Trump Administration Makes Significant Changes to U.S. Childhood Vaccine Schedule

The Trump administration has recently implemented substantial changes to the U.S. childhood vaccination schedule, marking its most significant impact on vaccination policy to date. Among these changes, several vaccines previously universally recommended have been downgraded to a designation called “shared clinical decision making,” affecting vaccines that protect against diseases including hepatitis A, rotavirus, influenza, hepatitis B, meningococcal disease, and COVID-19. While this change might appear minor—simply suggesting a conversation with a doctor—medical experts warn that it has deeper implications, as “shared clinical decision making” in vaccine terminology implies that the benefit-risk calculation isn’t straightforward, even though evidence strongly supports these vaccines.

These changes were announced on January 5 and have raised serious concerns among medical professionals because they did not follow the traditional protocol for updating the U.S. childhood vaccination schedule. Typically, such changes undergo a lengthy scientific review process culminating in recommendations from the Advisory Committee on Immunization Practices (ACIP). Dr. Lori Handy, pediatric infectious diseases physician and associate director of the Vaccine Education Center at Children’s Hospital of Philadelphia, notes that bypassing this deliberate open process makes it “really challenging to have confidence in any of the proposed changes.” Most concerning to medical experts is that no new evidence was presented to support reducing universally recommended vaccines, with Handy stating these changes “are not made in the best interest of children because more children will inevitably get sick.”

The administration claims these changes align the United States with vaccine schedules in peer nations, but Dr. Jake Scott, an infectious diseases physician at Stanford University’s School of Medicine, explains that “vaccine policy isn’t one-size-fits-all.” It must account for how healthcare is delivered in each country, including access considerations, infrastructure, and epidemiological differences between nations. Experts emphasize that the shared clinical decision making category is meant for situations where “individual factors meaningfully shift the risk-benefit calculation” and population benefit is uncertain—circumstances that don’t apply to the reclassified vaccines. This category is typically reserved for cases where medical and social risk factors “are so nuanced that it is challenging to make a clear routine recommendation,” such as the HPV vaccine for adults ages 27-45, but not for routine childhood immunizations where benefits clearly outweigh risks.

Looking more closely at the affected vaccines reveals why medical experts are concerned. For hepatitis A, a highly contagious virus that spreads person-to-person or through contaminated food, the vaccine has dramatically reduced incidence from 12 cases per 100,000 in 1995 to just 0.7 per 100,000 in 2022. As Handy points out, having a shared decision making conversation about hepatitis A risk is essentially “asking someone if they are going to eat,” which is “just not a practical conversation to have.” Similarly, the hepatitis B birth dose has been critical in preventing chronic infections in newborns, who face a one-in-four chance of premature death from complications if infected. For meningococcal disease, a fast-moving and potentially deadly infection with a case fatality rate of 4-20%, vaccination had been universally recommended for adolescents who frequently gather in close quarters and share drinks—essentially all teenagers.

The influenza vaccine’s redesignation is particularly concerning following the 2024-2025 flu season, which saw more childhood deaths (280) than any non-pandemic flu year since recordkeeping began in 2004. Data showed that 89% of children with available vaccination status who died were not fully immunized against flu. Even when vaccines don’t perfectly match circulating strains, they still provide substantial protection—this season’s flu vaccine offers 72-75% effectiveness against emergency department visits and hospital admissions for children and adolescents. Similarly, rotavirus vaccination, universally recommended since 2006, has significantly reduced hospitalizations for severe gastroenteritis in children under 5, from 76 per 10,000 in the pre-vaccine era to 34 per 10,000 by 2012.

With the administration stepping back from decades of robust vaccine policy, parents and healthcare providers can still look to the American Academy of Pediatrics childhood vaccine schedule, which previously aligned with CDC recommendations. Dr. Handy emphasizes that “clinicians can 100% continue to follow the schedule as laid out by the AAP,” while Dr. Scott advises, “When the federal government and pediatricians disagree, I would say trust the pediatricians.” The science supporting universal recommendation of these vaccines remains unchanged, but parents may now need to be more proactive during pediatric appointments to ensure their children remain up-to-date on vaccinations. Several states have already committed to maintaining previous vaccination schedules, with some forming alliances like the West Coast Health Alliance (California, Oregon, Washington, and Hawaii) to preserve public health policies no longer endorsed by the federal government and provide accurate information to the public.