In a radical shift in child immunisation policy, US federal officials this week announced unprecedented changes to its childhood vaccine schedule, sparking widespread condemnation from public health authorities worldwide.
The new policy, effective immediately, which will see the number of universally recommended immunisations slashed from 17 to 11, is modelled after the schedule used by Denmark, reports CIDRAP. However, Demark is a much smaller country and its recommendations are possibly not because of safety concerns, but because the jabs may be too expensive for the government to purchase, say US experts.
Although the Centres for Disease Control and Prevention (CDC) will continue to recommend 11 shots for all children, six others will be recommended only for children deemed to be at high risk of infection, said the agency’s acting director, Jim O’Neill, adding that a third group of vaccines will be available through “shared clinical decision-making” with medical providers.
However, public health experts have objected vociferously to the change, saying there’s no reason to alter a system that has prevented 1.1m deaths over the past 30 years.
“Abandoning the US evidence-based process is a dangerous and potentially deadly decision,” said Jason Goldman, MD, President of the American College of Physicians. “The evidence is clear that vaccines prevent deaths, hospitalisations and spread of disease.”
This comes as a World Health Organisation (WHO) expert committee has again confirmed that there is no causal link between vaccines and autism spectrum disorders (ASD), after a new review of global scientific evidence.
UN News reports that at a meeting in late November, the WHO Global Advisory Committee on Vaccine Safety examined 31 major research studies published between 2010 and August 2025.
The analysis covered data from multiple countries and looked both at vaccines in general and at those containing thiomersal – a preservative sometimes used to prevent contamination in multi-dose vials.
“The latest review strongly supports the positive safety profile of vaccines used during childhood and pregnancy and confirms the absence of a causal link with autism spectrum disorders,” concluded the committee.
This assessment drew on studies published over more than two decades, as well as a large national study from Denmark that tracked children born between 1997 and 2018.
The group reaffirmed earlier findings issued in 2002, 2004 and 2012: “Vaccines, including those with thiomersal and/or aluminium, do not cause autism.”
WHO urged governments to ensure that vaccine policies remain rooted in science. “Global childhood immunisation efforts represent one of the greatest achievements in improving lives, livelihoods and the prosperity of societies,” it noted.
Over the past 50 years, WHO estimates that vaccines have saved at least 154m lives.
The CDC will continue to recommend jabs against 11 diseases for all children, including measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella (chickenpox).
It is recommending six shots for “high-risk groups”, including vaccines that protect against respiratory syncytial virus (RSV), hepatitis A, hepatitis B, dengue and two vaccines targeting bacterial meningitis (MenACWY and MenB). Dengue vaccines have always been targeted only to a relatively small number of children in specific circumstances.
The vaccines recommended for shared clinical decision-making are for rotavirus, Covid-19, influenza, meningococcal disease, hepatitis A and hepatitis B.
In another important change, the CDC is now recommending only one dose of the HPV vaccine. Until now, it had recommended two or three HPV vaccines, depending on the age at which children receive their first shot.
Health and Human Services (HHS) Secretary Robert F Kennedy Jr has long claimed US children get “too many” vaccines, and the policy change fulfils a directive issued by President Donald Trump last month calling for the vaccination schedule to be aligned with that of Denmark and other countries that recommend fewer immunisation jabs.
The CDC said the changes followed an assessment of 20 developed nations, most of which have national healthcare systems that provide free healthcare from birth to death.
Changes are ‘radical, dangerous’
“This is a dark day for children and for their parents and for our country generally,” said Jesse Goodman, MD, MPH, a Professor of Medicine and Infectious Diseases at Georgetown University.
He compared the decision to a “torpedo” blowing up vaccination policy. “There will be more diseases, more infection, more hospitalisation,” said Goodman, a former Food and Drug Administration (FDA) chief scientist and former director of the agency’s centre for biologics evaluation and research.
