Get access to over 1,300 articles and reader Q&As
On Monday, the CDC announced significant changes to the childhood vaccine schedule. If you’re a parent who follows this stuff — or even if you’re not — you’ve probably seen the headlines, heard from anxious friends, or found yourself wondering what exactly is happening and what it means for your family.
The short version: Several vaccines that were previously recommended for all children are now either recommended only for high-risk groups or subject to “shared clinical decision-making” between parents and doctors. This is a departure from decades of public health practice, and it’s generating a lot of confusion and concern.
I want to be clear about what I’m going to do here: I’m going to walk you through what changed, what didn’t, and what this means practically for your family. I’ll also share some thoughts on the broader implications. But I want to start by saying that this change is not driven by new evidence about vaccine safety or efficacy. The decision to change the schedule reflects different priorities and goals, not new data.
If you’re feeling anxious or confused, you’re not alone. Let’s get into the details.
Give me the overview – what happened?
The CDC issues guidelines for recommended childhood vaccinations, known as a vaccination schedule. This schedule is not binding, but (historically, at least) it has been used by pediatricians and others in advising parents. Updates, additions, and changes to the schedule are suggested by the Advisory Committee on Immunization Practices (ACIP) and approved by the CDC director.
On Monday, in a move outside this normal process, RFK Jr. announced the CDC would revise the childhood vaccine schedule to remove a number of vaccines from those that are universally recommended. The previously recommended routine schedule covered 17 diseases; it now covers 11.
The new guidelines move many vaccines to be subject to “shared clinical decision making” – basically, people should discuss with their doctor whether the vaccine is right for them.
What specific vaccines were changed?
Under these new guidelines, vaccines are now in three categories.
- Category 1: Universally recommended
- Category 2: Recommended for certain high-risk groups
- Category 3: Based on shared clinical decision-making
The vaccines in each category are summarized in the link below.
For the vaccines in category 1, there are no significant changes. The only change is a recommendation of one dose for the HPV vaccine. This is supported by evidence from recent trials that suggest a single dose is as good at preventing cervical cancer as multiple doses. This is a change that was likely to occur even outside of this broader overhaul of the schedule.
For the vaccines in category 2, it’s important to review the particular things that determine risk. In practice, many of these recommendations are already largely in place, and this does not represent a significant change.
- RSV: The CDC continues to recommend a dose of the RSV vaccine for all babies in their first RSV season if their mother did not get vaccinated during pregnancy. This is in line with the current recommendation, so it does not change very much. Higher-risk children are recommended to get a second dose in their second RSV season.
- Hepatitis B: The full hepatitis B series, including the birth dose, is recommended for children whose mothers are hepatitis B positive. Previously, it was recommended for all babies, regardless of the mother’s hepatitis B status.
- Meningococcal B: This vaccine is typically given to first-year college students. It is still recommended for that group and likely will continue to be required by many colleges.
The larger changes are for the vaccines in category 3, where “shared decision making” is now recommended. The significant changes include:
- Hepatitis B: These guidelines suggest that parents may want to forego all hepatitis B vaccines if the mother is hepatitis B negative, which would leave them unprotected in adulthood.
- Rotavirus: The guidelines move this from universal to under shared decision-making. Rotavirus is a common cause of gastrointestinal illness in children. The argument for the change is that this isn’t a serious illness in most children.
- Influenza: The new guidelines suggest children should not necessarily be vaccinated for the flu. This is surprising given that young children, in particular, are a high-risk group.
- Meningococcal ACWY: This vaccine is typically given to children at 11 and with a booster at 16, to prevent meningitis and sepsis. This vaccine is now in the “shared decision-making” category, which may make it less likely that schools will mandate it (as most now do).
Why now? Is there any evidence?
This change is one that the Trump administration and RFK Jr. have telegraphed wanting to make, which is the reason for doing it now. This doesn’t reflect a change in evidence on efficacy or safety. The stated motivation is to align our recommendations with those of other countries – the new schedule is largely but not exclusively based on Denmark – and to improve trust in vaccines. The vaccines removed from the schedule are generally those for diseases that are less common and usually less serious.
A natural question many people will have: why wouldn’t we align the U.S. recommendations with those of other countries? In fact, there are at least two good reasons why we vaccinate more than in many places in Europe. One reason we have more vaccines is that we are richer; many countries do not use some vaccines because they judge the cost not to outweigh the benefit. Our higher health spending and higher average income make for a different calculus.
The U.S. also vaccinates more because we have worse access to health care. When people have to travel farther for doctors and have less access, it makes sense to do more prevention (i.e., vaccines) and less treatment.
Does the AAP have the same recommendations?
