The new childhood vaccination schedule may not be RFK Jr’s last big change
For decades, Americans have turned to the federal government for advice about which vaccines their children should receive and when. A panel of independent scientists with varying expertise made these recommendations according to longstanding public health principles, usually after months or even years of careful review of the evidence.
On Monday, Health and Human Services Secretary Robert F. Kennedy Jr. and policy appointees at the Centers for Disease Control and Prevention unveiled a new vaccination plan that reduced by a third the number of diseases from which American children would be protected, an extraordinary step in disregarding that process.
The impact of the changes appears to be limited, at least in the short term. The six vaccines removed from the routine schedule will continue to be available to all children with approval from a health care provider. And vaccination requirements for entry into daycare centers and schools lie with the states, not the federal government.
Still, Mr. Kennedy and his allies appear to be laying the groundwork for an entirely new approach to vaccination that values individual autonomy and aims to limit vaccines based on personal preferences rather than scientific expertise and proven benefits.
“I don’t think this will be the last of the major changes we will see,” said Dr. Anne Zink, an emergency physician at Mat-Su Regional Medical Center in Palmer, Alaska and a former state health official.
The previous vaccination schedule included some vaccinations that may not have been strictly necessary for everyone, partly because prevention is considered the best option in a country like the United States, which has a fragmented health system, Dr. Zinc.
She said she would have welcomed changes to the schedule, but “I would like to see things done in a transparent, science-based process.”
The new vaccination schedule reduces the number of diseases against which all children should be vaccinated from 17 to 11. Vaccinations against diseases such as measles, polio and whooping cough remain part of the routine schedule. But for other diseases, including hepatitis A and B, rotavirus, meningitis and influenza, the new recommendations suggest seeking medical attention before vaccinating most children.
Monday’s announcement came as a surprise to everyone who would normally have been involved in such decisions: CDC scientists, the agency’s outside advisers, medical organizations such as the American Academy of Pediatrics and the American Medical Association, and patient advocacy groups.
And federal health officials hinted that there would be more changes to come.
All currently available vaccines have been extensively tested in clinical trials and administered to millions of children. But federal officials falsely claimed that such studies had never been conducted or were inadequate, saying they wanted to examine the timing and safety of the shots as well as specific ingredients such as aluminum salts that have been used in vaccines for nearly a century to boost the immune response.
“I think this is going to be a really big year,” Del Bigtree, a well-known anti-vaxxer, said on his podcast Thursday.
The new schedule is “a massive, gigantic step for humanity,” Mr. Bigtree said. But he added: “It’s not everything I ever dreamed.”
Vaccinations against measles, chickenpox and human papillomavirus will still be recommended under the new schedule, which his listeners may find “annoying,” he said. He indicated that “private, secret meetings” would be held about further changes.
Mr. Bigtree and other allies of Mr. Kennedy have recently suggested that people could now directly sue vaccine manufacturers — who have been shielded from liability for decades — if they believe they have been harmed by vaccines that are no longer routinely recommended.
Before 1986, when the liability protection program was introduced, a large number of such lawsuits nearly bankrupted manufacturers.
Andrew Nixon, a spokesman for the Department of Health and Human Services, said, “We do not comment on speculative policy decisions,” adding that all vaccines would continue to be covered by the liability program.
The announcement of the revised schedule drew immediate condemnation from dozens of health and medical groups.
On Friday, more than 200 organizations called on Congress to “investigate why the schedule was changed, why credible scientific evidence was ignored, and why the committee charged with advising the HHS Secretary on vaccinations did not discuss the schedule changes as part of its public meeting process.”
The Pediatric Academy breaks with the decades-long partnership with the CDC and continues to recommend the current schedule. Insurance companies have also promised to meet the earlier schedule by the end of this year.
Many Democratic-led cities and states also immediately issued strong statements of support for the current schedule. Republican-led states have remained mostly silent, but none have yet shown any signs of adopting the new recommendations, Dr. James McDonald, a pediatrician and New York State Health Commissioner.
“It doesn’t matter if your state is Republican or Democratic, it doesn’t matter,” he said. “Every state health official understands the importance of vaccines.”
Some doctors believe parents, encouraged by decades of evidence of the value of vaccines, will continue to choose vaccinations. But others worry about how best to address the concerns they have already raised.
“What I hear from patients is, ‘The government is telling me I don’t need all the vaccines,'” said Dr. Zink, the emergency doctor in Alaska.
