By Josh Nathan-Kazis
The Trump administration on Monday tore up the federal government's childhood vaccine guidance, the most dramatic step yet in health secretary Robert F. Kennedy Jr.'s efforts to disrupt public health vaccination efforts in the U.S.
The Center for Disease Control and Prevention's child and adolescent immunization schedules, developed in public meetings and scientific papers by the CDC's Advisory Committee on Immunization Practices, have now been fully rewritten.
There were no public committee meetings to discuss the latest changes. Instead, they were adopted unilaterally on Monday by the acting director of the CDC, Jim O'Neill, an investor with no medical or public health degree.
The new CDC guidance recommends eight different vaccines to protect against 11 diseases. The prior schedule recommended 17 different shots, according to the U.S. Department of Health and Human Services.
Other shots that were formerly recommended for all children are now only recommended for "certain high-risk groups." That includes a shot that protects against meningococcal disease, and a shot that protects against hepatitis A.
Some shots, including the annual flu shot, have been moved into a category referred to as shared clinical decision-making. That means the shots are only recommended if a child's doctor and parents think he or she should get one.
The decision comes a month after ACIP recommended a delay in hepatitis B vaccination for most newborns.
The administration said Monday that insurers will still be required to pay for all the shots that the CDC recommended before the latest change. "All vaccines currently recommended by CDC will remain covered by insurance without cost sharing," said Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, in a statement.
But the dramatic pull-back in vaccine guidance could have significant impacts on vaccine uptake levels, which are already low.
The decision to drop the universal recommendation for influenza shots for children and adolescents comes amid what the CDC is calling a "moderately severe" influenza season, with flu rates elevated in most of the country. There have been nine influenza-associated pediatric deaths so far this season.
Kennedy, in a statement on Monday, said that the changes to the vaccine guidance were meant to match U.S. recommendations "with international consensus." The HHS statement cited a "comprehensive scientific assessment," written by the Food and Drug Administration's Dr. Tracy Beth Høeg and newly appointed HHS official Martin Kulldorff, two administration officials associated with Kennedy's efforts to rework U.S. vaccine policy, which argued that children in the U.S. get substantially more shots than those elsewhere.
"The U.S. is a global outlier among peer nations in the number of target diseases included in its childhood vaccination schedule and in the total number of recommended vaccine doses," Kulldorff and Høeg's memo reads.
Høeg has been making that case for months. At an ACIP meeting in December, Høeg made an argument for a shrinking of the U.S. childhood vaccine schedule based on example of Denmark, which recommends substantially fewer childhood vaccines.
Experts have disputed her reasoning. In a response to Høeg and others, the Vaccine Integrity Project, a program of the Center for Infectious Disease Research and Policy at the University of Minnesota, argued in late December that it is Denmark that is an outlier, not the U.S.
"By early childhood most high-income nations vaccinate against roughly a dozen to fifteen serious pathogens," the group said. "The United States, the United Kingdom, France, Germany, Israel, Japan, and Nordic neighbors such as Sweden, Finland, and Norway all fall squarely within this range. Denmark represents the low-water mark."
The U.S. is as the high end of the peer group, the Vaccine Integrity Project said. "But the claim that our country is uniquely aggressive in childhood vaccination collapses under even cursory international comparison," it concluded. "What is unique is Denmark's approach."
Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com
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(END) Dow Jones Newswires
January 05, 2026 16:03 ET (21:03 GMT)
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