Health Secretary Robert F. Kennedy Jr. this week removed universal federal recommendations for childhood vaccines against six diseases, drawing immediate condemnation from pediatricians who said the changes will deepen vaccine hesitancy and lead to more illness and death.
On Friday, the American Academy of Pediatrics and more than 200 medical, public health, and patient advocacy groups sent a letter to Congress demanding an investigation. “We urge you to investigate why the schedule was changed, why credible scientific evidence was ignored, and why the committee charged with advising the HHS Secretary on immunizations did not discuss the schedule changes as a part of their public meeting process,” the groups wrote.
The revisions arrive as childhood vaccination rates are already declining and outbreaks of measles and pertussis are producing increased hospitalizations and deaths, according to pediatricians treating affected patients. Leading medical organizations said they would continue following pre-existing vaccine schedules regardless of the federal shift.
What changed
The prior federal schedule had recommended vaccines against certain diseases universally for children. Under the new guidelines announced Monday, vaccines against hepatitis A, hepatitis B, rotavirus, RSV, flu, and meningococcal disease no longer carry universal recommendations.
RSV, hepatitis A, hepatitis B, and meningococcal vaccines are now recommended only for certain high-risk populations. Flu, rotavirus, hepatitis A, hepatitis B, and meningococcal vaccines are recommended through a process called “shared clinical decision-making.” The COVID-19 vaccine was moved to the shared decision-making category in a prior change last year.
Kennedy said in announcing the changes that they better align the United States with peer nations “while strengthening transparency and informed consent.”
Federal vaccine recommendations are not mandates. States retain the authority to require vaccinations for schoolchildren, and the practical effect of the federal changes depends on whether physicians and insurers follow them.
What ‘shared clinical decision-making’ means — and why doctors say the term matters
The phrase “shared clinical decision-making” has a specific technical meaning. According to the Advisory Committee on Immunization Practices, shared clinical decision-making vaccinations “are not recommended for everyone in a particular age group or everyone in an identifiable risk group” but are “individually based and informed by a decision process between the health care provider and the patient or parent/guardian.”
Surveys conducted last year by the Annenberg Public Policy Center at the University of Pennsylvania found the concept is widely misunderstood. Only about 2 in 10 U.S. adults knew that one meaning of shared decision-making is that “taking the vaccine may not be a good idea for everyone but would benefit some.” Only about one-third knew that pharmacists — who frequently administer vaccines — count as health care providers in that context.
Dr. Molly O’Shea, a Michigan pediatrician with two offices in the state, said the terminology signals to parents that only certain children require the affected vaccines. “It sends a message to a parent that actually there’s only a rarefied group of people who really need the vaccine,” she said. “It’s creating an environment that puts a sense of uncertainty about the value and necessity or importance of the vaccines in that category.”
O’Shea noted a distinction between the routine vaccine discussions pediatricians already conduct at every appointment and the formal shared decision-making process. Under the new guidelines, she said, parents seeking shots in the shared decision-making category would need to schedule a sitting consultation with a health care provider rather than a brief vaccine-only visit, and drive-up flu clinics could become harder to operate.
Doctors say they will hold their prior recommendations
Leading medical organizations said they would maintain prior vaccine schedules. O’Shea and other pediatricians said they planned to continue recommending the affected vaccines to their patients.
Dr. Steven Abelowitz, founder of Ocean Pediatrics in Orange County, California, said he heard from half a dozen parents within hours of Monday’s announcement. “It’s causing concern for us, but more importantly, concern for parents with kids, especially young kids, and confusion,” he said.
Abelowitz said the changes arrive at a moment when the consequences of declining vaccination rates are already visible. “We’re worried the fire’s out of control,” he said. “Already we’ve seen that with measles and pertussis, there are increased hospitalizations and even increasing deaths. So the way that I look at it — and my colleagues look at it — we’re basically regressing decades.”
O’Shea said she fears the revisions are eroding the trust parents place in medical expertise at a moment when that trust is already fraying. “If I take my car to the mechanic, I don’t go do my own research ahead of time,” she said. “I go to a person I trust and I trust them to tell me what’s going on.”
Some parents say they are staying the course
Megan Landry, whose 4-year-old son Zackary is a patient of O’Shea’s, said she plans to continue vaccinating him on the schedule she and O’Shea have discussed. “It’s my responsibility as a parent to protect my child’s health and well-being,” Landry said. “Vaccines are a really effective and well-studied way to do that.”
She said she relies on established medical evidence rather than the broader public debate. “Relying on evidence and trusted medical guidance really helps me to make those decisions,” she said. “And for me, it’s not just a personal choice for my own son but a way to contribute to the health of everybody.”