Dr. Jake Scott, a vaccine expert at Stanford University School of Medicine, said doctors who need to clarify guidelines for parents may not have the time to adequately address their concerns.
Requiring a healthcare professional to sign off on certain vaccines before children can access them sounds good in theory, Dr. Scott, however, is best suited for complex assessments, not for vaccines with clear benefits.
“It shows parents that there is a real issue here, even if there isn’t,” he added.
Since becoming health secretary, Mr. Kennedy has repeatedly emphasized his distrust of vaccines. He fired all 17 members of the Federal Vaccine Advisory Council and replaced them with several members who shared his skepticism.
In early December, an order from President Trump called on Mr. Kennedy to align the United States’ childhood vaccination schedule with that of peer countries such as Denmark, Germany and Japan. Mr. Kennedy responded: “Thank you very much, Mr. President. We’re in.”
They were. On Dec. 18, CDC acting director Jim O’Neill met with about a dozen agency scientists. The scientists provided a detailed analysis of the prevalence of vaccine-preventable diseases, the benefits of vaccinations, and differences between the United States and other countries.
According to a health official with knowledge of the events, Mr. O’Neill asked good questions and seemed to appreciate the answers, leading scientists to hope he would not make rash decisions.
But on Monday, the official said, the agency’s scientists found that nothing they said had made any difference.
The timeline now most closely resembles that of Denmark, although the two countries differ significantly in size, demographics and access to healthcare.
Some international experts feared that the changes to the U.S. vaccination plan could jeopardize vaccinations far beyond America’s borders.
“I think people will start to doubt whether the recommendations we have in Germany or other countries are really necessary,” said Dr. Reinhard Berner, a pediatrician who leads the panel that recommends vaccines in Germany.
In the United States, vaccination rates began to decline as the Covid pandemic disrupted routine medical care. A backlash against Covid vaccinations and regulations has further eroded confidence in vaccines.
The effect appeared to worsen last year when the country recorded its highest number of measles cases in three decades.
Mr. Kennedy has at times said that the measles vaccine can prevent the disease. But he has also repeatedly made falsehoods about the vaccine’s safety and effectiveness, including that it contains fetal debris and causes the same symptoms as the virus itself.
Mr. Kennedy’s rhetoric about improperly tested shots also appears to be gaining traction. A Pew Research Center survey found that only about half of Americans are currently very confident that childhood vaccines have been adequately tested and proven safe.
On Monday, health officials said parents have long been pressured into vaccinating their children against too many diseases and that fewer recommended shots would restore confidence.
“The updated pediatric schedule is an important step toward restoring informed consent and stopping states from overriding parental and health care provider vaccination decisions through mandates,” said Mr. Nixon, the Department of Health and Human Services spokesman.
The administration recently eliminated some requirements for states to report vaccination rates to the federal government, which will make it difficult to track whether the changes are actually increasing distrust and whether Americans even understand the new guidelines.
According to a recent poll, about 22 percent of Americans believe that the term “shared clinical decision-making” means that “taking the vaccine may not be a good idea for everyone, but it would benefit some.” Half or more of respondents said they did not know that registered nurses and pharmacists were health professionals and could provide needed advice.
Not all changes in the vaccination schedule have caused consternation among public health experts. The plan lowers the recommended doses of the HPV vaccine, which has reduced cervical cancer rates in girls and women, to one shot from the previous two.
Mr. Kennedy, who has benefited financially from lawsuits against vaccine maker Merck, has falsely claimed that the vaccine increases the risk of cervical cancer.
But before its former members were fired, the Federal Advisory Council on Vaccines was already considering this change. “The efficacy is so high that taking more than one dose really does not provide any clinical benefit,” said Dr. Ruanne Barnabas, chief of infectious diseases at Massachusetts General Hospital.
Experts are more concerned about not using other vaccinations. Fewer children vaccinated may mean pediatricians will see severe dehydration in children due to vomiting and diarrhea from rotavirus, liver damage from hepatitis, or brain damage from meningitis.
For the time being, however, insurance companies, states and medical associations are following the previous recommendations.
“We believe all of these vaccines are still on schedule,” said Claire Hannan, executive director of the Association of Immunization Managers, which represents state and local officials.
“They’re still recommended; they’re just not routine,” she said. “And they’re still covered.”
