On January 5, 2026, the Centers for Disease Control and Prevention announced a significant revision to the U.S. childhood immunization schedule. The agency reduced universal vaccine recommendations from 17 diseases to 11, moving several vaccines - including those for influenza, rotavirus, meningococcal disease, hepatitis A, and COVID-19 - to "shared decision-making" or high-risk categories only.

This change, prompted by a December 2025 presidential memorandum directing alignment with international practices like Denmark's approach, represents the most substantial shift in U.S. vaccination policy in decades. While the CDC and HHS officials cite declining vaccine uptake and efforts to restore public trust, the move raises critical questions about evidence-based policymaking and child health outcomes.

Historically, the CDC's Advisory Committee on Immunization Practices (ACIP) has developed vaccine recommendations through transparent review of scientific evidence. This recent overhaul departed from that standard process. Senior HHS officials cited low uptake rates - such as less than 10% for COVID-19 vaccines by 2023 - as justification, but the changes occurred without the usual public discussion or comprehensive independent expert review.

The vaccines moved from universal recommendations serve important public health functions. Rotavirus, for example, prevents severe diarrhea that hospitalizes thousands of U.S. infants annually. Meningococcal vaccines protect against bacterial meningitis, a potentially devastating illness. Hepatitis A and B vaccines prevent liver disease and cancer.

Shifting to "shared decision-making" assumes that parents and providers will consistently opt for these vaccines during routine visits. However, evidence from communities with lower vaccination rates suggests this assumption may be optimistic. When vaccines become optional rather than standard, uptake typically declines - particularly in communities already experiencing vaccine hesitancy.

Infectious disease experts have expressed concern that these changes could lead to resurgences of preventable diseases. Measles vaccination rates have already declined in some areas, and similar patterns could emerge for other diseases.

The shift may disproportionately affect vulnerable populations. Families in rural areas or those with limited healthcare access may face additional barriers when vaccines require special consultation rather than being part of standard care. Low-income families may have fewer opportunities for the extended provider discussions that "shared decision-making" implies.

Proponents of the changes point to countries like Denmark, which recommends fewer vaccines. However, direct comparisons require careful consideration of context. Denmark has universal healthcare coverage, relatively homogeneous disease exposure patterns, and robust public health infrastructure. The U.S. faces different challenges: uneven healthcare access, greater population diversity, and varied disease prevalence across regions.

What works in one country's specific context may not translate directly to another's. Public health policy requires tailoring to local epidemiology, healthcare systems, and population needs.

The stated goal of restoring public trust in vaccines is important. The pandemic clearly strained confidence in public health institutions. However, reducing evidence-based recommendations may not be the most effective path toward rebuilding that trust.

Trust typically grows from transparency, consistent communication, and demonstrated commitment to following scientific evidence - not from scaling back proven protections. As Dr. Céline Gounder notes, some pediatricians have grown distrustful of government processes and are developing independent guidance. Further departures from evidence-based standard-setting could accelerate this fragmentation.

Healthcare providers, parents, and public health professionals should remain informed through trusted sources including the American Academy of Pediatrics and World Health Organization. Those concerned about these changes can: