The CDC will revise the U.S. childhood immunization schedule for the first time in decades, reducing routine recommendations from 18 to 11 diseases, following a December directive from President Donald Trump to compare U.S. vaccine practices with those in peer nations. Acting CDC Director Jim O’Neill signed a decision memo Jan. 5 adopting changes recommended by NIH Director Jay Bhattacharya, MD, PhD, FDA Commissioner Marty Makary, MD, and CMS Administrator Mehmet Oz, MD.
Federal officials said in a Jan. 5 HHS news release that the update preserves access while shifting toward more individualized recommendations. Public health leaders, however, cautioned the move could sow further confusion.
“The best-case scenario is that nothing will change,” David Margolius, MD, director of public health for the city of Cleveland, told NBC News on Jan. 5. “The worst-case scenario is that this causes more confusion, more distrust, lower vaccination rates, and then just this trend of political parties and ideologies determining which vaccines people should get.”
Here are four things to know:
1. The new schedule creates three clinical categories.
The CDC will now group vaccines into:
• Recommended for all children
• Recommended for high-risk groups
• Recommended based on shared clinical decision-making
All vaccines remain covered by insurance with no cost-sharing.
2. Routine recommendations will be scaled back for several vaccines.
Vaccines no longer recommended for all children include those for hepatitis A and B, rotavirus, flu, RSV and meningococcal disease. These vaccines will still be available and covered but will require individual assessment based on risk or shared decision-making between families and clinicians.
3. Officials say the changes are in response to falling public trust.
Federal agencies cited a decline in vaccine uptake and confidence between 2020 and 2024 as a key driver of the shift. They said the new structure aims to clarify guidance and better reflect clinical risk.
4. Public health experts say global comparisons miss key context.
Experts warned that aligning U.S. guidance with countries such as Denmark overlooks differences in population size, diversity and disease exposure.
“Denmark is about the size of Maryland, so what works to protect a small, very highly vaccinated population like Denmark cannot be extrapolated for a very large, heterogeneous and much more diverse population like the U.S.,” epidemiologist Jessica Malaty Rivera, DrPH, told The Washington Post in December.
The decision has drawn sharp criticism from leading medical organizations, which raised concerns about the lack of transparency and scientific rigor behind the policy shift.
American Academy of Pediatrics President Andrew Racine, MD, PhD, said the decision “arbitrarily” removes routine recommendations for several vaccines with known impacts on U.S. children.
“At a time when parents, pediatricians and the public are looking for clear guidance and accurate information, this ill-considered decision will sow further chaos and confusion,” he said in a Jan. 5 statement on the organization’s website.
Echoing those concerns, the Infectious Diseases Society of America said the process lacked meaningful public input and deviated from longstanding scientific norms.
“Upending long-standing vaccine recommendations without transparent public review and engagement with external experts will undermine confidence in vaccines with the likely outcome of decreasing vaccination rates and increasing disease,” said IDSA President Ronald Nahass, MD, in a Jan. 5 statement on the organization’s website. The group described the changes as “reckless” and said they overlook demonstrated need for vaccines in the U.S.
The American Medical Association also voiced strong opposition, emphasizing that scientific evidence supporting routine immunizations remains unchanged.
“Changes of this magnitude require careful review, expert and public input, and clear scientific justification. That level of rigor and transparency was not part of this decision,” said AMA Trustee Sandra Adamson Fryhofer, MD, in a Jan. 5 statement on the organization’s website. “This undermines public trust and puts children at unnecessary risk of preventable disease.”
