HHS Changes Its Pediatric Vaccine Recommendations: What’s Different, What Remains, and What It Means for American Health

The federally recommended vaccine schedule for American kids abruptly changed Monday when the Department of Health and Human Services removed several vaccines from the list of shots recommended for all American children. The agency’s universal recommendations no longer include vaccines against flu, COVID-19, rotavirus, hepatitis A, hepatitis B, or meningococcal meningitis.

Under the new recommendations, these shots will still be available through a process of “shared clinical decision-making” between physicians and parents. The move reduces the total number of recommended vaccines from 17 to 11, and means that HHS now recommends fewer vaccines than multiple peer nations, including Canada and Australia.

While most families will still have free access to all 17 vaccines, physicians and public health experts say the change will sow confusion and risk the spread of preventable illnesses as vaccination rates fall. The U.S.—long a global leader in developing, testing, and reviewing vaccines to protect children—will join the “middle of the pack,” with long-term consequences for the integrity of U.S. vaccine policy and the public’s health, says Josh Sharfstein, MD, vice dean for Public Health Practice and Community Engagement and distinguished professor of the practice in Health Policy and Management.

What do HHS’s latest recommendations mean for families?

The American Academy of Pediatrics, which has called the changes “dangerous and unnecessary,” has not changed its vaccine recommendations.

Most parents will not need to pay out of pocket for these vaccines. The shots removed from HHS’s list of recommended vaccines will still be covered by federal health insurance programs including the Vaccines for Children program, which distributes vaccines to more than half of the children in the country. Private insurers are also expected to cover all 17 vaccinations.

“It's still possible to follow good recommendations, trust your pediatrician, and protect your children,” says Sharfstein, a former health commissioner for the city of Baltimore and a former health secretary in Maryland. Sharfstein also served as principal deputy commissioner of the U.S. Food and Drug Administration, which oversees the safety and effectiveness of vaccines.

But there could be changes ahead. States set their own vaccine requirements for school entry—not the federal government. In some states, vaccines that are no longer universally recommended may drop off the school vaccine requirements because they are deemed less important than other shots—and that could lead to a resurgence of disease and illness. However, some states have now banded together to establish their own vaccine recommendations.

A key concern is “the message that’s being sent” by removing vaccine recommendations, says Sharfstein. “If parents get the message that it’s just not that important to vaccinate, you really could see the decline in vaccination.”

How does the U.S. decide on a federal vaccination schedule—and how do we know it’s safe?

The decision to recommend vaccines is grounded in decades of evidence and real-world experience. The recommendations are built on epidemiology, safety data, and disease burden, says pediatric infectious disease specialist Ruth Karron, MD, a professor in International Health and a former member of the CDC’s Advisory Committee on Immunization Practices.

Among U.S. kids born between 1994 and 2023, the CDC estimates that routine childhood vaccinations prevented 508 million illnesses, 32 million hospitalizations, and 1.3 million deaths.

Typically, the U.S. immunization process, and changes to it, are guided by leading health experts, immunologists, and pediatricians who carefully review new data and evidence as part of the immunization recommendation process, according to the American Academy of Pediatrics.

The latest recommendation, “based on a brief review of other countries’ practices, upends this deliberate scientific process,” says Sharfstein.

Why do countries have different vaccines schedules?

The stated aim of HHS’s new recommendations is to align “the U.S. childhood vaccine schedule with international consensus,” Secretary of Health and Human Services Robert F. Kennedy Jr. said in a statement.

But when it comes to vaccines, there is no single global standard. Countries set various policies based on differences in diseases, disease burdens, priorities, and scientific expertise, says Sharfstein.

The U.S. has long been “at the forefront” of nations developing vaccine options to protect children, says Sharfstein, adding “The new federal recommendations have the goal of keeping the U.S. in the middle of the pack.”

“The federal government is abruptly dropping its recommendations for vaccines that protect against serious illness in children,” says Sharfstein. “If the result of this change is a significant decline in vaccination rates, these diseases will have the chance to hurt or kill more children.”

Hepatitis A: Transmitted through food or close person-to-person contact, hepatitis A can cause severe liver disease. Young children who are infected with hepatitis A may not have severe symptoms but excrete the virus in their stool and may infect other family members and caregivers. The hepatitis A vaccine is safe and well-tolerated, and provides protection for 20 years or longer.

Hepatitis B: This highly contagious disease may not cause symptoms in infancy, but infection early in life leads to chronic disease, liver cancer, and death decades later. Universal infant vaccination is critical, says Karron. Without hepatitis B vaccination, as many as 9 in 10 infants infected in their first year of life will become chronically infected, and up to 25% will eventually die from liver failure or cancer. Vaccinating only infants born to known infected mothers has already failed in the U.S., partly because nearly 1 in 5 pregnant people are not screened and because household transmission is common. “We’ve eliminated chronic hepatitis B in young children in our country. And this would be a backwards step,” says Karron.

Influenza: “The flu vaccine prevents hospitalization and death,” says Karron. In the 2024–2025 influenza season, 284 influenza deaths occurred in U.S. children—a near-record number. Eighty nine percent of these children were unvaccinated. News reports are now emerging of child deaths from influenza this year.

Meningococcal disease: Rare but catastrophic, meningococcal disease can kill a healthy child within hours and leave survivors with amputations or brain damage, Karron explains. Vaccination strategies vary by country based on local strains, but the principle is universal: Prevent sudden, irreversible tragedy. In the U.S., the lifesaving vaccine is typically given to teenagers in two doses. Meningococcal bacteria spread well in crowded conditions, and vaccination is especially critical for young people living in close quarters, such as college dorms and military barracks: “They are really at risk of serious meningococcal disease,” says Karron.

Rotavirus: An extremely common virus worldwide, rotavirus causes diarrhea and dehydration in very young children. Once responsible for 50,000–70,000 hospitalizations a year, rotavirus has been nearly eliminated through infant vaccination, says Karron. And beyond protecting children, the vaccine frees hospital capacity and reduces trauma for families.

COVID: SARS-CoV-2 continues to cause severe COVID disease in young children, who don’t have preexisting immunity to this virus. This is why the American Academy of Pediatrics continues to recommend COVID vaccination for all children ages 6–23 months, as well as older children with underlying high-risk conditions. Vaccination against COVID in pregnancy offers a double benefit: It protects mothers against COVID disease, which can be severe during pregnancy, particularly during the third trimester, and has been shown to prevent COVID hospitalization in infants from birth through 6 months, when they are too young to receive a COVID vaccine themselves. For this reason, the American College of Obstetrics and Gynecology recommends that women receive updated COVID shots when pregnant, planning to become pregnant, postpartum, or lactating.