US Department of Health and Human Services announced radical changes to the pediatric vaccination schedule on Monday, dramatically reducing the number of diseases against which U.S. children will be routinely vaccinated.
Under new recommendationsThe United States continues to recommend that all children be vaccinated against measles, mumps, rubella, polio, whooping cough, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV), and varicella, more commonly known as varicella.
Vaccines for all other diseases will now fall into one of two categories: recommended only for certain high-risk groups or made available through “shared clinical decision making,” the administration's preferred term for “optional.”
These include vaccinations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All of these vaccinations were previously recommended for all children.
According to the Department of Health and Human Services, insurance companies will still be required to fully cover all childhood vaccines on the CDC list, including those now considered optional.
Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule “protects children, respects families and restores trust in public health.”
But pediatricians and public health officials have widely condemned the shift, saying it will lead to more uncertainty for patients and a resurgence of diseases that had been under control.
“The decision to relax childhood vaccination schedules is misguided and dangerous,” said Dr. Rene Bravo, a pediatrician and president of the California Medical Association. “Today’s decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under threat.”
The American Academy of Pediatrics condemned the changes as “dangerous and unnecessary” and said it would continue to publish its own schedule of recommended vaccinations. In September, California, Oregon, Washington and Hawaii. announced that these four states will follow an independent immunization schedule based on recommendations from the AAP and other medical groups.
Federal changes have been expected since December, when President Trump signed presidential memorandum directing the health department to update the childhood immunization schedule “to bring it into line with such scientific evidence and best practices from similar developed countries.”
New vaccination recommendations in the United States are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.
As doctors and public health experts indicatedDenmark also has a robust publicly funded universal health care system, a smaller and more homogeneous population, and a different disease burden.
“The vaccines recommended in any given country reflect the diseases that are prevalent in that country,” said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. “Just because one country has a vaccination schedule that is perfectly reasonable for that country, it may not be reasonable at all” elsewhere.
For example, almost every pregnant woman in Denmark is tested for hepatitis B. In the United States, less than 85% pregnant women are screened for the disease.
Instead, the US has relied on universal vaccination to protect children whose mothers do not receive adequate care during pregnancy. Hepatitis B has been virtually eliminated in the United States since the introduction of a vaccine in 1991. Last month, a commission appointed by Kennedy voted for refusal the CDC's ten-year recommendation that all newborns be vaccinated against the disease at birth.
“Viruses and bacteria that have been kept under control are being released into the most vulnerable populations,” said Dr. James Alvin, a virologist and member of the nonprofit advocacy group Defend Public Health. “It may take a year or two for the tragic consequences to become clear, but it's like asking farmers in North Dakota to grow pineapples. It won't work and it can't end well.”
