On January 5, the Acting Director of the Centers for Disease Control and Prevention (CDC), Jim O’Neill, signed a decision memorandum that imposes immediate changes to the CDC childhood immunization schedule. This directive stemmed from a Presidential Memorandum that instructed the Department of Health and Human Services (HHS) and CDC to examine how U.S. childhood immunization recommendations compare to those of “peer, developed countries” and to align the U.S. guidance accordingly. The updated schedule significantly reduces the number of vaccines recommended for all children, instead now recommending some for high-risk groups only and/or recommending some through shared clinical decision-making between a clinician and a parent or guardian.
Changes to the CDC Immunization Schedule
Under the revised framework, immunizations against 11 diseases remain recommended for all children: measles, mumps, rubella, polio, diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), pneumococcal disease, varicella, and human papillomavirus (HPV). The HPV guidance was revised to reflect the recommendation of a single dose, rather than the previous two or three dose schedule.
Immunizations against the following diseases that had been universally recommended are reclassified under the new CDC immunization schedule: influenza, rotavirus, hepatitis A, respiratory syncytial virus (RSV), and meningococcal diseases. This follows reclassifications of the COVID-19 and hepatitis B vaccines made in 2025. Some of these immunizations are now recommended only for certain high-risk populations, like the vaccines against hepatitis B, meningococcal diseases, and RSV. Importantly, the new schedule recommends that all infants whose mother did not receive the RSV vaccine be given the RSV monoclonal antibodies, as all infants are at high risk of severe complications from RSV.
CDC also expanded the list of vaccines recommended based on shared clinical decision-making, to now include, among others, the influenza vaccine, encouraging individualized discussions between providers and families about risks and benefits. The U.S. saw a record number of pediatric deaths from flu during the 2024–2025 flu season; 90% of these deaths were in unvaccinated individuals.
HHS states that “[a]ll immunizations recommended by the CDC as of December 31, 2025, will continue to be fully covered by Affordable Care Act insurance plans and federal insurance programs, including Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children program,” and notes that no product was entirely removed from the schedule.
Community Letter Urges Congressional Oversight
AAI was among more than 230 organizations that signed a community letter to Congress, led by the American Academy of Pediatrics and the Infectious Disease Society of America, urging lawmakers to conduct swift and robust oversight into the changes made to the childhood immunization schedule. The letter states that the changes to schedule were not based on credible evidence and encourages investigation into why the immunization schedule was changed, why scientific evidence was ignored, and why this action was taken unilaterally without consultation of the CDC Advisory Committee on Immunization Practices.
