For decades, Americans have looked to the federal government for advice on which vaccines their children should get and when. A panel of independent scientists with diverse expertise provided those recommendations following longstanding public health principles, usually after months or even years of careful review of the evidence.
On Monday, in a move extraordinary for its disregard for this process, Health Secretary Robert F. Kennedy Jr. and political appointees at the Centers for Disease Control and Prevention delivered a new vaccine schedule that shrank the number of diseases American children would be protected against by one-third.
The changes appear to be limited in their impact, at least in the short term. The six vaccines dropped from the routine schedule are still available to all children, with a health care provider’s approval. And immunization requirements for entry into day care and schools rest with states, not the federal government.
Still, Mr. Kennedy and his allies appear to be laying the groundwork for an entirely new approach to immunization, one that prizes individual autonomy and seeks to limit vaccines based on personal preference rather than scientific expertise and established benefit.
“I don’t think this will be the last of the big changes we’re going to see,” said Dr. Anne Zink, a an emergency room physician at Mat-Su Regional Medical Center in Palmer, Alaska, and a former health officer for the state.
The previous vaccine schedule included some shots that might not be essential for everyone, in part because prevention is considered the best option in a country like the United States that has a fragmented health care system, Dr. Zink said.
She said she would have welcomed changes to the schedule but, “I’d like things to be done in a transparent, scientifically driven process.”
The new schedule cuts the number of diseases for which all children should be immunized to 11 from 17. Vaccines for illnesses like measles, polio and whooping cough are still part of the routine schedule. But for other diseases, including hepatitis A and B, rotavirus, meningitis and flu, the new recommendations advise consulting with a health care provider before most children receive the shots.
Monday’s announcement was a surprise to everyone who would normally have been involved in such decisions: scientists at the C.D.C., outside advisers to the agency, medical organizations like the American Academy of Pediatrics and the American Medical Association and patient advocacy groups.
And federal health officials hinted at more changes to come.
Currently available vaccines have all been extensively tested in clinical trials and have been administered to millions of children. But the federal officials, falsely claiming that such studies were never conducted or were inadequate, said they planned to probe the timing and safety of the shots, as well as of specific ingredients like aluminum salts, which have been used in vaccines for nearly a century to enhance immune response.
“I think this is going to be a really huge year,” Del Bigtree, a prominent anti-vaccine activist, said on his podcast on Thursday.
The new schedule is “a massive, gigantic step for humanity,” Mr. Bigtree said. But, he added, “It’s not everything I ever dreamed.”
Vaccines for measles, chickenpox and human papillomavirus are still recommended under the new schedule, which he said his audience might find “infuriating.” He hinted at “private, secret meetings” being held about more changes.
Mr. Bigtree and other allies of Mr. Kennedy’s have recently suggested that people may now directly sue vaccine manufacturers — who have for decades been shielded from liability — if they believe they were harmed by vaccines that are no longer routinely recommended.
Before 1986, when the liability protection program was established, a profusion of such lawsuits nearly drove manufacturers out of business.
Andrew Nixon, a spokesman for the Department of Health and Human Services, said, “We don’t 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 public health and medical groups.
On Friday, more than 200 organizations urged Congress to “investigate why the schedule was changed, why credible scientific evidence was ignored and why the committee charged with advising the H.H.S. secretary on immunizations did not discuss the schedule changes as a part of their public meeting process.”
Breaking with decades of partnership with the C.D.C., the pediatrics academy is still recommending the previous schedule. Insurance companies have also pledged to follow the earlier schedule through the end of this year.
Many Democrat-led cities and states also promptly issued emphatic avowals of support for the previous schedule. Republican-led states were mostly silent, but none have so far shown signs of adopting the new recommendations, said Dr. James McDonald, a pediatrician and New York State’s health commissioner.
“No matter whether your state is Republican-leaning or Democratic-leaning, it doesn’t matter,” he said. “Every state health official recognizes the importance of vaccines.”
Some physicians believe that, buoyed by decades of evidence for the value of vaccines, parents will continue to opt for the shots. But others are fretting about how best to address the concerns they already hear.
“What I’m hearing from patients is like, ‘The government’s telling me I don’t need to get all the vaccines,’” Dr. Zink, the emergency room physician in Alaska, said.
