The bombshell announcement that the Trump administration no longer fully recommends a third of childhood vaccines means the US moved from leading globally on vaccination to lagging behind other high-income nations in preventing disease, experts say.
The move is the latest and most significant escalation against vaccines from Robert F Kennedy Jr, a longtime vaccine skeptic and current secretary of the US Department of Health and Human Services (HHS).
“It’s the largest change in our vaccination schedule in modern American history,” said Jake Scott, infectious diseases specialist and clinical associate professor at Stanford University School of Medicine.
It is an “astounding” decision made without scientific evidence or public input that will worsen vaccine access and increase disease outbreaks, said Daniel Jernigan, former director of the National Center for Emerging Zoonotic Infectious Diseases.
US health officials, led by Kennedy, “want fewer vaccines”, Jernigan said, adding that they’re inflating the risks while burying the benefits of vaccines and “sowing confusion” for parents and providers.
Some shots are now only offered to “high-risk” groups – including hepatitis A, RSV (respiratory syncytial virus), hepatitis B and vaccines to prevent two types of meningitis. The dengue vaccine will continue to be recommended in high-risk areas only. Other vaccines are offered only under shared clinical decision-making, a previously rare designation that usually requires a doctor’s recommendation – including influenza, rotavirus, meningococcal disease, hepatitis A and hepatitis B. Covid vaccines were limited in this way in November. The CDC will also recommend one dose of the HPV (human papillomavirus) vaccine instead of two.
Health officials said in a press release this will move the US closer to “peer, developed countries” as instructed by Donald Trump in December. Yet most other high-income countries have similar vaccine schedules to America’s now-jettisoned recommendations.
The UK, Canada, Australia, Japan and most European countries have universal childhood recommendations for influenza, rotavirus and hepatitis B. All of them except for Japan routinely recommend vaccines against meningococcal disease to children. Canada, Japan, and most European countries recommend the RSV shot for all newborns, while Australia and the UK recommend the RSV vaccine for all pregnant people and the shot for high-risk newborns. The UK, Canada, Australia, Japan, and European countries recommend hepatitis A vaccines for high-risk populations.
Several of these countries also routinely recommend vaccines the US does not.
Japan added the rotavirus shot in 2020, and the UK just moved to recommend chickenpox vaccine to all. Decisions like these are frequently made because of the evidence accumulated by the US of the safety and effectiveness of these vaccines. The US policies “used to be considered leadership in the public health policy space”, Jernigan said.
Many of these countries are “moving towards more protection” offered by vaccines, Scott said. “A lot of countries are expanding their vaccine schedule, and a lot of them have looked to the US over the years.”
The new US schedule is now closer to that of Denmark, a much smaller nation with universal healthcare. When it comes to vaccine recommendations, “Denmark is an outlier”, Scott said. “They’ve got the most minimalist childhood vaccine schedule” of other high-income nations.
The US is itself an outlier, Scott said, when it comes to healthcare and social safety nets. The US is the only high-income nation without universal healthcare and paid family leave.
“We need to follow what our peer countries are doing – and have universal healthcare,” Jernigan said.
Most notably, the US has 330 million people – compared with Denmark’s 6 million – and a highly fragmented health system covering a massive geography and a diverse population. There are profound health disparities in America; nearly a third of the population does not have access to primary care. Lack of healthcare access or paid sick leave means diseases spread more before Americans seek care.
Dense urban centers alongside rural areas with very limited healthcare access, and plenty of travel across state and international borders, Scott said, means “disease moves differently” in the US. Going from a small town to a huge city – to attend a major university with tens of thousands of students living closely together, for instance – might open young people up to new disease threats, such as meningitis, Jernigan said: “It’s like traveling from your own country to a new country.”
In other nations with fuller healthcare systems, it can be easier to access vaccines that are recommended only to high-risk populations, instead of all children. The children of pregnant people with hepatitis B are at high risk of getting very sick, for instance, yet in the US they are the least likely to access hepatitis B vaccines because they are frequently unable to see doctors for testing or follow-up care.
Andrew Nixon, an HHS spokesperson, pointed to declining trust in public health, but did not provide evidence for how changing the vaccination schedule would affect public trust.
Even other countries with universal healthcare recommend similar vaccines as the US once did.
“I’ve never seen anything like that, where what other countries do is [given] the same weight as scientific evidence,” Jernigan said, comparing it with recommending that all drivers in the US switch to the left side of the road because other nations do so.
Scott said the recommendations aren’t “really about aligning with peer nations. It’s about finding a justification for this predetermined conclusion. They want to do away with vaccines.”
Officials also bucked the established scientific process in making the decision, with no public comment, no discussion from the Advisory Committee on Immunization Practices (ACIP), and no feedback from outside scientists or professional groups like the American Academy of Pediatrics (AAP), Jernigan said.
“We have a sweeping health policy that has no public engagement,” he said, noting that the process for making transparent decisions on vaccines was established long ago, yet “this administration just refuses to use the process”.
Scott echoed that concern, calling it “very concerning” and “very ominous” that these “changes weren’t voted on”, “weren’t debated in public” and “weren’t subjected to the evidence-to-recommendation framework that ACIP uses”.
Instead, the administration released a 33-page report from Tracy Beth Høeg, a frequent vaccine skeptic and now the top regulator of drugs at the US Food and Drug Administration (FDA), and Martin Kulldorff, a biostatistician who was briefly an ACIP adviser before being appointed to the HHS.
“It lists two authors, which is very odd – to have a sweeping document that leads to significant policy change list two authors,” Jernigan said. “You end up with what is really an opinion piece.”
The announcement itself lacked transparency. A small group of journalists was selected by HHS to be briefed about the changes on Monday; the Guardian was not invited.
Even the president’s directive to re-examine the schedule was unusual, Jernigan noted: “I’m trying to think if a president has ever said: ‘Atorvastatin for lowering cholesterol, I think that should be changed.’”
Officials constantly monitor vaccines for potential safety signals, and no new evidence about potential harms have been made public.
“The science hasn’t changed. The only thing that’s changed is who’s making the decisions and what conclusions they want to reach,” Scott said.
Such unscientific changes will have outsized harm, Jernigan said, adding: “We cannot let this be the new normal of what the government’s doing, because the government’s basically saying ‘just quit listening to me from now on.’ It’s really unfortunate.”
He hopes patients will continue seeking out vaccines, and providers will continue to recommend them: “You don’t want to be that parent of a child who [goes] to a college where they have a meningitis outbreak and then ends up losing a limb or dying.”
