How America’s new vaccine policy could reshape child health outcomes

Public health experts across the United States have raised urgent concerns following a sweeping revision of the country’s childhood immunisation schedule, warning that the move could weaken population-wide protection against preventable diseases and reverse decades of progress in child health. Under new guidance issued by the Centres for Disease Control and Prevention (CDC), routine childhood vaccination in the United States will now cover protection against 11 diseases—down from a broader schedule that previously included vaccines for influenza, rotavirus, hepatitis A and B, certain forms of meningitis, and respiratory syncytial virus (RSV).

Vaccines removed from the routine list will now be offered only to children considered medically high-risk or through what officials describe as “shared decision-making” between families and healthcare providers. The overhaul, requested by President Donald Trump in December and long advocated by Health Secretary Robert F. Kennedy Jr., marks one of the most consequential shifts in US vaccine policy in decades. While the administration insists the changes are intended to rebuild trust in public health institutions, critics argue that the decision undermines scientific consensus and exposes children to unnecessary risk.

In a statement, the Department of Health and Human Services (HHS) said the revised schedule followed a review of immunisation practices in 20 peer nations, concluding that the United States had become an “outlier” in the number of vaccines recommended for all children. “This decision protects children, respects families, and rebuilds trust in public health,” Kennedy said. President Trump, writing on his Truth Social platform, described the new schedule as “far more reasonable” and claimed it aligns the US with other developed countries. Officials also stressed that vaccines removed from the routine list remain available and that insurance coverage would not be withdrawn for families who choose to receive them.

Vaccines that remain broadly recommended include those against measles, mumps and rubella, whooping cough, polio, tetanus, chickenpox and human papillomavirus (HPV). However, the updated guidance reduces HPV vaccination to a single dose for most children, down from the previous two- or three-dose regimen depending on age. That change has drawn particular criticism from cancer specialists, who note that HPV vaccination has been shown to significantly reduce rates of cervical and other HPV-related cancers.

Medical associations and public health experts have widely condemned both the substance of the changes and the manner in which they were introduced, arguing that they bypassed established scientific processes and public consultation. Michael Osterholm, director of the Vaccine Integrity Project at the University of Minnesota, warned that scaling back recommendations for vaccines that protect against influenza, hepatitis and rotavirus would have serious consequences. “Abandoning these vaccines and altering the HPV schedule without a transparent public process to weigh risks and benefits will lead to more hospitalisations and preventable deaths among American children,” he said.

The American Academy of Paediatrics echoed those concerns, cautioning that international comparisons fail to account for disease patterns specific to the United States. “You can’t just copy and paste public health,” said Dr Sean O’Leary, chair of the Academy’s Committee on Infectious Diseases. “That’s essentially what they appear to be doing here.”

The American Medical Association also criticised the process, with its president, Dr Sandra Fryhofer, noting that policy changes of such scale demand rigorous scientific review and expert input. “Changes of this magnitude require careful review, public engagement, and clear scientific justification. That level of rigour and transparency was not part of this decision,” she said. In response to the revised federal guidance, paediatricians and major medical groups have released their own alternative immunisation schedule, continuing to recommend vaccines dropped by the administration. O’Leary highlighted influenza as a critical example, noting that 280 children died from flu-related complications last winter—the highest toll since 2009.

Senior HHS officials, speaking on condition of anonymity, revealed that the revised recommendations were developed largely by political appointees rather than the CDC’s Advisory Committee on Immunisation Practices (ACIP), which traditionally evaluates vaccine evidence and issues guidance. Scientists within the agency were reportedly restricted to presenting international comparisons and barred from making formal recommendations.

The decision comes at a particularly sensitive moment for US public health. Childhood vaccination rates have been declining steadily in recent years, while requests for vaccine exemptions are at record highs. At the same time, outbreaks of measles and whooping cough—diseases once close to elimination—are again being reported in several states. Public health experts warn that removing vaccines from the routine schedule sends a powerful signal to parents that those immunisations are optional or unnecessary, even when decades of evidence demonstrate their effectiveness.

Comparisons with other countries, critics argue, are also selectively framed. France, for instance, currently recommends vaccination against 14 diseases for children—three more than the US under the new guidance. Other countries achieve high disease control not by limiting vaccines but through stronger uptake, robust public trust, and consistent messaging. Kennedy, a long-time vaccine sceptic, has been a controversial figure in public health circles. Since assuming office, he has directed the CDC to drop COVID-19 vaccine recommendations for healthy children and pregnant women, disbanded its advisory committee, and ordered changes to the agency’s stance on vaccines and autism despite the absence of new scientific evidence linking the two.

Supporters of the administration argue that the changes empower parents and restore confidence in a system many Americans have come to distrust. Critics counter that weakening routine recommendations risks normalising vaccine hesitancy at a time when trust in science is already fragile.

For paediatricians on the front lines, the concern is immediate and practical. Fewer routine recommendations could translate into fewer vaccinations, more preventable illnesses, and renewed strain on hospitals and healthcare systems. As debates continue, one point of consensus remains clear among medical professionals: vaccination policy is not merely a matter of choice or comparison, but a cornerstone of population health. Whether the revised schedule strengthens trust or erodes protection may become evident not in policy statements, but in disease surveillance data—and in the health outcomes of children.

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