MW America's new vaccine doctrine for children replaces data with dogma
By Marie Mazur
The Trump administration has dropped recommendations for six vaccines and one preventative therapy for all children
The U.S. no longer recommends that all children get a flu shot. Instead, it suggests families, caregivers and providers make that choice through "shared clinical decision-making."
In just a few weeks, the U.S. went from a "quiet" recalibration of a single vaccine recommendation to a wholesale retreat from the basic architecture of childhood immunization. That shift is being sold as a victory for "individual choice." But in the real U.S. healthcare system, it looks much more like a high-risk social experiment with no safety net.?
In early December, a Centers for Disease Control and Prevention advisory committee ended the long-standing recommendation that every newborn receive a hepatitis B vaccine within 24 hours of birth, moving instead to a more selective approach modeled on that of Denmark.
The Trump administration has now gone much further. On Monday, the Department of Health and Human Services and the CDC slashed the routine schedule that previously recommended 18 pediatric vaccines. Now 11 vaccines are recommended for all children, while immunizations against influenza, hepatitis A and B, rotavirus, meningococcal disease, COVID-19 and RSV pushed into "high-risk" or "shared clinical decision-making" categories.
On paper, that sounds like nuance. In practice, it is a dramatic break from three decades of consensus that universal recommendations are the only reliable way to protect children in America's fragmented health system.
Read my last piece: CDC panel compares the U.S. hepatitis B child vaccine schedule to Denmark's - but omits crucial context
?"Individual-based decision-making" polls well because it evokes time, attention and continuity of care - a trusted doctor who walks every family through a personalized risk-benefit calculus. That is not how American healthcare actually works.
Millions of pregnancies go without consistent prenatal care, parents switch insurers and providers frequently, records are lost between hospitals and clinics, and many children have no regular pediatrician. The universal birth dose of the hepatitis B vaccine was adopted precisely because screening and follow-up fail. It was a backup plan for a chaotic system, not an example of bureaucratic overreach. The same is true for other childhood vaccines that are no longer recommended for all children.
The administration's preferred comparison - Denmark - obscures more than it reveals. Denmark is a smaller, wealthier country with universal health coverage, integrated health records, low rates of missed well-child visits and strong social support for families. When you step back from the fixation on Denmark, you can see that the U.S. childhood schedule was within the same broad band as most of its peer countries. Many high-income countries recommend a similar number of vaccines and have expanded, not shrunk, their pediatric influenza and meningococcal programs. ?
The way this change was made should also alarm anyone who cares about evidence-based policy. HHS and the CDC did not present new safety or effectiveness data to justify cutting back routine recommendations. Instead, the doctrine came first - "fewer shots, more choice" - with process addressed later through internal memoranda rather than the usual transparent deliberations of the CDC's Advisory Committee on Immunization Practices.
That is the opposite of how vaccine policy is supposed to work in a country that once prided itself on letting data, not slogans, drive immunization decisions.
There is also a broader pattern that healthcare investors can no longer ignore. Earlier this year, HHS Secretary Robert F. Kennedy Jr. cast doubt on mRNA vaccines and backed away from some federal mRNA procurement. He has now helped engineer a minimalist pediatric schedule that weakens demand for both current and future products. Wall Street analysts were unusually blunt when his nomination was announced, warning that his views on vaccines and regulation could destabilize healthcare markets. Those warnings were initially focused on COVID-19 and specific companies like Moderna (MRNA) and Pfizer $(PFE)$; they now apply to the entire childhood vaccine ecosystem.
For manufacturers, having stable evidence-based recommendations is the foundation of rational capital allocation. Companies make decade-long bets on facilities, cold-chain infrastructure and next-generation platforms based on the assumption that if a product is safe, effective and cost-effective, public health agencies will consistently support its use.
The new doctrine - in which long-standing vaccines can be downgraded in a single meeting of the CDC advisors or by internal directive, and large swaths of the schedule can be reversed by political appointees - introduces a new kind of policy risk. That risk will be priced into valuations and will dampen enthusiasm for investing in the very innovations that policymakers say they want, such as better flu, RSV, pneumococcal and meningococcal vaccines.
Defenders of the shift argue that "overvaccination" has been a problem and that trimming back recommendations is course correction. But the data tell a different story. The American Academy of Pediatrics and other groups have pointed out that U.S. vaccine recommendations are broadly aligned with global norms, and that childhood vaccines have prevented hundreds of millions of illnesses and more than a million deaths in recent decades. Where the U.S. truly lags is in coverage. It's still a challenge to address undervaccination in pockets of poverty and in communities with limited access to care. Watering down the recommendations solves the wrong problem and risks turning local gaps into national outbreaks.
None of this is to say that vaccine schedules should never change. Recommendations must evolve as epidemiology, technology and safety signals change. That is the role of expert bodies like ACIP, when they are allowed to function without political influence. A responsible recalibration would focus on better data systems, targeted outreach and support for primary care - the conditions that make nuanced, "individualized" decisions possible in the first place.
America is not Denmark, and pretending otherwise will not make its healthcare system more coherent or its politics less polarized. For children, the cost of this experiment will be measured in infections that could have been prevented and lives that did not have to be lost. For markets, this new layer of policy uncertainty punishes long-term investment. Vaccination has always been a core public good, with consistent evidence-based policy, and has been associated with more stable economic conditions.
Business leaders do not need to become vaccine experts, but they do need to watch this issue with the same discipline they employ to monitor other emerging systemic risks.
Marie Mazur is a strategic adviser to life-sciences companies. She has more than 25 years of leadership in global vaccine development, manufacturing and pandemic response at top-tier organizations and drugmakers. She is recognized for her work supporting innovation at the intersection of science, policy and markets. She serves on the strategic advisory group of the Partnership for International Vaccine Initiatives and on the board of Mid-Atlantic Diamond Ventures.
-Marie Mazur
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January 06, 2026 11:55 ET (16:55 GMT)
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