‘Red-State, Blue-State Divide’ Feared After CDC Changes Childhood Vax Schedule

Federal health officials’ sweeping decision Monday to overhaul the U.S. childhood vaccine schedule, significantly reducing the number of shots routinely recommended for all kids, is likely to deepen state divides over immunization mandates and further confuse parents, experts say.

It is up to individual states to determine if they want to adopt the newly announced Centers for Disease Control and Prevention recommendations that now advise universal vaccination against 11 diseases — down from 17.  

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The new guidelines will lead to “more splintering of vaccine policies” and a patchwork system, warned vaccine law expert Richard Hughes, who also predicted legal challenges to the way the change was implemented.

Northe Saunders, president of the pro-vaccine advocacy organization American Families for Vaccines, said “there’s going to be a red-state, blue-state divide where blue states look to the science, and red states look to the ill-conceived recommendations of the federal government.”

“With differing vaccine schedules state by state,” he continued, “parents aren’t going to know what the right thing to do for their family is.”

The new guidelines continue to universally recommend vaccines against 11 diseases including measles, mumps, rubella, polio and tetanus. But, shots protecting against a number of other diseases will no longer be recommended and will only be available for certain high-risk groups or after a consultation with a medical professional, also known as shared clinical decision-making. 

These include meningococcal disease — which causes meningitis — hepatitis A, hepatitis B, rotavirus and respiratory syncytial virus, more commonly known as RSV, the leading cause of infant hospitalization. 

CDC officials said their decision will more closely align the United States with other peer nations, mirroring a policy objective voiced by President Donald Trump in December, but one that critics claim is a false equivalency meant to further the administration’s anti-vaccine agenda.

“After an exhaustive review of the evidence, we are aligning the U.S. childhood vaccine schedule with international consensus while strengthening transparency and informed consent,” Health Secretary Robert Kennedy Jr., a longtime vaccine skeptic, said Monday. “This decision protects children, respects families, and rebuilds trust in public health.”

Sean O’Leary, chair of the American Academy of Pediatrics Committee on Infectious Disease, said Monday “what was announced today is part of a decades-long effort on the part of the health secretary to spread fear and falsehoods about vaccines. This is another step in the secretary’s effort to dismantle the U.S. vaccination system.”

While shared clinical decision-making for these vaccines “may sound good on its surface, it’s actually really problematic,” said O’Leary. Pediatricians are already having these conversations with parents before vaccinating their kids. Shifting the recommendation won’t strengthen those exchanges, “it just makes things more confusing for parents and clinicians,” he said.

The American Academy of Pediatrics will continue to recommend kids get vaccinated against all 17 diseases, and multiple states have already banded together to form regional health alliances and establish their own vaccine recommendations. In September, the governors of California, Oregon and Washington created the West Coast Health Alliance to “ensure residents remain protected by science, not politics.”

Later that month, several others announced the Northeast Public Health Collaborative. While neither alliance is solely focused on immunization policy, both have stated goals of science-based vaccine recommendations and equitable access to shots.

At the same time, Florida Gov. Ron DeSantis veered towards a vastly different approach, announcing the state’s intention to become the first to drop all vaccine mandates, including for schoolchildren. State officials have since taken steps towards making that goal a reality.

‘Children’s lives are at stake’

William Moss, director of the Johns Hopkins’ International Vaccine Access Center, told The 74 this week’s dramatic shift in the CDC’s recommendation “will lead to more disease and potentially some deaths in children in this country that could have been prevented.”

The process that led to the changes represents a sharp departure from past practices, which would have required extensive research, a forum for public comment, an opportunity for relevant stakeholders — such as vaccine manufacturers and pediatricians — to weigh in and a formal meeting of the CDC’s Advisory Committee on Immunization Practices, also known as ACIP. 

Significant changes such as the one announced Monday were historically “very deliberate by design,” said O’Leary because “literally children’s health and children’s lives are at stake.”

None of those steps were followed here, said Hughes, a George Washington University law professor.

“These are not rigorous analyses,” Hughes said. “These are not people who are qualified to be making these decisions. They’re not grounded in evidence. And for that reason they are unlawful.”

Kennedy last year fired all 17 ACIP members, replacing them with hastily hand-picked advisors who largely share his views on vaccines. It has since voted to overturn a recommendation that all newborns receive the hepatitis B vaccine; change policies surrounding the measles, mumps, rubella and varicella (chickenpox) combination vaccine; and roll back recommendations around 2025’s COVID 19 booster. 

The decision to change the childhood vaccine schedule in a much more far-reaching way did not go through ACIP, and the premise it was based on — to more closely match U.S. policy with those of other wealthy nations such as Denmark — is not a sound one, according to medical experts.

“You can’t just copy and paste public health,” said O’Leary, who argued there are fundamental differences between the counties that lead to very different needs.

Moss echoed this point: “Denmark has a universal health care system where we have this very fragmented, insurance-based health care system. Denmark’s the size of Wisconsin, so [the U.S. is] just a much bigger country, a more complex country.”

And, when it comes to diseases such as hepatitis B, Denmark has much stronger screening rates.

While HHS claimed all vaccines previously recommended will remain fully covered by insurance and available to parents who want to vaccinate their kids, others are less sure. According to O’Leary, HHS leaders appear to have misunderstood how insurance companies determine coverage: Historically vaccines recommended for high-risk groups are only covered for children included in that group.

At the very least, doctors and advocates argue, the shift will put up additional barriers in an environment that is already filled with vaccine hesitancy and confusion, inevitably leading to diminished uptake and, ultimately, more sick kids. Health care providers may also start stocking fewer vaccines, making it harder for families to access them. 

There also remains uncertainty around who can actually participate in the shared clinical decision-making; in some states, this may mean that pharmacists can no longer administer vaccines, such as RSV, independently. 

And even if the shots remain available, this week’s action by the CDC will likely further undermine confidence in vaccines, as immunization rates are already falling and diseases are on the uptick. 

In 2025, there were 2,065 confirmed measles cases — the most recorded since the U.S. deemed the virus eliminated a quarter-century ago. The vast majority of cases were in unvaccinated kids, two of whom died. 

Flu cases this season are also rising at a faster rate than in previous years, according to CDC data. There have been 7.5 million cases so far, leading to 81,000 hospitalizations, and 3,100 deaths — including eight children. Despite this week’s updated guidance, the CDC’s influenza website still recommends everyone 6 months and older receive a flu shot.