Vaccines and immunizations are safe, effective ways to prevent serious illness by teaching the body’s immune system to recognize and defend against harmful germs. For children and adolescents, vaccines are typically given according to the child and adolescent immunization schedule. The schedule shows which vaccines are recommended by age and offers guidance on intervals for catch-up vaccines, how to handle special situations (e.g., children with certain medical conditions or at higher risk of contracting a specific disease), and any contraindications or precautions by vaccine type. Until recently, the schedule recommended by the Centers for Disease Control and Prevention (CDC) aligned with the schedule recommended by the American Academy of Pediatrics and the scientific community as a whole.
On January 5, 2026, the Department of Health and Human Services (HHS) released a new child and adolescent immunization schedule, aimed to satisfy a December 2025 presidential memo ordering an expedited alignment of the recommendations to “peer, developed countries.” The new schedule is a dramatic departure from longstanding immunization recommendations – reducing the number of diseases targeted from 18 to 11 – and it was issued without adhering to the established process for making such changes. Two known vaccine skeptics authored an assessment of childhood vaccination in 20 countries before proposing the updated schedule. The authors purported that the updated schedule brought core childhood vaccine recommendations in the US in line with other “peer countries.” Following the January 5th release, STAT News analyzed the vaccine recommendations of 38 countries, including the US, and found that this updated schedule makes the U.S. an outlier, comparable only to Denmark.
The release of the new schedule also follows an announcement from the Centers for Medicare & Medicaid Services (CMS) on December 30, 2025 that removed four vaccine-related measures from mandatory Medicaid and CHIP quality reporting requirements – two related to children and adolescents and two related to prenatal immunization. Taken together, these policy changes are very alarming; they risk exposing children to preventable disease without any public input or plan to monitor the ramifications. In the days following these two announcements, Secretary Kennedy has made additional changes to the composition of ACIP and other, related vaccine committees.
Previously, the child and adolescent schedule recommended universal vaccination targeting 18 diseases with 15 immunizations, some of which required multiple doses. Under the schedule announced January 5th, vaccination against only the following 11 diseases will be recommended for all children: diphtheria, tetanus, acellular pertussis (whooping cough), haemophilus influenza type b (HiB), pneumococcal conjugate (pneumonia), polio, measles, mumps, rubella, human papillomavirus (HPV), and varicella (chickenpox). Vaccines previously recommended for all children will now only be recommended for certain high-risk groups or under shared clinical decision-making (SCDM). This includes: respiratory syncytial virus (RSV), hepatitis A, hepatitis B, rotavirus, COVID-19, influenza, and meningococcal ACWY (meningitis). See the table below for a summary of the proposed changes. Importantly, the scientific evidence behind the vaccinations previously recommended universally has not changed. Instead, the schedule change stems from a shift in priorities among political leaders.
According to the announcement, despite changing the schedule, all of the immunizations previously recommended will continue to be covered by federal insurance programs, including Medicaid, CHIP, the Vaccines for Children (VFC) program, and under Marketplace plans, without cost-sharing. However, the announcement occurred outside of the typical process for updating the schedule and it remains unclear how the new schedule will be adopted. Typically, CDC’s Advisory Committee on Immunization Practices (ACIP) considers any new evidence and then issues updated child and adult immunization schedules. This process includes public meetings, typically scheduled months in advance, with presentations about the new evidence before the members vote on recommended changes. The CDC Director then decides whether to adopt the updated schedules and publishes them in the Morbidity and Mortality Weekly Report (MMWR). But in this case, the announcement first came through the news stories, followed by a press release and fact sheet from HHS detailing the changes laid out in the CDC Director-signed decision memo, circumventing the established process. As of the publication of this blog, there are no further details about the upcoming February 25-26 ACIP meeting, which was scheduled prior to the announcement of these changes. Additionally, CDC’s webpage on immunization schedules does not contain these changes, but rather a message that states, “The content of this page is being revised to reflect updated childhood immunization recommendations recently made by the CDC.”
While these process fouls may seem minor, some of the steps are actually laid out in statute and bypassing them raises questions about whether the assurances that all previously recommended vaccines will continue to be covered without cost sharing will hold up over time. The VFC program, which purchases and distributes child and adolescent immunizations for children with Medicaid coverage, some children with CHIP coverage (those enrolled in Medicaid expansion CHIP programs), and uninsured and underinsured children, is required to use “the list established (and periodically reviewed and as appropriate revised) by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention)” under SSA § 1928(e). As noted, the new schedule was not established, reviewed or revised by ACIP.
Additionally, even if the newly comprised ACIP panel rubber-stamps the changes and all of the previously recommended vaccines continue to be covered, there are other ramifications to consider that could impact access to vaccines. First, as any parent or patient well knows, access to care requires more than just insurance policies stating that they cover the service. The service must actually be available. Changes to recommendations for COVID vaccines for children in August 2025 led to several barriers to access, especially for young children who are most susceptible to severe illness. Many providers stopped stocking pediatric COVID vaccines due to regulatory confusion and financial risk (for privately insured children), leaving parents who want to vaccinate their children without viable options. Second, if vaccine manufacturers anticipate lower demand following the schedule change, they could seek higher prices for vaccines no longer universally recommended. This could increase costs for the federal government when negotiating the CDC’s VFC contract and for private insurance. Even more worrisome, manufacturers could withdraw from the U.S. market.
These are just some of the risks that underscore why it is doubly alarming that the schedule change coincides with CMS’ announcement that two child and adolescent vaccine-related quality measures will be removed from mandatory Medicaid and CHIP quality reporting requirements. The first measure falling by the wayside, childhood immunization status (CIS-CH), measures the percentage of two-year olds who had the recommended doses of DTaP, polio, MMR, HiB, hepatitis B, chicken pox, pneumococcal conjugate (PCV), hepatitis A, rotavirus, and influenza (flu) vaccines by their second birthday. The second measure that was dropped, Immunizations for Adolescents (IMA-CH), measures the percentage of thirteen-year old adolescents who had the recommended doses of meningococcal, Tdap and HPV by their 13th birthday. Comparing the new schedule to the quality measures reveals why the Administration may not be interested in tracking how states are performing on these health measures designed to protect children’s health. Their new vaccine schedule only recommends universal vaccination for about half of these diseases.
In conclusion: The new immunization schedule marks the biggest departure from previous recommendations, comes without the typical, public process, and its impacts will not be measured.
