WASHINGTON — When Robert F. Kennedy Jr. assumed the role of health secretary almost one year ago, he said he had one overriding goal: to improve children’s health. But Kennedy’s sudden, unilateral, and sweeping change to the nation’s childhood vaccine schedule, announced Monday, will do the opposite, pediatrics and public health experts warn.
“Our kids are going to die from some of these diseases that we have resources against,” Elizabeth Choma, a D.C. pediatric nurse practitioner, said.
The new, pared-down list of recommended vaccines takes heavy inspiration from Denmark, which promotes shots against only 10 diseases. By comparison, last year the U.S. Centers for Disease Control and Prevention schedule included vaccines against 17 diseases. Health experts pointed out that Denmark is much smaller than the U.S. and has universal health care.
“Our population and health care system are very different versus the countries the administration claims to be comparing us against,” Rekha Lakshmanan, executive director of The Immunization Partnership, said. “This decision will lead to more children falling ill, suffering from preventable diseases, and putting undue stress on parents.”
Vaccination has for decades been a tried-and-true (and largely uncontroversial) way to protect children against illnesses like polio, chickenpox, and pneumonia. Rates of death from infectious diseases in childhood have plummeted as a result, and countless children have avoided lifelong problems, such as hepatitis-caused liver disease or a painful bout of shingles decades after having chickenpox.
Now, those gains face formidable opposition: a growing movement of vaccine critics — led by Kennedy and his top advisers — who want fewer shots in arms and greater freedom to refuse vaccination. Shrinking the childhood vaccine schedule has been one of Kennedy’s longtime aims. With President Trump’s buy-in, the secretary got to work.
High-ranking Health and Human Services officials reorganized the schedule, moving vaccines that were previously recommended for all or most children to limited categories, such as “shared clinical decision-making,” or only for high-risk populations.
Among the vaccines recommended for specific children at high risk are shots for respiratory syncytial virus (RSV) and dengue. Vaccines against meningococcal ACWY, meningococcal B, hepatitis A, and hepatitis B are recommended for high-risk children, and fall under the shared decision-making category for all other kids. Parents may also consult with their child’s pediatrician about rotavirus, Covid-19, and flu vaccines.
“High-risk,” in the case of vaccines, usually means patients must meet specific criteria in order to get the shots covered by insurance. “Shared clinical decision-making” means parents or guardians and pediatricians may jointly decide which vaccines make sense for a certain child to get based on their risks and exposures.
In practice, however, it can mean doctor’s offices pressed for time may be less likely to promote vaccines that fall under that category, and patients less likely to ask about them.
“I wouldn’t be surprised if clinicians stop stocking ones under that banner,” Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, said Monday. (The AAP has its own vaccine schedule, and is suing HHS over vaccine policy.)
In some states, pharmacists or other clinicians don’t have full authority to practice shared clinical decision-making for patients of all ages. That may present a barrier for some families who have trouble getting consistent primary care.
Shifting certain shots into the shared decision-making group could also put pressure on elected officials in red states to strip those vaccines from school-entry requirements, former Food and Drug Administration Commissioner Scott Gottlieb said. “If that happens, vaccination rates could fall sharply, fragmenting along state lines and producing stark regional differences in protection against disease.”
HHS officials said this week that all vaccines recommended by the CDC as of December — before the change — will be covered by insurance, including through Affordable Care Act plans and federal programs like Medicaid, Children’s Health Insurance Program, and Vaccines for Children, which pays for vaccines for just over half of American children.
What scares those in the world of pediatrics, though, is imagining how the new schedule could play out over time. If vaccination levels drop, those who have compromised immune systems, like newborns and children with serious conditions, will be at much higher risk of serious illness and death.
Diseases that are now infrequent but highly contagious, like rotavirus, could begin to reemerge, said Choma, a clinical assistant professor at the George Washington University School of Nursing. Healthy children will also be at increased risk, simply because they haven’t built up antibodies against potentially severe diseases. Clinicians or trainees who are not used to treating previously rare infectious diseases may be caught flat-footed. And down the line, some children who recover will face a higher burden of chronic disease in adulthood.
Some changes to the immunization schedule could generate confusion, pediatrics experts say. The CDC already changed its recommendation on hepatitis B, ending the practice of universal newborn vaccination that vastly curbed rates of disease in young people. Some pediatricians and hospitals said they’d continue the newborn hep B dose anyway.
The latest round of alterations raises questions about the meningococcal ACWY vaccine, for example. That vaccine was moved from a universal recommendation (for children ages 11 and up) to one based on shared clinical decision-making. However, many middle schools in the U.S. require students to be vaccinated against the bacterial infection. Meningitis can spread easily and cause brain swelling, sepsis, loss of hearing or limbs, and death. About 10 out of every 100 people with meningitis dies, and those who survive can suffer profound and lifelong consequences.
Health care workers are now left deciding whether to follow the new HHS guidance or stick with the schedule they know.
“The nation relies on the CDC to provide scientifically based recommendations, which must be made through an open and transparent process,” the American College of Emergency Physicians said in a statement. “These unjustifiable changes to the vaccination schedule have real consequences that will harm children from preventable illnesses and create unnecessary public health risks for millions of people.”
The supply of vaccines could also be threatened if, for example, commercial insurers decided to stop covering certain shots, or patient demand steeply declines. In what many experts consider a worst-case scenario, vaccine makers could decide certain shots aren’t worth their investment.
In the past, part of what has kept the U.S. vaccine supply intact are legal protections afforded to vaccine manufacturers by Congress. These allow for injury claims to be resolved outside of court if the vaccines were recommended by the CDC. Kennedy’s core followers wish to dismantle that system, called the Vaccine Injury Compensation Program.
Previously, all but dengue, RSV, mpox, Covid, and PPSV23 (pneumococcal) vaccines were covered by the program, and Covid vaccines are covered by the Countermeasures Injury Compensation Program.
In response to STAT’s questions about which vaccines will retain coverage under the vaccine injury program, HHS spokesperson Emily Hilliard said, “Vaccines recommended by the CDC for children based on shared clinical decision-making continue to be covered by the VICP.”
She did not specify any vaccines on the new schedule that would be left out of the VICP.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
