Federal health officials on Monday announced dramatic revisions to the slate of vaccines recommended for American children, reducing the number of diseases prevented by routine shots to 11 from 17.
Jim O’Neill, acting director of the Centers for Disease Control and Prevention, has updated the agency’s immunization schedule to reflect the changes, effective immediately, officials said at a news briefing.
The announcement is a seismic shift in federal vaccine policy, and perhaps the most significant change yet in public health practice by Robert F. Kennedy Jr., the health secretary, who has long sought to reduce the number of shots American children receive.
The states, not the federal government, have the authority to mandate vaccinations. But recommendations from the C.D.C. greatly influence state regulations. Mr. Kennedy and his appointees have made other changes to the childhood vaccination schedule, but those have had smaller impact.
The new schedule circumvents the detailed and methodical evidence-based process that has underpinned vaccine recommendations in the nation for decades. Until now, a federal panel of independent advisers typically reviewed scientific data for each new vaccine, and when and how it should be administered to children.
Public health experts expressed outrage at the sweeping revisions, saying federal officials did not present evidence to support the changes or incorporate input from vaccine experts.
“The abrupt change to the entire U.S. childhood vaccine schedule is alarming, unnecessary and will endanger the health of children in the United States,” said Dr. Helen Chu, a physician and immunologist at the University of Washington in Seattle and a former member of the federal vaccine advisory committee.
Dr. Chu also took issue with the health officials’ claim that the move would increase trust in vaccines and boost immunization rates. It will do the opposite, she warned.
“Already, parents are worried about what they are hearing in the news about safety of vaccines, and this will increase confusion and decrease vaccine uptake,” Dr. Chu said.
The new schedule continues to recommend vaccines against some diseases, including measles, polio and whooping cough, for all children.
Immunization against other diseases — such as respiratory syncytial virus, the leading cause of hospitalization in American infants — will be recommended for only some high-risk groups.
But other shots, including those against rotavirus, influenza and hepatitis A, can be administered to children only after consultation with a health care provider.
It is unclear what evidence led to these decisions, said Dr. Demetre Daskalakis, who led the C.D.C. center that oversaw vaccine policy before he resigned in August.
“Stealth announcements of seismic changes in vaccine policy should include experts in pediatrics, infectious diseases and immunology,” Dr. Daskalakis said. “These are lacking as is scientific process and a review of the data.”
On Dec. 5, President Trump directed Mr. Kennedy to align the U.S. vaccination schedule with those of other wealthy nations, citing Denmark, Germany and Japan.
“President Trump directed us to examine how other developed nations protect their children and to take action if they are doing better,” Mr. Kennedy said in a statement.
“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” he said. “This decision protects children, respects families, and rebuilds trust in public health.”
The new schedule reflects a collaborative effort by the health agencies under Mr. Kennedy’s purview.
In their report, officials called the United States a “global outlier among peer nations” in terms of the vaccines it recommends. But public health experts noted that with one or two exceptions, the vaccination schedule in the United States is nearly identical to those of Canada, Britain, Australia and Germany.
Japan omits some vaccines in the American schedule but includes others, like a shot against Japanese encephalitis, that are not routinely administered in the United States.
Even with the President’s endorsement, some legal experts questioned whether Mr. Kennedy had the authority unilaterally to remake the vaccine schedule.
Under a federal law called the Administrative Procedure Act, “agencies are supposed to undertake a rigorous process and ground these kinds of major policy decisions in evidence,” said Richard H. Hughes IV, a lawyer who teaches vaccine law at George Washington University.
Agencies are forbidden to act “arbitrarily and capriciously,” Mr. Hughes said. (Mr. Hughes is leading an effort to sue Mr. Kennedy and the health department over changes to Covid vaccine recommendations Mr. Kennedy announced last year.)
Health officials said that they reviewed vaccine recommendations in 20 countries, and that the new schedule reflects “consensus” over the shots considered most important.
Discussions with health officials from those nations preserved the recommendation for the shot against varicella, or chickenpox, as well as one dose against the human papillomavirus, which is credited with sharply eliminating the risk of cervical cancer among American women.
Experts have pointed out that each country’s schedule is designed to fit its population and health care realities. The childhood schedule now closely resembles that of Denmark, a country with free health care and a population about 2 percent of that of the United States.
Health officials said the changes would not affect access to the vaccines or their coverage by insurance companies.
“All vaccines currently recommended by C.D.C. will remain covered by insurance without cost sharing,” Dr. Mehmet Oz, administrator for the Centers for Medicare & Medicaid Services, said in a statement.
“No family will lose access,” Dr. Oz said.
This developing story will be updated.
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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