The US has taken the unprecedented step of cutting the number of vaccines it recommends for every child in a move that leading medical groups have said would undermine protections against a half-dozen diseases.
The change is effective immediately, meaning that the US Centers for Disease Control and Prevention will now recommend that all children get vaccinated against 11 diseases.
Vaccines against flu, rotavirus, hepatitis A, hepatitis B, some forms of meningitis, or RSV are no longer broadly recommended.
Instead, protections against those diseases are only recommended for certain groups deemed high risk, or when doctors recommend them in what's called "shared decision-making."
Trump administration officials said the overhaul, a move long sought by Health Secretary Robert F Kennedy Jr, would not result in families who wanted the vaccines losing access to them, and said insurance would continue to pay.
But medical experts said the decision created confusion for parents and could increase preventable diseases.
States, not the federal government, have the authority to require vaccinations for schoolchildren. While CDC requirements often influence those state regulations, some states have begun creating their own alliances to counter the Trump administration's guidance on vaccines.
The change comes as US vaccination rates have been slipping and the share of children with exemptions has reached an all-time high, according to federal data.
At the same time, rates of diseases that can be protected against with vaccines, such as measles and whooping cough, are rising across the country.
The US Department of Health and Human Services (HHS) said the overhaul was in response to a request from President Donald Trump in December.
Trump asked the agency to review how peer nations approached vaccine recommendations and consider revising US guidance accordingly.
HHS said its comparison to 20 peer nations found that the US was an "outlier" in both the number of vaccinations and the number of doses it recommended to all children.
Officials with the agency framed the change as a way to increase public trust by recommending only the most important vaccinations for children to receive.
"This decision protects children, respects families, and rebuilds trust in public health," Kennedy said in a statement Monday.
Among those left on the recommended-for-everyone list are vaccines against measles, whooping cough, polio, tetanus, chickenpox and human papillomavirus, or HPV. The guidance reduces the number of recommended vaccine doses against HPV from two or three shots, depending on age, to one for most children.
Medical experts said Monday's changes, without what they said was public discussion or a transparent review of the data, would put children at risk.
"Abandoning recommendations for vaccines that prevent influenza, hepatitis and rotavirus, and changing the recommendation for HPV without a public process to weigh the risks and benefits, will lead to more hospitalisations and preventable deaths among American children," said Michael Osterholm of the Vaccine Integrity Project, based at the University of Minnesota.
Sean O'Leary of the American Academy of Pediatrics said countries carefully considered vaccine recommendations based on levels of disease in their populations and their health systems.
"You can't just copy and paste public health and that's what they seem to be doing here," Dr O'Leary said.
"Literally, children's health and children's lives are at stake."
Most high-income countries recommend vaccinations against a dozen to 15 serious pathogens, according to a recent review by the Vaccine Integrity Project, a group that works to safeguard vaccine use.
France today recommends all children get vaccinated against 14 diseases, compared to the 11 that the US now will recommend for every child under the new schedule.
Doctors' groups criticise decision
The changes were made by political appointees, without any evidence that the current recommendations were harming children, Dr O'Leary said.
The paediatricians' group has issued its own childhood vaccine schedule that its members are following, and it continues to broadly recommend vaccines that the Trump administration demoted.
Dr O'Leary singled out the flu vaccine, which the government and leading medical experts have long urged for nearly everyone starting at age six months. He said the government was "pretty tone deaf" for ending its recommendation while the country was at the beginning of a severe flu season, and after 280 children died from flu last winter, the most since 2009.
Even a disease that parents might not have heard of, rotavirus, could come roaring back if vaccination erodes, he added. That diarrhoeal disease once hospitalised thousands of children each winter, something that no longer happens.
Senior officials at HHS said the decision was made without input from an advisory committee that typically consults on the vaccine schedule. The officials spoke on the condition of anonymity because they were not authorised to discuss the changes publicly.
Kennedy longtime vaccine sceptic
The move comes as Kennedy, a long time activist against vaccines, has repeatedly used his authority in government to translate his scepticism about the shots into national guidance.
In May, Kennedy announced the CDC would no longer recommend COVID-19 vaccines for healthy children and pregnant women — a move immediately questioned by public health experts who saw no new data to justify the change.
In June, Kennedy fired an entire 17-member CDC vaccine advisory committee — later installing several of his own replacements, including multiple vaccine sceptics.
Kennedy in November also personally directed the CDC to abandon its position that vaccines do not cause autism, without supplying any new evidence to support the change.
AP
