Federal officials scale back childhood vaccination schedule in historic move
Public health experts say new childhood vaccination guidelines will sow confusion.
A decision by federal officials to scale back the number of vaccines recommended for children surprised some Northeastern University public health experts, who warn the move could confuse parents and increase the risk of preventable diseases.
The Department of Health and Human Services, headed by Secretary Robert F. Kennedy Jr., announced Jan. 5 that the Centers for Disease Control and Prevention was reducing the number of diseases prevented by childhood vaccination from 17 to 11.
Under the revised guidance, the CDC continues to recommend vaccines for measles, mumps and rubella, polio, whooping cough and other illnesses. But vaccinations for several diseases — including respiratory syncytial virus, rotavirus, and hepatitis A and B — are no longer universally recommended and are instead subject to “shared clinical decision-making” between parents and physicians, or limited to high-risk groups.
Neil Maniar, director of Northeastern’s master of public health program, called the new policy recommendation a “seismic change.”
“We are significantly changing the childhood vaccination schedule that has been shown to be very effective for several decades now,” he said.
Even slight delays or disruptions in the vaccination schedule will mean fewer immunized children and “unnecessary spikes in diseases that can have lifelong implications for individuals,” Maniar said.
Elizabeth Glowacki, a Northeastern associate teaching professor in public health and health sciences, said the new recommendations are bound to cause confusion and stress for parents.
“These changes are unfolding quickly,” she said, adding that there is a lack of accompanying information about how individual viruses, such as rotavirus, a gastrointestinal disease that once hospitalized thousands of children a year, spread.
Kennedy said in the announcement that the changes followed a Dec. 5 directive by President Donald Trump to take a close look at the vaccination schedules put in place by other developed nations and “to take action if they are doing better.”
“The assessment reviewed 20 peer, developed nations and found that the U.S. is a global outlier among developed nations in both the number of diseases addressed in its routine childhood vaccination schedule and the total number of recommended doses,” while failing to have higher vaccination rates, the statement said.
Using the Denmark model
Public health officials said the new U.S. directive most closely follows the schedule in place in Denmark, which federal officials said immunizes children against 10 diseases.
Maniar said there are distinct differences between the U.S. and Denmark, which he noted has a relatively homogeneous population of 6 million people, of whom 85% or more are of Danish descent, all of whom enjoy universal health care.
Denmark is roughly the size of Maryland, he said, and the United States has 350 million people and a heterogeneous population.
The United States is not Denmark, and there’s no reason to impose the Danish immunization schedule on America’s families,” said Dr. Andrew D. Racine, president of the American Academy of Pediatrics.
He called the new schedule an “ill-considered decision” that will sow chaos and confusion and erode, not restore, confidence in immunizations.
A Massachusetts pediatrician who called the benefits from current vaccines phenomenal and risks minuscule, said hepatitis A and B, rotavirus, RSV and meningococcal meningitis — which are no longer included among 11 vaccines recommended for all children — are serious illnesses that can sometimes be fatal.
“There is absolutely no good reason to stop vaccines, or monoclonal antibodies, against them from being universally recommended,” said Dr. Leif Norenberg of Briarpatch Pediatrics in Sandwich, Yarmouthport and Nantucket.
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Sweeping changes
Making sweeping changes in the vaccination schedule reinforces the idea, especially for anti-vaccine groups, that opposing immunizations is a sort of moral litmus test, said Ashleigh Shields, a Northeastern assistant teaching professor and expert in health communication.
For the general public, “it can make relationships with vaccines even more complicated,” she said.
Shields and Glowacki said they believe in health care transparency and patients advocating for themselves and their children.
“But we can do that without validating false claims,” Shields said.
The “shared clinical decision-making” about vaccines espoused in the new directive shouldn’t be an excuse to perpetuate misleading information, Glowacki said.
The CDC’s new guidance is the latest in its skepticism about the safety of childhood vaccines.
In November, the agency challenged scientific consensus by changing its vaccine safety website to say that the vaccines do not cause autism, which is not evidence-based.
Over the summer, Kennedy asked, unsuccessfully, for a medical journal to withdraw a Danish study that did not find a connection between aluminum in childhood vaccines and chronic diseases, as reported in the science journal Nature.
Vaccine hesitancy
The head of a nonprofit program that partners with pediatric practices in more than 20 states to help low-income children get off to a healthy start said it’s too soon to grasp how parents across the country are receiving the pared vaccination schedule.
Rahil D. Briggs, national director of Healthy Steps, part of the ZERO to THREE organization, said the program’s affiliated pediatrician offices “are seeing an uptick in vaccine refusal and hesitancy,” especially due to concerns about autism.
“This new guidance has the distinct possibility of creating more confusion and stress for families and has dangerous implications for children and communities,” she said, adding that one practice has noted it has seen increased cases of vaccine-preventable diseases.
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Elana Doyle, a mother of three young children from Mashpee, Massachusetts, said she doesn’t consider the new recommended schedule a shock since “historically, medical advice evolves over time.”
She said it’s important that the schedule continue to recommend “core childhood vaccines” for all, including those for MMR, diphtheria, tetanus and pertussis (DTaP) and Haemophilus influenzae type b (the Hib), as access to others at parental discretion.
“What matters most to me is that we’ll continue to be given clear information on the benefits and possible side effects of each vaccination from our pediatricians, so we can make informed decisions for our families,” Doyle said.
Insurance coverage
Parents can still get insurance coverage for the previously recommended vaccines for their children, as the American Academy of Pediatrics continues to advise.
But Glowacki said physicians will face “a really difficult communication scenario” due to the pared-down immunization schedule.
Maniar called the new directive a “major change” being implemented without proper public health input and guidance.
“People will unnecessarily become very sick and likely die as a result,” he said. “There’s no way to sugarcoat that.”
