. Caitlin Rivers, an epidemiologist and director of the Center for Outbreak Response Innovation at the Johns Hopkins Bloomberg School of Public Health.

Denmark is not a good blueprint for US vaccine policy, said Anders Hviid, who leads vaccine safety and effectiveness research at the Statens Serum Institut in Denmark.

They’re “two very different countries. Public health is not one size fits all,” he told CNN in an email.

In Denmark, “everyone has access to excellent prenatal and childhood care. As I understand it, that is not the case for everyone in the US. Vaccines prevent infections that may have poor outcomes for children who do not have access to good healthcare.”

Faltering information

HHS in a statement said that reducing the number of recommended vaccines would help restore public trust in health agencies — and possibly confidence in vaccines themselves. The agency reasoned that despite recommending more shots, the US does not have higher vaccination rates than peer countries that rely on “education rather than mandates.”

The government’s vaccine outreach and messaging has been vastly reshaped under Kennedy, who has questioned vaccine safety for decades.

It is a “confusing time” for doctors and parents, Dr. Sean O’Leary, chair of the American Association of Pediatrics Committee on Infectious Diseases, said Monday.

“What was announced today is part of a decades-long effort on the part of the health secretary to spread fear and falsehoods about vaccines, and this is another step in the secretary’s effort to dismantle the US vaccination system,” O’Leary said.

At the same time, public information about vaccination rates is faltering.

Last week, the Centers for Medicare & Medicaid Services dropped requirements for states to report childhood vaccination status for beneficiaries, a move that experts say may raise unnecessary doubts about the importance of vaccines. CMS sent a letter to state health officials on December 30 stating that vaccination data no longer needs to be submitted to the agency that oversees Medicaid and Medicare.

“This is another message that could create doubt in people’s minds about the need for vaccines, and that isn’t something that’s supported by current science,” said ​Dr. Michelle Fiscus, a pediatrician and chief medical officer of the Association of Immunization Managers.

The CMS requirement for reporting childhood immunization status was relatively new — it was implemented in 2024 — and there are other federal systems to track immunization rates. But more than 40% of children in the US are covered by Medicaid and the Children’s Health Insurance Program, or CHIP, and immunization surveillance offers important insights.

CMS said it plans to “explore options to facilitate the development of new vaccine measures” after dropping this requirement. These new measures may include tracking how often parents are informed about vaccine safety and side effects and alternative vaccine schedules, as well as how to capture “preferences related to vaccines” and how religious exemptions may be accounted for.

States may continue to voluntarily report childhood vaccination data to CMS, but Fiscus says that may depend on the political party of local leaders.

“I think this is going to contribute to this schism between states based on their party of government,” she said. “We’ll see more of this patchwork of state policies around immunizations, and that’s unfortunate, because these diseases don’t really care about state borders so much.”

Can’t ‘cowboy’ change

The changes drew criticism from Louisiana Republican Sen. Bill Cassidy, a physician who voted for Kennedy as health secretary only after assurances that he would “work within” the current vaccine approval and safety monitoring systems.

“Changing the pediatric vaccine schedule based on no scientific input on safety risks and little transparency will cause unnecessary fear for patients and doctors, and will make America sicker,” Cassidy wrote in an X post that also pointed to ongoing measles and whooping cough outbreaks.

Cassidy, who chairs the Senate Health, Education, Pensions and Labor Committee, asked Kennedy months ago to testify before the committee. The request followed a September hearing with ousted CDC Director Dr. Susan Monarez, who alleged that Kennedy sought to override vaccine decisions.

Health officials said Monday that they consulted with career staff at the CDC and the FDA about the changes to the vaccine schedule.

Officials also insisted that these changes do not sideline ACIP, the panel of vaccine advisers that convenes for public meetings several times a year to discuss and vote on recommendations.

A senior official said that ACIP will continue to meet several times a year and that the CDC will update the vaccine schedule based on their advice.

But a sudden, broad change to the schedule without public debate won’t instill confidence, said public health experts including former ACIP member Dr. Noel Brewer, a professor of public health and health behavior at the University of North Carolina at Chapel Hill.

“We can’t cowboy the nation to good health with a bunch of sudden and poorly considered health policy changes,” Brewer added.

Correction: A previous version of this report incorrectly listed RSV among the vaccinations with new recommendations.

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CNN’s Deidre McPhillips, Adam Cancryn, Brenda Goodman, Jen Christensen and Nadia Kounang contributed to this report.