The federal government has sharply cut the number of recommended childhood vaccines, eliminating six routine shots that have protected millions of people from serious illness, long-term disability and death.
Just three of the six vaccines that the Centers for Disease Control and Prevention (CDC) will no longer routinely recommend—hepatitis A, hepatitis B and rotavirus—have prevented nearly 2 million hospitalizations and more than 90,000 deaths over the past 30 years, according to publications by the same person.
Vaccines against these three diseases, as well as respiratory syncytial virus (RSV), meningococcal disease, influenza and Covid, are now only recommended for children at high risk of severe illness or after “shared clinical decision-making,” meaning consultation with doctors and parents.
The CDC maintains its recommendations for 11 childhood vaccines: measles, mumps and rubella; whooping cough, tetanus and diphtheria; a bacterial disease known as Hib; pneumonia; polio; chicken pox; and human papillomavirus (HPV).
According to information sheet Public and private health insurance from the Department of Health and Human Services (HHS) will continue to cover vaccines for diseases that are no longer universally recommended by the CDC; Parents who want to vaccinate their children against these diseases will not have to pay out of pocket for the doses.
Pediatric disease experts were puzzled by the change in guidance. HHS explained that the changes were made after a “scientific review of the evidence” and that they are consistent with vaccination programs in other developed countries.
HHS Secretary Robert F. Kennedy Jr., an anti-vaccination activist, pointed to Denmark as a model. However, most European countries' vaccination schedules are more similar to the newly modified American standard.
For example, in Denmark, where there is no vaccination against rotavirus, there are about 1,200 hospitalizations per year for this infection in infants and young children. The rate in the country of 6 million people is similar to what it was in the United States before the vaccine was introduced.
“They agree with 1,200 or 1,300 children being hospitalized, which is just the tip of the iceberg in terms of childhood suffering,” said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and co-inventor of the approved rotavirus vaccine. “We don't accept this. They should try to imitate us, not the other way around.”
Public health officials said the new guidance puts the responsibility on parents to research and understand each childhood vaccine and why it's important.
The following is a summary of diseases that vaccines prevent but have been ignored:
HRV. Respiratory syncytial virus is the most common cause of hospitalization in infants in the United States.
This respiratory virus usually circulates in the fall and winter and causes cold-like symptoms, although it can be fatal in young children. It causes tens of thousands of hospitalizations and hundreds of deaths every year. According to the National Foundation for Infectious Diseases, approximately 80% of children under 2 years of age hospitalized with RSV have no identifiable risk factors. The long-awaited vaccine against this disease was introduced in 2023.
Hepatitis A. Hepatitis A vaccination, which was phased in in the late 1990s and recommended for all young children starting in 2006, has resulted in a more than 90% reduction in cases since 1996. This foodborne virus causes a very nasty illness that still affects adults today, especially people who are homeless or use drugs or alcohol. They were reported in 2023 total 1648 cases and 85 deaths.
Hepatitis B. This disease causes liver cancer, cirrhosis and other serious conditions. especially dangerous when infants or young children become infected with it. The hepatitis B virus is transmitted through blood and other body fluids, even in microscopic quantities, and can survive on surfaces for up to a week. Between 1990 and 2019, vaccination led to a 99% reduction in reported cases of acute hepatitis B in children and adolescents. Liver cancer in minors has also dropped significantly due to universal childhood vaccinations. However, the virus is still present, with 2,000 to 3,000 acute cases reported annually among unvaccinated adults. More than 17,000 cases of chronic hepatitis B have been diagnosed in 2023. The CDC estimates that about half of infected people do not know they are infected.
Rotavirus. Before routine administration of the current rotavirus vaccines began in 2006, about 70,000 young children were hospitalized each year and about 50 died from the virus. “It was known as winter vomiting syndrome,” explained Sean O'Leary, a pediatrician at the University of Colorado. “It was a terrible disease that we hardly see anymore.”
However, the virus is still prevalent on surfaces touched by infants, and “if vaccination rates decline, children will be hospitalized again,” Offit warned.
Meningococcal vaccines. These vaccines are primarily needed for teenagers and college students, who are especially vulnerable to serious illness caused by these bacteria. In the United States, between 600 and 1,000 cases are reported annually, but more than 10% of patients die and one in five survivors are left with permanent disabilities.
Flu and Covid. These two respiratory viruses have caused the deaths of hundreds of children in recent years, although they tend to be more serious in older people. Currently, the country is experiencing a resurgence of influenza; over the past season, 289 minors died from this cause.
What is shared clinical decision making?
With the new changes, decisions about whether to vaccinate children against influenza, Covid, rotavirus, meningococcal disease and hepatitis A and B will now depend on what authorities call “shared clinical decision making,” meaning families must consult with a health care provider to determine whether the vaccine is appropriate for their children.
“This means the provider must talk with the patient to explain the risks and benefits and make an individualized decision,” he said. Laurie Handypediatric infectious disease specialist at Children's Hospital of Philadelphia.
Previously, the CDC used the term only in very specific circumstances, such as deciding whether a person in a monogamous relationship needed the HPV vaccine, which prevents sexually transmitted infections and certain types of cancer.
The CDC's new approach is inconsistent with the science, Handy said, given the proven protective benefits that vaccines provide to the vast majority of the population.
In their report justifying the changes, HHS officials Tracy Beth Hoeg and Martin Kulldorf said the U.S. vaccination system requires more safety research and more parental choice. They said a loss of confidence in public health, caused in part by an overly expansive vaccination schedule, has led to more families refusing vaccines against serious threats such as measles.
The vaccines on the schedule that were changed by the CDC had already undergone extensive safety studies when they were evaluated and approved by the Food and Drug Administration (FDA).
“These vaccines have a higher standard of safety than any other medical intervention we have,” Handy said. “The value of routine recommendations is that they help the public understand that these vaccines have been tested in every way.”
Eric Balla pediatrician in Orange County, California, said the change in recommendations will cause more confusion among parents who may think the vaccine's safety is in question.
“It is critical for public health that vaccine recommendations are very clear and precise,” Ball said. “Anything that creates confusion will only lead to more children getting sick.”
Ball explained that instead of focusing on the child's medical needs, he often has to use limited counseling time to reassure parents that vaccines are safe. The fact that the vaccine falls under “shared clinical decision making” has nothing to do with safety concerns, but many parents may interpret it that way.
The HHS changes do not affect state vaccination laws and should therefore allow responsible doctors to continue recommending vaccines as before, according to Richard Hughes IVlawyer and professor at George Washington University who is leading lawsuits against Kennedy over vaccine changes.
“Any pediatrician can be expected to follow the compelling scientific evidence and recommend vaccination to their patients,” he said. The law protects providers who follow professional guidelines for care, he added, and “RSV, meningococcal disease and hepatitis remain serious health threats to children in this country.”