The AAP has its own vaccine schedule, which has not changed. They are not obligated to use the new CDC schedule, and they have indicated they plan to keep their recommendations unchanged.
Can I still get the “old” schedule for my child? Will insurance cover it?
Yes, for now. The administration has been clear that all vaccines on the older schedule will still be covered by insurance, including Medicaid and Vaccines for Children, which serve many lower-income children. If you would like to continue to get all the previously recommended vaccines, you should be able to.
Given that many or most parents and pediatricians will continue to follow the older vaccination schedule, vaccines should still be available. If you would like to use this schedule, you can tell your pediatrician you want to adhere to the AAP schedule, which is unchanged.
So what is the impact of these changes?
Ironically, given that the stated goal of this change was to enhance trust in vaccines, I expect the actual outcome will be lower trust. For many people, this change will reinforce their view that there is some large safety concern about vaccines. There isn’t, and that’s not the motivation for the change, but given the broader rhetoric around vaccines, it’s not surprising that people would land there.
I expect overall vaccination rates to be lower on all vaccines, including those that are still universally recommended. We are also likely to see states and school districts remove vaccine mandates, which will lower vaccination rates further. The overall impact will be increased cases of vaccine-preventable diseases.
Finally, these changes will make parents’ lives more difficult – there is already enough to navigate without having to deal with confusing and conflicting information from so many sources. For that, I’m sorry.
The bottom line
- The CDC announced changes that remove several childhood vaccines from the pediatric vaccine schedule.
- These changes are not driven by new evidence about vaccine safety or efficacy.
- The AAP has its own vaccine schedule, which has not changed. Parents are still able to follow this older vaccination schedule if they choose.
A correction was made on January 8th, 2026: An earlier version of this article listed both of the Meningococcal vaccines in category 2. The Meningococcal ACWY should be in category 3.
Community Guidelines
Log in
An additional impact of these changes is it could also become more difficult to obtain vaccines that now fall under the ‘shared decision making’ category, such as the flu vaccine. This change might reduce the number of doses a pediatrician’s office carries. It also might require a longer visit or more numerous visits due to the requirement that a parent should consult with a doctor before the child receives the vaccine.
I experienced this recently in Tennessee when attempting to get the COVID vaccine for my 8-month-old daughter. Obtaining the flu and RSV vaccine (at that time) was simple, but my clinic (affiliated with a major research university) was stocked out of pediatric COVID vaccines for months due to what they cited as ‘changes at the federal level’ that made obtaining doses slower for states. While a nurse was able to quickly give my daughter her flu and RSV vaccine, we waited an extra 1.5 hrs for a doctor to drop into the room to ask if I had any questions about the COVID vaccine. The doctor and I then both signed a form acknowledging ‘shared decision making’ had happened, which approved the nurse to give my daughter the COVID vaccine. I imagine this could be a similar scenario for how the influenza vaccine may be administered to children, and this additional time and paperwork will create an extra burden for patients, doctors, and health clinics.
To clarify, the current AAP guidelines specify that the quadrivalent Meningitis vaccine that protects against four bacterial strains be given at age 11-12 years and again at age 16 years, and the Meningitis B vaccine be given with shared clinical decision making at age 16 to 17, with one or two booster shots one to six months later depending on when the patient will be in dorms, barracks, or classrooms. These vaccines protect kids and young adults in middle school, high school, college, military and other shared spaces from devastating, rapidly progressing, often fatal disease, with brain damaging and limb-damaging sequelae to survivors if medical intervention occurs too late. Bacterial meningitis progresses within minutes to hours so needs to be taken extremely seriously.
Kids with special situations (no spleen, sickle cell disease, immunocompromised, travel to epidemic or hyperendemic countries, travel to the Haj) have a different schedule (the vaccines can be given in infancy).
Many countries immunize all of their kids for various strains of meningitis in infancy, depending on incidence of the strains. There is also now a vaccine that protects against the five bacterial strains in a combined vaccine and some countries give this in infancy.
If an exposure occurs, even if vaccinated, the exposed person should be given a prophylactic antibiotic, but widespread use of vaccines can prevent outbreaks and significantly reduce this possibility.
Before the Meningitis B vaccine came to market, a college student at my son’s college died from Meningitis B. The following semester, four more students contracted the disease but thankfully were able to access medical intervention early enough to save them. They happened to be in a city with a major medical center minutes away, but this is not always the case with colleges or military situations.
For my own daughter who was going to be working in a developing country where healthcare was several hours away from her worksites, I made sure that she had third shots of the Meningitis vaccines. People ask health professionals, “what would you do for your own child?” so that is my answer.