The U.S. took the unprecedented step Monday of dropping the number of vaccines it recommends for every child — leaving other immunizations, such as flu shots, open to families to choose but without clear guidance.
Officials said the overhaul to the federal vaccine schedule won’t result in any families losing access or insurance coverage for vaccines, but many medical experts slammed the move, saying it could lead to reduced uptake of important vaccinations and increase disease.
Kelly Leung, 11, center, is reassured by Multnomah County Deputy Health Officer Dr. Ann Loeffler, left, and Sarah Roy, RN, as Leung receives vaccinations at McDaniel High School in Northeast Portland, Feb. 8, 2023. The catch-up vaccination clinic, offered in conjunction with Portland Public Schools and Multnomah County’s Education Service District, aimed to provide childhood vaccines for youth 5-19, before the immunization deadline in the schools.
Kristyna Wentz-Graff / OPB
The change, which officials acknowledged was made without input from an advisory committee that typically consults on the vaccine schedule, came after President Donald Trump in December asked the U.S. Department of Health and Human Services to review how peer nations approach vaccine recommendations and consider revising its guidance to align with theirs.
HHS said the vaccines it is no longer recommending will still be considered a part of the childhood vaccine schedule, and as a result, will still be paid for by private insurance and Medicaid.
HHS said its comparison to 20 peer nations found that the U.S. was an “outlier” in both the number of vaccinations and the number of doses it recommended to all children. Officials with the agency framed the change as a way to increase public trust by recommending only the most important vaccinations for children to receive.
“This decision protects children, respects families, and rebuilds trust in public health,” Health Secretary Robert F. Kennedy Jr. said in a statement Monday.
Medical experts disagreed, saying the change without public discussion or a transparent review of the data would put children at risk.
“Abandoning recommendations for vaccines that prevent influenza, hepatitis and rotavirus, and changing the recommendation for HPV without a public process to weigh the risks and benefits, will lead to more hospitalizations and preventable deaths among American children,” said Michael Osterholm of the Vaccine Integrity Project, based at the University of Minnesota.
Under the new guidelines, the CDC will continue to recommend all children receive routine vaccination against 11 pathogens: measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Hib, pneumococcal disease, HPV, and varicella.
The CDC now recommends vaccines for Hepatitis A, Hepatitis B, rotavirus, meningococcal disease, influenza, and COVID-19 only for high-risk children. A monoclonal antibody for RSV will also be recommended just for the high-risk group.
States determine which vaccines are required for school attendance. Officials with the Oregon Health Authority said the state continues to follow the American Academy of Pediatrics (AAP) vaccine schedule for children, which includes the shots that have been downgraded by the CDC.
“Removing recommendations sends a message to the public that these vaccines are not necessary or effective, which runs 100% counter to everything we know about the science and our decades of experience,” said Ben Hoffman, a professor of pediatrics at OHSU and a past president of the AAP.
Hoffman said he fears seeing a resurgence of diseases like rotavirus, one of the vaccines that’s no longer recommended. It’s a contagious childhood illness that causes diarrhea and dehydration. During his clinical training 30 years ago, Hoffman said, people frequently brought children in to the clinic or emergency department due to rotavirus.
“During my time with the Indian Health Service in the late 90s, we actually had several children die as a result of dehydration,” he said.
A vaccine against rotavirus has been available since 2006. Today, Hoffman said, he rarely sees cases of rotavirus.
“That disease just disappeared, like happens with so many things that we have effective vaccines for,” he said.
Dropping the universal recommendation for rotavirus vaccination does not appear to align the U.S. more closely with other high-income nations, according to data HHS shared alongside its decision.
A “comprehensive scientific assessment” published by the agency includes a table comparing vaccine policies in 20 high-income countries.
HHS’s table shows that 17 of them pay for universal childhood vaccination against rotavirus, including Australia, Japan, Germany, the Netherlands, Canada and the United Kingdom.
In a memo outlining the rationale behind the changes to the schedule, CDC staff only mentioned the three countries that do not vaccinate against rotavirus: Denmark, Belgium, and Portugal.
The memo notes that rotavirus deaths in the U.S. fell from an average of 3.3 children per year to 1.6 per year after two vaccines were approved for rotavirus. It also states that vaccines increase the risk of bowel obstruction in children by around 1 or 2 cases per 100,000 vaccinated children, and that several European countries do not recommend it.
“Reasonable people can reach different conclusions about recommending the rotavirus vaccine for all children,” the memo concludes.
Hoffman said the administration has been signaling for several weeks that it would align the U.S. vaccine schedule with Denmark’s, a country that takes a more limited approach to vaccination.
Denmark, Hoffman said, has fewer people than the state of Massachusetts and doesn’t share the United States’ vast geography or diversity.
“I think this is an excuse to further an agenda from Secretary Kennedy that he has been promulgating for decades, and this is a way for him to whitewash it,” he said.