Officials with the American Academy of Paediatrics (AAP), which has not changed its childhood vaccination recommendations, also oppose the new schedule. Many paediatricians and family doctors told CIDRAP they would continue to follow AAP’s guidance, rather than that of the CDC.
“I’m not sure why they want to bring the diseases back but that’s their goal,” said Sean O’Leary, MD, who chairs the AAP’s infectious disease committee. “With RSV we’ve already seen population-level impact. Why do they want more hospitalisations? Hepatitis A is a miserable disease, and it’s particularly bad as children age.”
He added that the emphasis on shared clinical decision-making will only further confuse both parents and doctors.
“The fact is, paediatricians already do this all day, every day,” he said. “It just makes things more confusing for parents and clinicians. So when the evidence is clear that the benefits outweigh the risks, the guidance should be clear, not confusing as what has now happened today.”
Michael Osterholm, PhD, MPH, of the Vaccine Integrity Project and the director of the University of Minnesota’s Centre for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, said: “Eliminating vital US childhood vaccine recommendations without public discussion or transparent review of the data the decision was based on is a radical and dangerous decision.” he said. “This wildly irresponsible decision will put lives at risk.”
Return of vaccine-preventable diseases?
The changes come as more American children are dying from vaccine-preventable diseases, which have returned as immunisation rates have declined.
Two Texas children died from measles last year in an outbreak that has reached more than 2 000 cases and shows no sign of stopping. Thirteen people died from pertussis (whooping cough), which infected nearly 28 000 Americans last year.
In fact later this month, the country may lose its official measles elimination status, which it has held since 2000.
The country also recorded at least 288 flu deaths in children last year, the highest number for a non-pandemic flu season. Several children have already died of flu this year, in what is predicted to be a severe influenza season.
Changes likely to be challenged in court
The AAP had already filed a lawsuit against Kennedy in July, claiming that he violated the Administrative Procedures Act when he issued a directive removing the Covid-19 vaccine from the CDC immunisation schedule for children and pregnant women.
“For decades, changes in the American vaccine have been discussed in public meetings at the CDC with expert review of the available evidence,” said Kevin Ault, MD, a Professor of Obstetrics and Gynaecology at the Western Michigan University Homer Stryker School of Medicine, and a former member of ACIP. “The new guidelines are not supported by data, and there was no input from stakeholder groups like the AAP and the American Academy of Family Physicians.”
“The goal of this administration is to make vaccines optional,” said Paul Offit, MD, an infectious disease and vaccine specialist at Children’s Hospital of Philadelphia. “I think that’s where we’ve been moving.”
‘Alarming’
"The abrupt change 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 and a former member of the federal vaccine advisory committee.
The New York Times reports that she also took issue with officials’ claims that the move would increase trust in vaccines and raise immunisation rates, warning that it would do the opposite.
Federal 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 US was 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 US.
Is it legal?
“ … their decision will have to justify clearly both why this is a good idea, given the differences between the countries, and why the Secretary thinks it’s justified to overturn prior expert recommendations, to survive judicial review,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.
Experts have pointed out that each country’s schedule is designed to fit its population and healthcare realities. The childhood schedule now closely resembles that of Denmark, with its free healthcare and a population about 2% of that of the US.
Denmark omits some vaccinations from its recommendations not because of any concerns about safety, but because they may be too expensive for the government to purchase, given the risks in that population.
But for many of those diseases, the situation in the US is vastly different, some public health experts – including some in Denmark and Germany – have said.
Before the rotavirus vaccine was routinely administered in the US, for example, the disease led to the hospitalisation of up to 70 000 American children each year.
Without a recommendation for routine vaccination, “there will be more children who are going to be at risk of severe, severe dehydration from this virus”.
UN News – WHO expert group reaffirms no link between vaccines and autism (Open access)
CIDRAP article – HHS announces unprecedented overhaul of US childhood vaccine schedule (Open access)
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Measles jab a personal choice, says Kennedy after child’s death