Dr. Jake Scott, a vaccine expert at Stanford University School of Medicine, said physicians, who will need to clarify the guidelines for parents, might not have the time to address their worries adequately.
The requirement that a health professional sign off on certain vaccines before children can access them sounds good in theory, Dr. Scott said, but it is best suited for complex judgment calls, not for vaccines with unequivocal benefit.
“It tells parents that there’s a genuine question here, even when there isn’t,” he added.
Since he became health secretary, Mr. Kennedy has steadily emphasized his distrust of vaccines. He fired all 17 members of the federal vaccine advisory committee and replaced them with several members who share his skepticism.
In early December, a directive from President Trump urged Mr. Kennedy to align the childhood vaccination schedule in the United States with those of peer countries like Denmark, Germany and Japan. Mr. Kennedy responded: “Thank you, Mr. President. We’re on it.”
They were. On Dec. 18, Jim O’Neill, the C.D.C.’s acting director, met with about a dozen scientists from the agency. The scientists provided a detailed analysis of the prevalence of vaccine-preventable diseases, the benefits from vaccines and the differences between the United States and other countries.
Mr. O’Neill, according to a health official with knowledge of the events, asked good questions, and seemed to appreciate the answers, leaving the scientists hopeful that he would not make any rash decisions.
But on Monday, the official said, the agency scientists realized that nothing they said had made any difference.
The schedule now most closely resembles that of Denmark, even though the two countries are vastly different in size, demographics and access to health care.
Some international experts worried that the changes to the U.S. schedule could jeopardize immunizations well beyond America’s borders.
“I think people will begin to doubt if the recommendations that we do have in Germany or other countries are really necessary,” Dr. Reinhard Berner, a pediatrician who heads the panel that recommends vaccines in Germany, said.
In the United States, vaccination rates began dropping when the Covid pandemic disrupted routine medical care. A backlash against Covid shots and mandates further eroded trust in vaccines.
The effect seemed to worsen last year, when the country experienced the highest number of measles cases in three decades.
Mr. Kennedy has at times said the measles vaccine can prevent the disease. But he has also repeated falsehoods about the shot’s safety and effectiveness, including that it contains fetal debris and causes the same symptoms as the virus itself.
Mr. Kennedy’s rhetoric about shots not having been properly tested also appears to be gaining traction. One poll, by the Pew Research Center, found that only about half of Americans are now highly confident that childhood vaccines have been adequately tested and shown to be safe.
On Monday, health officials said that parents had long been coerced into vaccinating their children for too many diseases and that having fewer recommended shots would restore trust.
“The updated childhood schedule is an important step toward restoring informed consent and discouraging states from removing immunization decisions from parents and health care providers through mandates,” Mr. Nixon, the Health Department spokesman, said.
The administration recently eliminated some requirements for states to report immunization rates to the federal government, which will make it difficult to track whether the changes do in fact increase mistrust, and whether Americans even understand the new guidelines.
About 22 percent of Americans believe the term “shared clinical decision-making” means “taking the vaccine may not be a good idea for everyone but would benefit some,” according to a recent poll. Half or more of those surveyed said they did not realize that registered nurses and pharmacists were health professionals and could offer the required counsel.
Not all the changes in the vaccine schedule have caused consternation among public health experts. The schedule drops recommended doses of the HPV vaccine, which has slashed the cervical cancer rate in girls and women, to one shot from the previous two.
Mr. Kennedy, who has benefited financially from lawsuits against the vaccine’s manufacturer, Merck, has incorrectly claimed that the vaccine increases the risk of cervical cancer.
But before its former members were dismissed, the federal vaccine advisory committee was already weighing that change. “The efficacy is so high, there’s really no clinical benefit to receiving more than one dose,” said Dr. Ruanne Barnabas, chief of the division of infectious diseases at Massachusetts General Hospital.
Experts are more worried about the omission of other vaccines. Fewer children immunized may mean pediatricians will begin to see severe dehydration in children from vomiting and diarrhea induced by rotavirus, liver damage from hepatitis, or brain damage caused by meningitis.
For the time being, however, insurance companies, states and medical groups are proceeding according to the earlier recommendations.
“Our view is that all these vaccines are still on the 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.”
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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